Wills and Estates Intake Form

Wills & Estates Intake Form

Wills and Estates Intake form

1. Basic Information

1.1 Your Details

Name in full

Previous or other names

Date of Birth

Occupation

Address

Postal address

Phone number

Referred by?

1.2 Existing Will & Attorneys

Do you have an existing…

Will

Yes

Last Reviewed…

Powers of Attorney

Yes

Last Reviewed…

Binding Death Benefit Nominations

Yes

Last Reviewed…

1.3 Health Concerns

Do you have any brain-related disorders; memory loss or confusion; or take any medication that could impact on cognitive function?

Yes

Please describe

Your Family

What is your relationship status

Married

De-facto

Separated or Divorced

never married or divorced

Partner’s full name

Partner’s Mobile Number

Partner’s DOB

Partner’s full name

Are you contemplating marriage

Yes

When did you start living together

Has a property settlement occurred?

Yes

Do you have children

From your current relationship?

Yes

From your previous relationship?

Yes

1.4 Your Children (including step and adopted children)

Child's full name	Address	Date of Birth	Mother	Father

1.5 Your Grandchildren (including step, adopted grandchildren)

Grandchild’s Name	Date of Birth	Age	Mother	Father

1.6 Household members

Other than those listed above…

Does anyone else live with you?

Yes

If yes

Their Full Name	Relationship to you

1.7 Other dependents

Other than those listed above…

Is there anyone else financially dependent on you?

Yes

If yes

Their Full Name	Relationship to you	Nature of their dependency

2. Assets & Liabilities

Real estate

Address of the property:	Registered owner(s):	Type of ownership:	Location of title:	Mortgage:	Property value:

Bank Accounts

Bank or Financial Institution:	Account holder(s):	Account type:	Approximate value:

Motor vehicles

Make	Model	Year

Investments

Type of investment:	Held with:	Approximate value:

Loans and debts

Details of money you owe:

Is there a loan agreement?

Yes

Details of money owed to you:

Is there a loan agreement?

Yes

Repayment to estate?

To be repaid

To be forgiven

Insurance

House and Contents:

Yes

Company

Vehicle insurance

Yes

Company

Health insurance

Yes

Company

Life insurance

Yes

Company

Superannuation

Fund	Value	Current Nomination	Binding

Businesses

Are you an office holder of any private companies?

Yes

Are you the beneficiary/ trustee of any trusts?

Yes

Are you in a partnership?

Yes

3. Executor/Trustee

Who do you want your executor(s) to be?

Executors

Executor's Full Name	Executor's Address	Executor's Relationship to You

Who do you want your alternative executor(s) to be?

Alternative Executors

Alternative Executor's Full Name	Alternative Executor's Address	Alternative Executor's Relationship to You

4. Guardian of Minor Children

Do you wish to appoint a guardian of minor children?

Yes

Full Name of Surviving Parent

Guardian’s Full Name

Guardian’s Relationship to You

5. Specific Bequests

Do you wish to leave any specific items of property to a particular person?

Yes

If yes

Description of the Property	Name of Beneficiary

6. Beneficiaries of the Residue

Who do you wish to leave the balance of your estate to?

Full name	Relationship To You

If something happens to the above beneficiary (ies), who do you wish to leave the balance of your estate to?

Full name	Relationship To You

Is there anyone who you feel a responsibility to provide for not mentioned in your Will? If Yes – Please list

Full name	Relationship To You

Are there any special provisions or instructions you wish to cover in your Will? If Yes – Please list

Full name	Relationship To You

7. Enduring Powers of Attorney and Medical Decision Makers

An enduring power of attorney is a legal document that lets you appoint someone to make decisions about personal or financial matters. This person is called an attorney. The power endures - or continues - if and when you are unable to make decisions.

Who do you want your attorney(s) to be?

Attorney's Full name	Attorney's Address

If naming more than one attorney, how would you like them to make decisions?

Please Select

Who do you want your alternative attorney(s) to be?

Alternative Attorney’s Full Name	Alternative Attorney’s Address

MEDICAL DECISION MAKER

A person to make medical decisions if you cannot give consent. Your medical decision maker is the first person on the list who is reasonably available, and willing and able to make the decision

First Decision Maker	Second Decision Maker	Third Decision Maker	Forth Decision Maker

8. Additional notes

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Privacy Policy

At Shelbourne Legal, we take privacy and security of your personal information very seriously. Shelbourne Legal will only use your personal information for the purpose for which you have provided it. We will not disclose your personal information to third parties, unless you have consented to such disclosure or in other circumstances where such disclosure is required or permitted by law.

We endeavour to keep all personal information safe by taking all reasonable precautions to protect personal information from misuse, loss, unauthorised access, modification or disclosure.

Wills & Estates Intake Form

1. Basic Information

1.1 Your Details

1.2 Existing Will & Attorneys

1.3 Health Concerns

Your Family

Do you have children

1.6 Household members

1.7 Other dependents

2. Assets & Liabilities

Loans and debts

Insurance

Businesses

3. Executor/Trustee

Who do you want your executor(s) to be?

Who do you want your alternative executor(s) to be?

4. Guardian of Minor Children

5. Specific Bequests

6. Beneficiaries of the Residue

7. Enduring Powers of Attorney and Medical Decision Makers

8. Additional notes

Privacy Policy

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