Questionnaire Legalshield Form – Fill Out and Use This PDF

p 1 of 6 • Will Questionnaire

PLEASE PRINT

es • tate n. Everything that you own at your passing after payment of debts and taxes. You make deci- sions regarding the share of your estate that you wish to give to your beneficiaries.

will n. A document which provides who is to receive your property, who will administer your estate, who will serve as guardian of your children, if applicable, and other provisions.

peace of mind n. The wonderful feeling you get as a LegalShield member after having your Will prepared by a qualified law firm at a reasonable price.

FOR YOUR INFORMATION

MEMBER AND SPOUSE FILLING OUT A SEPARATE FORM

In order to meet each person’s unique needs, you must each fill out a Will Questionnaire

Get Started!

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WHAT YOU’LL NEED TO FILL THIS OUT:

•Copy of your Pre-or-Post Marriage Contract (if applicable)

•Names and birthdates of your children and grandchildren (if applicable)

•The name and contact information of the person you’ve chosen to be guardian of your child(ren), the trustee(s) of your estate, and your personal representative.

HELPFUL INFORMATION BEFORE YOU GET STARTED!

•This Will Questionnaire is NOT your Will. It will help your Provider Law Firm prepare your Will. All questions applicable to you MUST be completed in their entirety in order to have your Will prepared. Providing an estimated dollar amount for assets and debts is suffi- cient. All information provided is confidential.

•If you need more space to answer a question, attach a separate sheet and indicate the question number to which it pertains.

•If you have questions while filling out this form, don’t hesitate to call your Provider Law Firm at the number on your membership card.

•If you need the number to your firm, call Member Services at 1-800- 440-8857 (7 am - 7 pm, Mon-Fri, Central Standard Time).

1)Full legal name (first, middle, last)

______________________________________________________

All other names by which you have been known:

______________________________________________________

Membership Number ____________________________________

Age ____ Date and Place of Birth __________________________

Sex q Male qFemale Are you a Canadian citizen? q Y qN If no, country of citizenship _______________________________

2) Current residence:

Address ____________________________________________

Postal Code _________________________________________

Home Phone _______________ Work Phone _______________

3)If you are married, list your spouse’s full legal name. If in a partnership, list partner’s name:

(first, middle, last, maiden) _____________________________________

Spouse/Partner’s SIN _________________DOB______________

If applicable, date of marriage__________

Place of marriage ______________

4)Do you and your spouse have a Prenuptial Agreement? q Y q N q N/A

If yes, attach copy with any filing data.

5)Do you plan on marrying or entering into a partnership agreement in the near future? q Y q N q N/A

6)If either you or your spouse has been divorced, please answer the following. If not applicable, please go to question #8.

Date of marriage ________________________________________

Date of divorce judgment _________________________________

Court rendering judgment _________________________________

Date of spouse’s death (if applicable) ________________________

7)Obligations persuant to previous marriages:

_________________________________________________________

8)If applicable, are any of your children, stepchildren or grandchildren born outside of marriage? If yes, please provide details:

____________________________________________________

9)If you have children, including adopted children, state the following for each child. If you do not have children, please go to question #15.

	Full name	Son/Daughter	Date of birth	Child of current
				marriage? (Y/N)

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10) a. Deceased biological or legally adopted children if applicable.

Full name	Son/Daughter	Date of death

b. Deceased child’s living children if applicable:

Full name	Son/Daughter	Date of birth	Parent’s Name

11)If you have stepchildren, do you want them treated the same as your natural born or legally adopted children in your Will? q Y q N q N/A

If yes, state the following for each:

Full name	Male/Female	Date of birth	Parent’s Name

12)If you have grandchildren, state the following for each. If not, go to question #13.

	Full name	Parent’s Name	Grandson /	DOB	Living?
			Granddaughter		(Y/N)

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Will Questionnaire • p 2 of 6

FOR YOUR

INFORMATION

Spouse: Legally married per- son. Adult Interdependent Partner: A person who has lived with another person in a relationship of interdepen- dence for a continuous pe- riod of three years, or of some permanance, if there is a child of the relationship by birth or adoption, OR the person has entered into adult interde- pendent partner agreement.

FOR YOUR

INFORMATION

Your surviving spouse, adult interdependent part- ner, your children under 18 years and any children over 18 years who are physically or mentally dis- abled and thereby unable to earn a livelihood, have a right to apply for a greater share of your estate.

p 3 of 6 • Will Questionnaire

guard • i • an n.

A person lawfully invested with the power, and charged with the duty, of taking care of the person who is incapable of doing so because of age or other incapacity.

FOR YOUR INFORMATION

JOINT TENANTS WITH

RIGHT OF SURVIVORSHIP

If you own property jointly with another person as “joint tenants with right of survivorship,” your interest in that property will pass to the survivor upon your death. It will not pass according to the terms of your Will. If you own property jointly with another person without right of survivorship, your interest in that property will pass according to the provisions in your Will.

FOR YOUR INFORMATION

BENEFICIARY DESIGNATIONS

Beneficiary designations in life previously made in insurance policies, retirement plans, etc., will determine who receives those monies upon your death, not the provisions in your Will.

