CLIENT INFORMATION

Marital Status

Married

What is your Spouse/Partner's full name? Will your spouse or partner be joining this estate plan?

Single

Divorced

When did the marriage end and are there any ongoing obligations from your divorce decree (e.g. support payments, required life insurance, or property restrictions, etc.)

Widowed

Has your late spouse's estate been fully administered?

What is the approximate total value of your estate?

Select an option Under $1 million $1 million - $5 million Over $5 million Not Sure

CHILDREN'S INFORMATION

List all children with full name and date of birth:

Who do you want to serve as guardian for your minor children, if any?

Please provide a primary and alternate choice — full name, relationship, and city/state. We'll collect their contact details at your signing appointment.

Do any of your children come from a previous relationship, marriage, or adoption outside the current marriage?

Yes

If so, please provide more details (which child, whose child)

No

Have you had any children who are deceased? This helps us draft language for their descendants, if any.

Yes

Please add any additional details, we'll discuss this further during your consultation.

No

Do you have any additional beneficiaries outside of your immediate family?

(e.g., other relatives, close friends, charities, or organizations — we'll discuss the details during your consultation)

OTHER BENEFICIARY INFORMATION

Do any of your children or individuals listed above have special needs or receive government benefits?

Yes

If yes, please identify the individual and explain the circumstances.

No

ASSET INFORMATION

Do you own real estate?

Select an option Yes No

Please list each property by address and indicate how it is currently titled

e.g., in your name alone, jointly with spouse, in a trust

Do you have any Bank Accounts?

(Checking, Savings, Certificates of Deposit, Money Market, etc.)

Select an option Yes No

Please list each account type and the approximate number of accounts

(e.g., 2 checking accounts, 1 savings, 1 money market)

Do you own Stocks and/or Bonds?

Select an option Yes No

Please describe your stocks and/or bonds holdings and indicate approximately how many accounts or positions you hold

(e.g., brokerage account at Fidelity with stocks and mutual funds, 1 bond portfolio)

Do you have any outstanding debts or liabilities?

(e.g., mortgage on primary residence, auto loan, credit card debt)

Yes

Please list each debt or liability

No

Do you own any Life Insurance policies and/or Annuities?

Select an option Yes No

Please list each policy or annuity and who is currently named as beneficiary

(e.g., term life policy, beneficiary: spouse; annuity, beneficiary: daughter)

Do you own any Retirement Plans?

Select an option Yes No

Please list each retirement account and who is currently named as beneficiary.

(e.g., 401k through employer, beneficiary: spouse; IRA, beneficiary: daughter)

Do you own any Business Interests?

Select an option Yes No

Please describe each business interest, your ownership percentage, and whether there is an existing buy-sell agreement or succession plan in place.

(e.g., 50% owner of XYZ LLC, no buy-sell agreement; sole owner of ABC sole proprietorship)

Do you own any other assets?

(e.g. anticipated inheritance, gifts, lawsuit judgments, digital currencies)

Select an option Yes No

Please describe each asset, including any digital assets or online accounts.

ESTATE PLANNING GOALS

Do you have existing estate planning documents?

(Will / Trust / Power of Attorney / Health Care Directive / HIPAA Release)

Select an option Yes No

If yes, briefly describe each document. You may upload copies below.

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Who do you want to carry out the wishes of your estate?

Please provide a primary and alternate choice — full name, relationship, and city/state. We'll collect their contact details at your signing appointment.

Who do you want to manage your financial matters if you become incapacitated?

Please provide a primary and alternate choice — full name, relationship, and city/state. You may name the same person(s) as above, if you wish. We'll collect their contact details at your signing appointment.

Who do you want to make medical decisions for you if you're unable?

Please provide a primary and alternate choice — full name, relationship, and city/state. You may name the same person(s) as above, if you wish. We'll collect their contact details at your signing appointment.

ADDITIONAL INFORMATION

Is there anything else you'd like us to know — additional assets, questions, concerns, or unique circumstances not covered above?

E-ACKNOWLEDGEMENT

ACKNOWLEDGEMENT AND ACCEPTANCE

I understand that the information I submit is confidential and will only be used in connection with my legal matter and in accordance with the Privacy Policy (https://pichoniranilaw.com/privacy-policy).

THANK YOU