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CLIENT PERSONAL INFORMATION SHEET

The purpose of this form is to evaluate the size of your estate and to gather the basic information for us to provide you with an opinion as to the length of time it will take to prepare your Will and the charges applicable. This questionnaire is designed in a manner that allows you to give pertinent information to our office without providing personal information (such as identification of bank accounts) on line that may put you at risk. An interview is a must in order to discuss the best way to distribute your assets and ensure that your Will is in compliance with your wishes, with the minimum tax consequences.

* required fields

Testator's Full Name: ( Please type in your legal name as it appears on your birth Certificate ):
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(Also known as):

Address:
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Telephone (Business):
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Email Address:
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Date of Birth:
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Marital Status:

Full name of Spouse, if applicable

Full names of all children, if any:
Name:	Address:	Date of Birth:





If single or divorced: are you planning to get married soon? : yes no
Addition Comments:
Details of any divorce decrees or dissolutions:


ASSETS: LIST OF ASSETS: We do not require that you give the dollar value of these assets as of now. Simply write down the municipal addresses of any real estate property you own, identify the year and make of the motor vehicles of value which you possess and list significant valuables such as jewelry, paintings, collections.
(a) REAL ESTATE PROPERTY: Please list details of any owned by you and set out whether you own these properties in your name alone or with someone else. If the property is owned by you and someone else, please advise as to whether title is being held jointly or as tenants in common. Please specify your percentage of interest, if applicable:
Please note we will require that you bring in your ownership papers for our review at the time of the interview
(b) AUTOMOBILES, BOATS AND RECREATIONAL VEHICLES: Please list details of any owned by you:

(c) FARM MACHINERY, TOOLS, LIVESTOCK AND QUOTAS: Please provide details, if any:

(d) HEIRLOOMS, ARTWORK, PLATE, JEWELLERY AND ANY COLLECTIONS ETC.: Please provide details, if any:

(e) HOUSEHOLD GOODS AND FURNITURE: Please provide details, if any:

(f) OTHER ASSETS: E.g. tax sheltered investments, royalties, etc. Please provide details, if any:


APPOINTMENT OF YOUR EXECUTOR The executor is the person who will carry out your wishes under your Will. We suggest that you provide the names of the person(s) you trust and who you feel would be most competent to handle your affairs after your death. The person can be a spouse or a child over 18 years. We recommend that the person be younger than you and lives in Ontario.
Names of Executor(s) in order of preference:
(1) Date of Birth:
Address:
Relationship to you:
(2) Date of Birth:
Address:
Relationship to you:
(3) Date of Birth:
Address:
Relationship to you:

The beneficiary is the person you wish to give your assets to. If the person is a minor, you may set up a trust to hold the assets for the minor until such time as the minor reaches of age. A spouse and/or children can be beneficiaries.
Names of Beneficiaries and identification of gifts:
Name of Beneficiary: Date of Birth:
Address:
Relationship to you:
Assets you wish to give:
Name of Beneficiary: Date of Birth:
Address:
Relationship to you:
Assets you wish to give:
Name of Beneficiary: Date of Birth:
Address:
Relationship to you:
Assets you wish to give:
Name of Beneficiary: Date of Birth:
Address:
Relationship to you:
Assets you wish to give:
Name of Beneficiary: Date of Birth:
Address:
Relationship to you:
Assets you wish to give:
Name of Beneficiary: Date of Birth:
Address:
Relationship to you:
Assets you wish to give:

SAFETY DEPOSIT BOXES
Do you hold a safety deposit box?	yes no
INSURANCE, ANNUITIES, RRSP's, DPSP's and PENSIONS:
Do you have any life insurance?	yes no
If yes, who is named as beneficiary and what is your relationship to the person?

Do you have any annuities?	yes no
Do you have any RRSPs?	yes no
Do you have a pension plan?	yes no
Do you have any other assets not identified above that you want to give to your beneficiary(ies)? yes no If yes, please identify these assets.

MONEY ON DEPOSIT
Do you have any savings in the bank?	yes no
SHARES, BONDS, DEBENTURES, GUARANTEED INVESTMENT CERTIFICATES
Do you have any shares, bonds, debentures or guaranteed investment certificates or other types of similar investments?
yes no
If yes, please list them. You are not required to provide the dollar value of the investments as of now .

INTERESTS IN PARTNERSHIP OR UNINCORPORATED BUSINESS:
Do you have any interests in any partnership or unincorporated business? yes no
If yes, please submit details:
Please note that we will require that you bring in copies of any agreements at the time of the interview.
DEBTS INCLUDING MORTGAGES:
Please list the debts that you carry including mortgages, loans, debts owned under a promissory note, visa and other credit card debts . You are not required to give the dollar amount of the debts you owe as of now.
Creditors :


SPECIAL CLAUSES:
Would you need a guardian for minor's property? If yes please name the guardian(s):

Any special instructions ?

Do you wish to exclude any person (e.g. illegitimate or adopted child, if applicable)? If yes, please submit details :

Funeral Instructions:

Do you wish to donate any organs? yes no
If yes, please submit instructions:

POWER OF ATTORNEY:
Will you require the preparation of a power of attorney for property or for personal care? yes no
BOOK YOUR APPOINTMENT
Please provide the best times to call you to set up an appointment. Note our office hours are Monday to Friday, 09:00 a.m. to 05:30 p.m. If you need an appointment urgently please tick here.

SURVEY INFORMATION : Kindly advise us as to how you learned about NLCI Your Real Estate Lawyer Professional Corporation: select one of the following options: *
TV /RADIO ADVERTISING REAL ESTATE SALES REPRESENTATIVE, Please provide name: NLCI STAFF WEB SITE OTHER if other, please give details: