New Client Estate Planning | Onboarding Questionnaire — Married "*" indicates required fields Step 1 of 8 12% Confidential Estate Planning InformationVirginia Estate and Trust Law protects your data with the highest degree of confidentiality. Before you begin: The information you provide in this questionnaire is the foundation of your estate plan. Your plan will only be as good as the information is complete and accurate. Please do your best to submit the completed questionnaire prior to your meeting with your attorney to ensure the meeting is as productive as possible.Prefer to Work on this Form Offline? Print and Complete the Appropriate Form:New Client Estate Planning Questionnaire – Married New Client Estate Planning Questionnaire – SingleYour Name* First Last Your Attorney*Are you already working with a specific Virginia Estate & Trust Law attorney? Please SelectNancy Newton “Newnie” RogersLisa D. BingenSarah E. BrownlowHelen L. KempKatherine E. RamseyHeather H. SzajdaAlexandra B. BadmanLeah E. HenschenM.R. LitmanScott W. MasselliClaire M. StickleyThomas S. Word, Jr.T. Scott Word IIINone CurrentlyClient Referral*Did someone refer you to Virginia Estate & Trust Law? Yes No Name of ReferenceTell us who referred you, so we can thank them. First Last Contact InformationPersonal Email Address* Enter Email Confirm Email Work Email Address Enter Email Confirm Email Primary Phone*Work PhoneOther PhonePreferred Method of ContactPersonal Email AddressWork Email AddressPrimary PhoneWork PhoneOther PhoneHome Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Mailing Address*Is your Mailing Address different than your Home Address? Yes No Mailing Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Your Personal InformationName Prefix PrefixDr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Middle Last Suffix Name as it Appears in Legal Documents Date of Birth* Month Day Year Social Security Number (SSN) Occupation Employer Marital StatusThis form will adjust automatically based on your marital status. Are you currently married?* Yes No Information Regarding Your SpouseName Prefix PrefixDr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Middle Last Suffix Name as it Appears in Legal Documents Date of Birth* Month Day Year Social Security Number (SSN) Occupation Employer Primary PhoneWork PhoneOther PhonePersonal Email Address Work Email Address Parental StatusThis form will adjust automatically based on your parental status. Do you have children or dependents?* Yes No Information Regarding Your ChildrenChild 1 Full Legal Name Prefix PrefixDr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Middle Last Suffix Child 1 Formal NameHow their name should appear on legal documents. Date of Birth* Month Day Year Are They Married? Yes No Child 1 Mobile PhoneChild 1 Office PhoneChild 1 Home Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Do you have other children?* Yes No Child 2 Full Legal Name Prefix PrefixDr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Middle Last Suffix Child 2 Formal NameHow their name should appear on legal documents. Date of Birth* Month Day Year Are They Married? Yes No Child 2 Mobile PhoneChild 2 Office PhoneChild 2 Home Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Do you have other children?* Yes No Child 3 Full Legal Name Prefix PrefixDr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Middle Last Suffix Child 3 Formal NameHow their name should appear on legal documents. Date of Birth* Month Day Year Are They Married? Yes No Child 3 Mobile PhoneChild 3 Office PhoneChild 3 Home Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Do you have other children?* Yes No Child 4 Full Legal Name Prefix PrefixDr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Middle Last Suffix Child 4 Formal NameHow their name should appear on legal documents. Date of Birth* Month Day Year Are They Married? Yes No Child 4 Mobile PhoneChild 4 Office PhoneChild 4 Home Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Do you have other children?* Yes No Child 5 Full Legal Name Prefix PrefixDr.MissMr.Mrs.Ms.Mx.Prof.Rev. First Middle Last Suffix Child 5 Formal NameHow their name should appear on legal documents. Date of Birth* Month Day Year Are They Married? Yes No Child 5 Mobile PhoneChild 5 Office PhoneChild 5 Home Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Your Financial Summary – Combined AssetsPlease estimate current fair market value.Primary ResidenceJointly TitledOwned by youOwned by your spouse Add RemoveSecondary ResidenceJointly TitledOwned by youOwned by your spouse Add RemoveOther Real EstateJointly TitledOwned by youOwned by your spouse Add RemoveCash & EquivalentsInclude all bank accounts, money market accounts, certificates of deposit, credit union accounts, and any other type of cash account.Jointly TitledOwned by youOwned by your spouse Add RemoveMarketable SecuritiesInclude all stocks, bonds, partnerships, etc., that are publicly traded other than those held in retirement plan accounts.Jointly TitledOwned by youOwned by your spouse Add RemoveRetirement AccountsInclude all retirement plan accounts, including 401ks, IRAs, Roth IRAs, SEP IRAs, etc. Jointly TitledOwned by youOwned by your spouse Add RemoveBusiness Interests, Corporations, Partnerships, LLCs, etc.Include any interest in a business whether you are actively involved in the operation of the business or not, and interests in limited or general partnerships and limited liability companies that are NOT publicly traded.Jointly TitledOwned by youOwned by your spouse Add RemoveProfit Sharing / RSUs / Stock BonusJointly TitledOwned by youOwned by your spouse Add RemoveAnnuitiesJointly TitledOwned by youOwned by your spouse Add RemoveCryptocurrencyJointly TitledOwned by youOwned by your spouse Add RemoveTangiblesOther Tangibles/Collectibles Including Art, Jewelry, Furnishings, Antiques, etc.Jointly TitledOwned by youOwned by your spouse Add RemoveVehicles & BoatsJointly TitledOwned by youOwned by your spouse Add RemoveOther Notable AssetsInclude any other asset that has not been listed above, e.g., 529 plans, UTMA accounts, promissory notes, copyrights, patents, royalties, firearms, mineral rights, precious metals, etc. Provide details in Section X. Jointly TitledOwned by youOwned by your spouse Add RemoveNet Death Benefits (Insurance)Jointly TitledOwned by youOwned by your spouse Add RemoveTOTAL ASSETSJointly TitledOwned by youOwned by your spouse Add RemoveDocument UploadPlease upload any documents related to your assets listed above. Drop files here or Select files Max. file size: 128 MB. Your Financial Summary – Combined LiabilitiesPlease estimate current fair market value.Mortgage, Primary ResidenceJointly TitledOwned by youOwned by your spouse Add RemoveMortgage, Secondary ResidenceJointly TitledOwned by youOwned by your spouse Add RemoveOther DebtsJointly TitledOwned by youOwned by your spouse Add RemoveTOTAL LIABILITIESJointly TitledOwned by youOwned by your spouse Add RemoveDocument UploadPlease upload any documents related to your debts and liabilities above. Drop files here or Select files Max. file size: 128 MB. Total Jointly Titled Net AssetsYour Total Net AssetsYour Spouse's Total Net AssetsTotal Combined Net AssetsYour Taxable Estate Your Retirement Plan Account InformationPlease input information related to your Retirement Account(s). A section for your spouse is provided below. You also will have the opportunity to upload documents related to your Retirement Account(s) at the end of this section.Financial Institution Type (e.g., 401k, Traditional or Roth IRA) Current Fair Market ValuePrimary Beneficiary Secondary Beneficiary Loans Against Account? Net Current Fair Market ValueDo You Have Another Retirement Account? Yes No Financial Institution Type (e.g., 401k, Traditional or Roth IRA) Current Fair Market ValuePrimary Beneficiary Secondary Beneficiary Loans Against Account? Net Current Fair Market ValueYour Total Retirement Account ValueDocument UploadPlease upload any documents related to your Retirement Account(s). Drop files here or Select files Max. file size: 128 MB. Do You Have A Third Retirement Account? Yes No Financial Institution Type (e.g., 401k, Traditional or Roth IRA) Current Fair Market ValuePrimary Beneficiary Secondary Beneficiary Loans Against Account? Net Current Fair Market ValueDo You Have A Fourth Retirement Account? Yes No Financial Institution Type (e.g., 401k, Traditional or Roth IRA) Current Fair Market ValuePrimary Beneficiary Secondary Beneficiary Loans Against Account? Net Current Fair Market ValueDo You Have A Fifth Retirement Account? Yes No Financial Institution Type (e.g., 401k, Traditional or Roth IRA) Current Fair Market ValuePrimary Beneficiary Secondary Beneficiary Loans Against Account? Net Current Fair Market ValueDo You Have A Sixth Retirement Account? Yes No Financial Institution Type (e.g., 401k, Traditional or Roth IRA) Current Fair Market ValuePrimary Beneficiary Secondary Beneficiary Loans Against Account? Net Current Fair Market ValueYour Total Retirement Account ValueDocument UploadPlease upload any documents related to your Retirement Account(s). Drop files here or Select files Max. file size: 128 MB. Your Spouse's Retirement Plan Account InformationFinancial Institution Type (e.g., 401k, Traditional or Roth IRA) Current Fair Market ValuePrimary Beneficiary Secondary Beneficiary