Get Started!
1
1) Full name (rst, middle, last):
All other names by which you have been known:
Membership Number:
Age: Date of Birth (DOB): Sex: Male
Female
Are you a US citizen?* Y N If no, country of citizenship:
2) Current residence
Street address:
City:
County or Parish: ST: ZIP:
Home Phone: Work Phone:
3) If you are married, your spouse’s full name (rst, middle, last, maiden):
DOB: Date of marriage:
Place of marriage:
Are you currently living with your present spouse? Y N
4) Do you and your spouse have a Prenuptial Agreement which identies and disposes
of separate spousal property?
Y N N/A
If yes, attach copy with any ling data.
* Non-citizen estate taxation varies from taxation for US citizens.
estate
Everything that you own at your
passing after payment of debts
and taxes. You will make decisions
regarding the percentage share
of your estate that you wish to
give to your beneficiaries. And if
you wish, you may leave specific
items of property (car, investments,
heirlooms, etc.) or sums of money to
your beneficiaries.
will
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
The wonderful feeling you get as a
LegalShield member after having
your Will prepared by a qualified
law firm at a reasonable price.
What You’ll Need to Complete This Questionnaire:
• Copy of your Prenuptial Agreement (if applicable).
• Names and birth dates 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 their estate, and your personal
representative/executor.
• To best serve you in completing your Will for estate tax purposes, you’ll be
asked to provide the approximate dollar amount of such items as: your home,
other real estate, bank accounts, vehicles, retirement plans, life insurance
policies, and debts such as mortgages, loans, medical or others over $5,000.
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.
• 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 lling 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 rm, call Member Services at 1-800-654-7757
(7 a.m. - 7 p.m., Monday-Friday, Central Time).
p 1 of 6 • Will Questionnaire
Please print
MEMBER AND SPOUSE FILLING
OUT A SEPARATE FORM
In order to meet each person’s
unique needs, you must each ll
out a Will Questionnaire.
For Your
Information
2 3 4 5 6