Personal And Financial Information Form

ADVERTISEMENT

Personal and Financial Information Sheet
*** All information contained in this form is confidential and protected by attorney-client privilege. ***
Name: ________________________________ DOB: _________________ □ US citizen □ Naturalized citizen □ resident alien
occupation: ___________________________________________________________________________□ retired □ employed
Marital status: □ single/widow(er) □ married (date _________) □ first □ second □ other ______ Social Security No.: _____________
Spouse (if applicable): _________________________________ DOB: ______________ DOD (if applicable) _________________
□ US citizen □ Naturalized citizen □ resident alien
occupation: _________________________________□ retired □ employed
□ first marriage □ second marriage □ other ______ Social Security No.: _____________
Address: ________________________________________ City: ___________________ State: _______ Zip Code ___________
Home # _________________ Cell # _________________ Work # _________________ e-mail address _____________________
Which number(s) would you prefer to be contacted at? □ home □ cell □ work What is best time? _________________________
Referred to us by: Name: ________________________________________ Firm Name: ________________________________
Financial Advisor :_________________________ Firm: __________________ Phone: _______________________
Contacts:
Accountant: ______________________________ Firm: __________________ Phone: _______________________
Spouse □ NA
Existing Estate Planning:
You
Date Document Executed
Will
□ Yes □ No
□ Yes □ No
Date: _____________________
Trust
□ Yes □ No
□ Yes □ No
Date: _____________________
Power of Attorney
□ Yes □ No
□ Yes □ No
Date: _____________________
Health Care Proxy
□ Yes □ No
□ Yes □ No
Date: _____________________
Living Will
□ Yes □ No
□ Yes □ No
Date: _____________________
Long-Term Care Insurance
□ Yes □ No
□ Yes □ No
Daily benefit: _____________________
Your health status plays an important role in the designing of an estate plan best suited for you and your loved ones.
You - current health status:
□ Good
□ Concern
□ Problem
Specific concern/problem:
Spouse - current health status: □ Good
□ Concern
□ Problem
Specific concern/problem:
Spouse  NA
You
Do you have children:
□ Yes How many? ______
□ No
□ Yes How many? ______
□ No
Please specify:
□ joint □ you □ step □ adopted □ foster
□ joint □ you □ step □ adopted □ foster
Do you have grandchildren:
□ Yes How many? ______
□ No
□ Yes How many? ______
□ No
Please specify:
□ joint □ you □ step □ adopted □ foster
□ joint □ you □ step □ adopted □ foster
Is there anyone in your family with special needs or that requires special consideration?
□ Yes
□ No
Comments/ Concerns:
What do you want us to help you accomplish? _____________________________________________________________________
Is there anything else about you or your family or your personal goals you would like to tell us?

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 4