ࡱ> >@= bjbj ;<%%%% 1%m@Oz'FPѕM%=0m m : PERSONAL DATA SHEET Date: Lawyer: PART I - FAMILY INFORMATION 1. Full name: 2. Address: 3. Date and place of birth: 4. Phone (home): Phone (business): 5. Occupation: Annual income: 6. Residence for income tax purposes: Domicile: Citizenship: 7.Marital status: 8. Spouse's name: Spouse's date of birth: Spouse's address: 9. Child's name: Child's date of birth: Child's address: Child's name: Child's date of birth: Child's address: Child's name: Child's date of birth: Child's address: 10. Others to be named Name: Date of birth: Address: Name: Date of birth: Address: PART II GENERAL 1. Do you have a will? Does your spouse have a will? 2. Are you presently receiving benefits from an estate or trust? If so, please give particulars. 3. Have you set up a trust to benefit another person? If so, please give particulars. 4. Do you and your spouse have a marriage contract? Please provide a copy. 5. Are you an executor or trustee of any estate? 6. Do you have your own accountant or life insurance agent? Name: Address: Name: Address: 7. Do you own or have an interest in a business (i.e., sole proprietorship, partnership or limited company)? Please provide copies of business agreements. Please give details. 8.Have you been married more than once? If yes, please provide copies of decree nisi and/or decree absolute, separation agreement, etc. PART III ASSETS 1.Automobiles and boats Item: Item: Value: Value: In whose name: In whose name: 2. Approximate value of household goods and contents: 3.Real estate Location: Location: Value: Value: Original cost: Original cost: In whose name: In whose name: 4.Bank accounts Name of bank: Name of bank: Address of bank: Address of bank: Account number: Account number: In whose name: In whose name: Average balance: Average balance: 5.Safety deposit box Location: Box number: 6. Life insurance Name of company: Name of company: Policy number: Policy number: Type of plan: Type of plan: Named beneficiary: Named beneficiary: Value to your estate: Value to your estate: 7. RRSPs, RIFs, pensions and annuities Name: Name: Contract number: Contract number: Named beneficiary: Named beneficiary: Value to your estate: Value to your estate: 8. Investments Please list all stocks and/or bonds and their original costs and estimated market values: PART IV LIABILITIES 1. Mortgages payable by you Amount owing: Amount owing: Name of mortgagee: Name of mortgagee: 2. Other debts Amount owing: Amount owing: Name of creditor: Name of creditor: PART V SUMMARY Total value of assets$ Less total value of liabilities $ Net value of estate $ PART VI WILL INSTRUCTIONS 1.Disposition of household goods, personal effects, jewellery, automobiles, etc.: 2.Disposition of residence and/or cottage: 3.Cash legacies: 4.Disposition of RRSPs, RIFs, annuities, pensions: 5. Disposition of residue (including trust for spouse and/or minors, payments of income from trust, payment of capital from trust, time of distribution of trust, provision should any beneficiaries predecease, etc.): 6.Instructions concerning executors and trustees: 7. Are death taxes to be paid from capital without recourse to beneficiaries? Are there special provisions for beneficiaries in other jurisdictions? 8. Are executors to have broad powers for retention, sale and investment of assets and, if a trust company, investment in own securities, etc.? 9. Special clauses to be included (a) Appointment of guardians and custodians for children: Name(s): Address(es): (b) Fee agreement/pretake: (c) Exclude illegitimates: (d) Family law clauses: 10. Do you wish to have a general financial power of attorney? Name and address of your attorney(s): 11. Do you wish to have a continuing power of attorney for health care? 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