WILL QUESTIONNAIRE

SECTION 1 - CLIENT INFORMATION

Full Name:
Any other name by which you are known:
Current Address:
Telephone Number:
Mobile Number:
Email address:
Date of Birth:
Employment Details:
National Insurance Number:
Relationship Status:
Partners Name:
Date of Birth:
Contact Details:
Employment Details:
National Insurance Number:
SECTION 2 – FAMILY DETAILS
Number of Children:
1. Name
Date of Birth
Address
Financial Status (dependant)
2. Name
Date of Birth
Address
Financial Status (dependant)
3. Name
Date of Birth
Address
Financial Status (dependant)
4. Name
Date of Birth
Address
Financial Status (dependant)

Parents: (leave blank if your parents are deceased)
Names
Date of Birth
Address
Financial Status (dependant)

Next of Kin: - Provide details of your nearest living relatives if you have no living spouse, children or parents

Other Dependants/Parties you wish to benefit:

Name
Date of Birth
Address
Relationship with client
Financial Situation

SECTION 3 - ASSETS

1. Property - Your Home

Address
Estimated Value
Amount left on Mortgage
Is the Property jointly held with your spouse?
If so how is it held? - Tenants in common/Joint Tenants/Don't know

2. Additional Properties/Land

Address
Estimated value

3. Chattels - Estimated value
4. Cash - including Bank and Building Society accounts, National Savings - estimated value
5. Shares & Investments - estimated value
6. Insurance Policies - estimated value
7. Other Assets
8. Liabilities
9. Likely Changes e.g. Potential Inheritance - please provide brief details
10. Details of Gifts - please detail any substancial gifts (i.e. over £3000) that you have made in the last 7 years
SECTION 4
1. Any Funeral Directions you wish to include
2. Appointment of Executors - You may name a family member, friend or a professional executor, eg the Partners of Greens. Professional Executors charge for their services.  
(a) Name
Address
Occupation
Contact Number
(b) Name
Address
Occupation
Contact Number
(c) Name
Address
Occupation
Contact Number
SECTION 5
Legacies of money or assets
SECTION 6
Residuary Estate - who would you like to share in the residue?
SECTION 7
Would you like to consider  
a) making a Living Will to give directions to assist your relatives and doctors make decisions about your medical treatment if you are unable to make those decisions yourself
b) making a Lasting Power of Attorney in relation to your Property and Affairs giving someone else authority to manage them in case you become incapable in the future.
c) making a Lasting Power of Attorney in relation to your Health and Welfare giving someone else authority to make those decisions for you.

Thank you for completing the Questionnaire
Please Click Submit and we will respond as soon as possible.

If you have any difficulties filling out the Questionnaire or have any queries at all, then please telephone us on: 01584 87 3918.