Estate Planning Information - Personal Data

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ESTATE PLANNING INFORMATION - PERSONAL DATA
Please provide personal data and information concerning your current assets, giving general
market value and form of ownership (individually or jointly) and liabilities as follows:
Your Full Name:
Soc. Sec. #:
Spouse’s Full Name:
Soc. Sec. #:
Address:
Phone #:
Date of Birth (self):
/
/
Place:
Date of Birth (spouse):
/
/
Place:
Children (names & ages) (please indicate “his, hers or ours” if blended family):
(If divorced, separated, pre-nuptial/ante-nuptial agreement, please provide copy of decree or
agreement):
Current beneficiary designations on
life insurance:___________________________________
annuities:_______________________________________
retirement plans:_________________________________

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