#1-3455 HARVESTER RD.

BURLINGTON, ONTARIO

L7N 3P2

Telephone: 631-1147

Fax (905) 333-1624

CONFIDENTIAL ESTATE AND FINANCIAL

PLANNING INFORMATION

NOTE This is not intended to be a Will, but is for Will planning purposes only.

Please use last page and additional pages if space is insufficient.

Please mark any questions as N/A if such is the case.

Date:

PERSONAL AND SPOUSE INFORMATION:

1. Full Name:

(please circle first name used)

Any other name used:

2. Address (in full):

__________________________________________________________________

Postal Code

3. Telephone Nos. Home: Business:

4. Occupation: Citizenship:

Date of Birth:

5. Name of spouse (in full):

Address (if not same as above):

6. Spouse’s citizenship:

Spouse’s date of birth:

7. Date of marriage:

8. Have you been married previously?

9. If so, were there any children of the previous marriage?

10. Place and date of divorce (if any):

ADDITIONAL PERSONAL INFORMATION:

1. Place of birth:

2. Place of residence when married:

3. Place of marriage:

4. Do you have a marriage contract?

5. Is your present residence permanent: If not, please explain–

INFORMATION ABOUT YOUR CHILDREN (including adopted children)

1. 2.

(full name) (full name)

(address) (address)

(date of birth) (marital status) (date of birth) (marital status)

(name of child's spouse) (name of child's spouse)

(number of children) (number of children)

3. 4.

(full name) (full name)

(address) (address)

(date of birth) (marital status) (date of birth) (marital status)

(name of spouse) (name of spouse)

(number of children) (number of children)

OTHER BENEFICIARIES TO BE CONSIDERED:

(Full names and addresses, and relationship to you,of any other persons to be considered in your planning; e.g. your parents, grandchildren, brothers and sisters, etc; similarly, those of your spouse; friends and charitable organizations)

1. 2.

(full name) (full name)

(address) (address)

(relationship to you) (relationship to you)

3. 4.

(full name) (full name)

(address) (address)

(relationship to you) (relationship to you)

5. Do any of these people have a financial need now, or will they have in the event of your death?

6. Are you currently supporting or providing funds to anyone else? Yes No

1. 2.

(full name) (full name)

(address) (address)

(date of birth) (marital status) (date of birth) (marital status)

(name of spouse) (name of spouse)

INFORMATION ABOUT YOUR ASSETS:

(Please mark as N/A any requests for information not relevant to your asset position and use last page for additional information if necessary)

1. RESIDENCE Address:

(a) Year purchased: (b) Cost when purchased: $

(approximate)

(alone, joint tenant with survivorhsip (approximate)

tenants in common)

(e) Outstanding mortgage(s): First Mortgage $ (approximate)

Second Mortgage $ (approximate)

(f) Is this your principal residence or that of your spouse?

2. RECREATIONAL PROPERTY Address:

(or location)

(a) Year purchased: (b) Cost when purchased: $

(approximate)

(alone, joint tenant with surivorship, (approximate)

tenants in common)

(e) Outstanding mortgage(s):

(f) Is this your principal residence or that of your spouse?

3. RENTAL PROPERTY OWNED BY YOU Address:

(a) Current Value: $ (approximate)

(b) Year Purchased: (c) Cost when purchased: $

(approximate)

4. FARM OR BUSINESS PROPERTY Address:

(a) Current Value: $ (approximate)

(b) Year purchased: (c) Cost when purchased: $

5. PENSION AND OTHER PLANS (including RRSP’s)

(a) Do you belong to or contribute to a company pension plan? Yes No

Name and address of company

Who is the beneficiary?

What are the benefits?

Does the plan terminate on your death?

(b) Have you contributed to the Canada or Quebec Pension Plan?

For how many years?

Company: Address:

Beneficiary:

Current Value $ Who will continue to

Make contributions?

(d) Does your spouse have any of the above plans? Yes No

6. INSURANCE ON YOUR LIFE OR OWNED BY YOU

(a) Name and address of your insurance company:

__________________________________________________________________

(b) Face value of policy: $ Policy Number:

7. GROUP LIFE INSURANCE

(a) Name and address of insurance company:

(b) Face value of policy: $ Policy Number:

(d) Name of beneficiary:

8. INVESTMENTS (bonds, stocks, monies owing to you by mortgage investments or otherwise)

(a) Approximate total value: $

(b) Approximate total cost: $

(d) Are there companies located outside Ontario?

9. BUSINESS OR PROFESSIONAL FINANCIAL INFORMATION

(a) Business name:

(in full)

Address:

(b) Nature of business:

(d) Sole Propriertorship , Partnership ,

Incorporated Company

10. PERSONAL AND HOUSEHOLD ITEMS

Approximate total value: $ Insured Value: $

11. LISTED PERSONAL PROPERTY (e.g., paintings, jewellery, stamps, sculptures)

Approximate total value: $

12. BANK ACCOUNTS

Approximate total value: $ Are any accounts joint?

If so, name of joint owner

13. INTEREST in estates, trusts, expected inheritances:

(continue on last page if necessary)

Please provide copies of appropriate documents if applicable.

14. FOREIGN INCOME (e.g., US dividends or rental payments)

15. OTHER ASSETS (including automobiles)

16. Do you have disability benefits? Yes No

Name and address of company:

LIABILITIES List bank loans and other significant debts or contingent liabilities.

1. $

(amount) (owed to) (address)

2. $

3. $

POSSIBLE EXECUTOR(S) AND GUARDIAN(S)

1. Proposed Executor(s):

(a) (b)

(full name) (full name)

(address) (address)

2. Proposed alternate Executor(s):

(a) (b)

(full name) (full name)

(address) (address)

3. Proposed guardian(s):

(a) (b)

(full name) (full name)

(address) (address)

4. Will guardian(s) themselves require funds

To accommodate your children?

5. Will the children be residing outside Ontario? Or outside Canada?

ADDITIONAL:

1. Do you wish to leave specific funeral and burial instructions for your Executors?

2. Do you now have an up-to-date Power of Attorney for Property in force?

3. Do you now have an up-to-date Power of Attorney for Personal Care in force?

ADDITIONAL DETAILS OR COMMENTS: