Modern Financial Services Company

Contact Information

Full Name * Email Address * Phone Number Street Address Date of Birth

Family Information

Marital Status — Select one — Married Divorced Widowed Single Separated Spouse's Full Name (if applicable) Spouse's Date of Birth Children — list full names and ages Other Dependents (elderly parents, disabled adults, etc.)

Existing Estate Documents

Do you have a current Last Will and Testament? — Select one — Yes No If yes, where is the original located? Approximate date of last will Do you have a Revocable Living Trust? — Select one — Yes No If yes, where is the trust document? Approximate date of trust Do you have a Durable Power of Attorney (financial)? — Select one — Yes No Do you have an Advance Healthcare Directive / Living Will? — Select one — Yes No

Beneficiary Designations

Who should receive your assets? List major accounts below.

Life Insurance Policies — primary and contingent beneficiaries Retirement Accounts (401k, IRA, etc.) — primary and contingent Bank / Investment Accounts with named beneficiaries (POD/TOD) Any other beneficiary designations

Specific Bequests (Who Gets What)

List any specific items you want to go to specific people (jewelry, family heirlooms, vehicles, etc.)

Guardians for Minor Children

Do you have minor children (under 18)? — Select one — Yes No Proposed Guardian (person to raise children) Relationship to you Backup / Successor Guardian (if first cannot serve) Any special instructions for guardians

Executors & Trustees

Proposed Executor (person who handles your estate after death) Relationship to you Backup Executor Proposed Trustee (if you have a trust) Relationship to you Backup Trustee

Funeral & Final Wishes

Preference — Select one — Burial Cremation Undecided / No preference Cemetery or final resting place (if known) Specific instructions (service type, readings, music, etc.) Do you have prepaid funeral arrangements? — Select one — Yes No

Additional Information

Anything else we should know about your estate planning goals?