Loans Against Account? Net Current Fair Market ValueDoes Your Spouse Have Another Retirement Account? Yes No Financial Institution Type (e.g., 401k, Traditional or Roth IRA) Current Fair Market ValuePrimary Beneficiary Secondary Beneficiary Loans Against Account? Net Current Fair Market ValueYour Total Retirement Account ValueDoes Your Spouse Have A Third Retirement Account? Yes No Financial Institution Type (e.g., 401k, Traditional or Roth IRA) Current Fair Market ValuePrimary Beneficiary Secondary Beneficiary Loans Against Account? Net Current Fair Market ValueDoes Your Spouse Have A Fourth Retirement Account? Yes No Financial Institution Type (e.g., 401k, Traditional or Roth IRA) Current Fair Market ValuePrimary Beneficiary Secondary Beneficiary Loans Against Account? Net Current Fair Market ValueDoes Your Spouse Have A Fifth Retirement Account? Yes No Financial Institution Type (e.g., 401k, Traditional or Roth IRA) Current Fair Market ValuePrimary Beneficiary Secondary Beneficiary Loans Against Account? Net Current Fair Market ValueDoes Your Spouse Have A Sixth Retirement Account? Yes No Financial Institution Type (e.g., 401k, Traditional or Roth IRA) Current Fair Market ValuePrimary Beneficiary Secondary Beneficiary Loans Against Account? Net Current Fair Market ValueYour Spouse's Total Retirement Account ValueDocument UploadPlease upload any documents related to your spouse’s Retirement Account(s). Drop files here or Select files Max. file size: 128 MB. Your Closely Held Business InformationPlease provide copies of all shareholder / partnership / operating agreements. You can upload them at the end of this section. A section for your spouse is provided below.Business Name Percentage Owned by You Tax Classification(e.g., S-Corp, C-Corp, Partnership, Disregarded Entity) Estimated Fair Market ValueShareholder / Partnership / Operating Agreement in Place? Document UploadUpload all applicable files pertaining to your closely held business information. Drop files here or Select files Max. file size: 128 MB. Do You Have Another Business? Yes No Business Name Percentage Owned by You Tax Classification(e.g., S-Corp, C-Corp, Partnership, Disregarded Entity) Estimated Fair Market ValueShareholder / Partnership / Operating Agreement in Place? Document UploadUpload all applicable files pertaining to your closely held business information. Drop files here or Select files Max. file size: 128 MB. Your Spouse's Closely Held Business InformationPlease provide copies of all shareholder / partnership / operating agreements. You can upload them at the end of this section.Business Name Percentage Owned by Your Spouse Tax Classification(e.g., S-Corp, C-Corp, Partnership, Disregarded Entity) Estimated Fair Market ValueShareholder / Partnership / Operating Agreement in Place? Document UploadUpload all applicable files pertaining to your spouse’s closely held business information. Drop files here or Select files Max. file size: 128 MB. Does Your Spouse Have Another Business? Yes No Business Name Percentage Owned by Your Spouse Tax Classification(e.g., S-Corp, C-Corp, Partnership, Disregarded Entity) Estimated Fair Market ValueShareholder / Partnership / Operating Agreement in Place? Document UploadUpload all applicable files pertaining to your spouse’s closely held business information. Drop files here or Select files Max. file size: 128 MB. Your Life Insurance InformationPlease input information on your life insurance policy(ies). You can upload related files at the end of this section. A section for your spouse is also provided below.Policy Owner Insurance Company Type (Term, Whole Life, etc.) Policy Number Estimated Fair Market ValueCash ValueDeath BenefitLoans Against Policy? Primary Beneficiary Secondary Beneficiary Net Death BenefitDo You Have Another Life Insurance Policy? Yes No Policy Owner Insurance Company Type (Term, Whole Life, etc.) Policy Number Estimated Fair Market ValueCash ValueDeath BenefitLoans Against Policy? Primary Beneficiary Secondary Beneficiary Net Death BenefitYour Total Net Death BenefitNet Benefit of all your life insurance policiesDocument UploadUpload all applicable files pertaining to your insurance policies. Drop files here or Select files Max. file size: 128 MB. Your Spouse's Life Insurance InformationPlease input your Spouse’s information. Policy Owner Insurance Company Type (Term, Whole Life, etc.) Policy Number Estimated Fair Market ValueCash ValueDeath BenefitLoans Against Policy? Primary Beneficiary Secondary Beneficiary Net Death BenefitDoes Your Spouse Have Another Life Insurance Policy? Yes No Policy Owner Insurance Company Type (Term, Whole Life, etc.) Policy Number Estimated Fair Market ValueCash ValueDeath BenefitLoans Against Policy? Primary Beneficiary Secondary Beneficiary Net Death BenefitYour Spouse's Total Net Death BenefitNet Benefit of your spouse’s life insurance policiesDocument UploadUpload all applicable files pertaining to your spouse’s insurance policies. Drop files here or Select files Max. file size: 128 MB. Additional Questions For YouPlease provide a copy of all existing estate planning documents you may have, any document relevant to any of the following questions to which you answer “yes,” and any other documents relevant to your estate, e.g., buy-sell agreements, etc.Do you have a pre-marital or post-marital agreement?* Yes No Have you ever lived in Arizona, California, Idaho, Louisiana, New Mexico, Nevada, Texas, Washington or Wisconsin?* Yes No Is either of you the citizen of a country other than the United States?* Yes No Has either of you been previously married?* Yes No Do you have post-death obligations under a settlement agreement?* Yes No Does either of you have a deceased child?* Yes No Do either of you own real property outside Virginia?* Yes No Do either of you own assets jointly with any person other than each other?* Yes No Do either of you own any insurance on the life of another person?* Yes No Is either of you the current beneficiary of a trust created by someone else?* Yes No Have you ever created an irrevocable trust for the benefit of yourself or another person?* Yes No Are you an UTMA or 529 custodian, or trustee of any property, for your children or another person?* Yes No Do either of you anticipate any significant change in your assets, liabilities or income, e.g., from an inheritance or retirement, etc?* Yes No Do either of you have anyone who is financially dependent on you other than your minor children?* Yes No Do either of you or does any family member have any significant health issues or disabilities?* Yes No Do you have any concerns about a beneficiary's situation, e.g. marital instability, substance abuse, creditor problems or eligibility for public benefits, etc.?* Yes No Has either of you made gifts in excess of $10,000 in value to any one person in any year after 1981?* Yes No Has either of you filed a gift tax return?* Yes No Do either of you have a safe deposit box?* Yes No Location of Safe Deposit Box Have you or a family member participated in any assisted reproductive technology procedure that resulted in the storage of gametes or embryos?* Yes No Do either of you have an interest in making charitable gifts?* Yes No Do either of you have any special requests regarding funeral, burial or cremation, or donation of body or organs?* Yes No Please provide detailed explanations to all questions to which you answered “yes” or other asset or family details of which we should be aware:Document UploadPlease upload all documents for the answers to which you said “yes” above. Drop files here or Select files Max. file size: 128 MB. Your Other AdvisorsDo you have an accountant?* Yes No Do you have an investment advisor?* Yes No Do you have a life insurance agent?* Yes No Do you have a primary physician?* Yes No Does your spouse have a primary physician?* Yes No Do you have other advisors?* Yes No Accountant Name First Last Accountant Email Address Accountant Firm Name Accountant Phone NumberAccountant Address City State StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Investment Advisor Name First Last Investment Advisor Email Address Investment Advisor Firm Name Investment Advisor Phone NumberInvestment Advisor Address City State StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Life Insurance Agent Name First Name Last Name Life Insurance Agent Email Address Life Insurance Agent Firm Name Life Insurance Agent Phone NumberLife Insurance Agent Address City State StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Your Primary Physician Name First Last Your Primary Physician Email Address Your Primary Physician Firm Name Your Primary Physician Phone NumberYour Primary Physician Address City State StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Your Spouse's Primary Physician Name First Last Your Spouse'sPrimary Physician Email Address Your Spouse's Primary Physician Firm Name Your Spouse's Primary Physician Phone NumberYour Spouse's Primary Physician Address City State StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Other Advisor First Last Other Advisor Firm Name Other Advisor Phone NumberOther Advisor Address City State StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Additional InformationPlease list any specific goals, concerns, or questions that you currently have with respect to the estate planning process:HiddenSection Break