Halfway Point

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13)Are any of your children or other beneficiaries mentally or physically disabled or have special needs? q Y q N If so, note any special provisions:

____________________________________________________

____________________________________________________

If so, are they presently receiving, or do you anticipate that they may apply for disability benefits in the future? q Y q N

14)If your children are under age eighteen (18), state the follow- ing for the person you wish to act as their guardian in the event of your death or in case of the joint death of you and your spouse (if married). If you do not have any minor chil- dren, please go to question #15.

Name(s)____________________________________________

Address ____________________________________________

Relationship ________________________________________

If at the time of your death, the person(s) named above is/are unwilling to serve as guardian (custodian), please list an alternate:

Name(s)_________________________________

Address _________________________________

Relationship ______________________________

15)List the estimated value of your assets as of today’s date. Include the dollar amount in the appropriate column(s).

				VA L U E
h. Life Insurance					If Joint Assets-	Designated
	A S S E T S
					Name	Beneficiary
	Policies
	a.	Home
	b. Other real estate*
	c. Chequing, savings, or credit union accounts
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2.
	d. Automobiles &
	Other Vehicles
	e. Stocks, Mutual funds
	& other investments
	f. Interest in a business
	g. RRSPs
	h. Life Insurance
	Policies
	i. Miscellaneous
	T O TA L S

* Indicate if outside of Canada.

16)List your estimated debt in each category as applicable. Include the dollar amount in the appropriate column(s).

	D E B T S	Individual	Spouse’s	Joint/Debts Joint Debts/
		Debts	Separate	Non-Spouse
			Debts

a. Mortgages on home

17)Do you want your spouse or partner as your personal representative/executor? q Y q N

Please list an alternate below. If not married or you wish to appoint someone other than your spouse, please indicate below.

Full name ________________________________________

Address __________________________________________

Please list an alternate in case this person is unwilling or un- able to serve:

Full name _________________________________________

Address __________________________________________

Do you wish them to act jointly? q Y q N

If yes, with whom?

Full name ________________________________________

Address__________________________________________

18) Many people make special provisions for family heirlooms, jewelry, or other items of special value to be distributed to friends or relatives. If you have such property and would like to leave it to a specific person, please complete the following.

Item Special Identifying Features Recipient

_________________________________________________

_________________________________________________

Will Questionnaire • p 4 of 6

FOR YOUR INFORMATION

Any shareholder agreement for a corporation in which you own shares should be forwarded with this package to your Provider Law Firm.

FOR YOUR INFORMATION

Your personal representative will manage and distribute your estate in accordance with the terms of your Will. The person you choose should be responsible, trustworthy, and willing and able to handle the responsibilities of the role. Since the responsibilities can extend over a number of years, you should choose a person of an appropriate age.

FOR YOUR INFORMATION

If your personal representative resides outside your Province, he or she may be required to post a bond equal to the value of your estate. If possible, choose a personal representative that resides in your Province or choose joint personal representatives, one of whom resides in your Province.

p 5 of 6 • Will Questionnaire

FOR YOUR

INFORMATION

MUTUAL/MIRROR WILLS

Usual for a couple. Both spouses or partners have the same provisions in their wills.

19)Indicate how you want your assets to pass when you die.

Please check the ONE option you prefer:

qOption A I want my assets to pass to my spouse and children as follows:

•To my spouse, if surviving.

•If my spouse predeceases me, my assets will be divided in equal shares to my children.

•If any of my children predecease me, that child’s share shall be distributed to his or her children in equal shares.

•In the event my spouse and all of my chil- dren and descendents fail to survive me, I want my assets to be distributed as follows:

FOR YOUR

INFORMATION

One typical estate plan for married or partnered persons provides that if, when you die, your spouse or partner, all your children and grandchildren have predeceased you, your estate is to be divided equally between your family and the family of your spouse or partner. Usually, both you and your spouse or partner contribute to the estate.

Almost Done!!

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qOption B I am unmarried with children and want my assets to pass as follows:

•In equal shares to my children.

•If one or more of my children predeceases me, that child’s share in my estate is distributed to his or her children in equal shares.

•In the event all my children and descendents fail to survive me, I want my assets to be distributed as follows:

____________________________________

____________________________________

____________________________________

qOption C None of the above. I want my assets to pass as follows:

____________________________________

____________________________________

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Full name __________________________________________________

Address ___________________________________________________

Please list an alternate in case this person is unwilling or unable to serve:

Full name __________________________________________

Address ____________________________________________

Please indicate your wishes by checking one box below:

q I want this person to be able to act on my behalf immediately. qI want this person to be able to act on my behalf only upon

certification by a doctor that I am no longer able to make decisions and act for myself.

Who would you like to serve as your representative responsible for making sure your property wishes are carried out?

Full name __________________________________________

Address ___________________________________________

Please list an alternate in case this person is unwilling or unable to serve:

Full name __________________________________________

Address ___________________________________________

FOR YOUR INFORMATION

TAXES

While Death taxes are not currently imposed in Canada, income taxes must often be paid after death. Income tax may include tax on accrued capital gains (increase in the value of property over time.)