Will Questionnaire

Once you have completed this questionnaire please call us at (250) 426-4352 to schedule an appointment to discuss your will & estate planning options. We are wheelchair accessible and in-home visits are available. Thank you, from all of us here at Smith Alliance. We look forward to assisting you!

* How does your name appear on your birth certificate?

(If different from your birth certificate) What name do you currently use?

* Your Address

Street Address

Address Line 2

City

State / Region / Province

ZIP / Postal Code

Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France France Metropolitan French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao, People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia, The Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka St. Helena St. Pierre and Miquelon Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Yugoslavia Zambia Zimbabwe Country

Home Phone

Other Phone

* Birthdate

* Place of Birth

Occupation

Are you married or living in a common-law relationship?

Yes

No

Name of Spouse

First

Last

Spouses Occupation

Spouses Date of Birth

Spouses Place of Birth

Are you divorced or separated?

Yes

No

Please provide details on your divorce or separation

Are you contemplating a marriage in the near future?

Yes

No

Do you have any children? (Natural or legally adopted)

Yes

No

Please provide your childrens full legal name(s), age(s) and occupation(s)

Do any of your children have any disabilities?

Yes

No

Please list your childs disability

Have any of your children predeceased you?

Yes

No

Would you like their share of your estate to go to their children?

Are you planning to leave a spouse or a child out of your Will or have an unequal distribution amongst your children?

Yes

No

I don't know

If your children are under the age of 19, what age would you like your children to receive their inheritance?

re and upbringing of your child)If your children are under the age of 19, who would you like to appoint as their guardian? ( *** Note *** The guardian is the person who will look after the daily care)

First Choice

Alternate Choice

Second Choice

Who would you like to be the Executor of your Estate? ( *** Note *** The executor of your estate is the person who will handle the legal and financial paperwork for your estate. They will have control over your assets until your estate is finally distributed)

First Choice

Second Choice

Third Choice

Do you own any real estate?

Yes

No

Please tell me where the property is located and if you own it in your name only or jointly with another person(s).

How would you like your estate divided?

If the beneficiary/ies listed above were to predecease you, then how would you like your estate divided?

Do you have life insurance?

Yes

No

Who is the beneficiary of your life insurance policy?

First

Last

Do you have any pensions, investments and/or RRSPs?

Yes

No

Please tell me which pensions, investments and/or RRSPs you have and whether or not there is a beneficiary named for them including for any death benefits.

What is the name(s) of your accountant and/or financial advisor, if any, that are assisting you with your financial matters?

First

Last

Do you own or operate a business?

Yes

No

Please provide me with details.

Would you like any clauses in your Will regarding funeral arrangements? If so, please describe below.

What type(s) of Income do you have? (salary, pensions, investments)

What type(s) of Expenses do you have each month?(rent, loans, bills)

Where do you normally conduct your banking?

What type(s) of accounts do you have at this bank?

Do you have a safety deposit box?

Yes

No

Do you own any assets outside of the province of BC?

Yes

No

Please tell me the type of assets & where they are located?

Do you suffer from any medical conditions which may affect your mental ability to think clearly or to make decisions?

Yes

No

(Alzheimer’s, depression, bi-polar disorder, dementia, head injury, drug or alcohol addiction)

Please provide details of your medical condition(s).

* Are you currently taking any drugs or medication which could affect your ability to think clearly or to make decisions?

Yes

No

Please provide details.

Please list any additional questions or concerns you would like me to be aware of while preparing your will.

Disclaimer: Please note that this website provides general legal information only and nothing within it should be considered to be legal advice. You should consult a lawyer to obtain legal advice about your particular legal matter. No solicitor/client relationship is created by using this site.