Estate Planning Client Data | Abraham Mazloumi & Associates

Client

Client Marital Status

Client First Name

Client Last Name

Client Address Line

Client City

Client State/Province

Client Post Code

Client Phone Number

Client Email Address

Spouse (if applicable)

Spouse First Name

If applicable

Spouse Last Name

If applicable

Spouse Phone Number

Spouse Email Address

Please note: you need to enter a person’s complete contact details only once. If you want to assign the same individual to multiple “estate roles,” you only need to enter his/her name in the subsequent sections.

Children (if applicable)

First Child

First Name - 1st Child

1st Born Child

Last Name - 1st Child

Address - 1st Child

City - 1st Child

State/Province - 1st Child

Post Code - 1st Child

Phone Number - 1st Child

Email Address - 1st Child

Second Child

First Name - 2nd Child

2nd Born Child (if applicable)

Last Name - 2nd Child

Address Line - 2nd Child

City - 2nd Child

State/Province - 2nd Child

Post Code - 2nd Child

Phone Number - 2nd Child

Email Address - 2nd Child

Third Child

First Name - 3rd Child

3rd Born Child (if applicable)

Last Name - 3rd Child

Address Line - 3rd Child

City - 3rd Child

State/Province - 3rd Child

Post Code - 3rd Child

Phone Number - 3rd Child

Email Address- 3rd Child

Fourth Child

First Name - 4th Child

4th Born Child (if applicable)

Last Name - 4th Child

Address Line - 4th Child

City - 4th Child

State/Province - 4th Child

Post Code - 4th Child

Phone Number - 4th Child

Email Address - 4th Child

Primary Health Care Proxy (HCP)

Primary HCP

First Name - Primary HCP

Primary Health Care Proxy (HCP)

Last Name - Primary HCP

Address Line - Primary HCP

City - Primary HCP

State/Province - Primary HCP

Post Code - Primary HCP

Phone Number - Primary HCP

Secondary HCP

First Name - Secondary HCP

Secondary Health Care Proxy (HCP)

Last Name - Secondary HCP

Address Line - Secondary HCP

City - Secondary HCP

State/Province - Secondary HCP

Post Code - Secondary HCP

Phone Number - Secondary HCP

Tertiary HCP

First Name - Tertiary HCP

Tertiary Health Care Proxy (HCP)

Last Name - Tertiary HCP

Address Line - Tertiary HCP

City - Tertiary HCP

State/Province - Tertiary HCP

Post Code - Tertiary HCP

Phone Number - Tertiary HCP

If you would like to list additional proxies, please enter their information below:

Power of Attorney - Primary Agents

Primary Agent 1

First Name - Primary Agent #1

Power of Attorney (POA)

Last Name - Primary Agent #1

Address Line - Primary Agent #1

City - Primary Agent #1

State/Province - Primary Agent #1

Post Code - Primary Agent #1

Phone Number - Primary Agent #1

Email Address - Primary Agent #1

Primary Agent 2

First Name - Primary Agent #2

Power of Attorney (POA)

Last Name - Primary Agent #2

Address Line - Primary Agent #2

City - Primary Agent #2

State/Province - Primary Agent #2

Post Code - Primary Agent #2

Phone Number - Primary Agent #2

Email Address - Primary Agent #2

If you would like to list additional Primary Agents, please enter their information below:

Power of Attorney - Successor Agents

Successor Agent 1

First Name - Successor Agent #1

Power of Attorney Successor Agent (POAS)

Last Name - Successor Agent #1

Address Line - Successor Agent #1

City - Successor Agent #1

State/Province - Successor Agent #1

Post Code - Successor Agent #1

Phone Number - Successor Agent #1

Email Address - Successor Agent #1

Successor Agent 2

First Name - Successor Agent #2

Power of Attorney Successor Agent (POAS)

Last Name - Successor Agent #2

Address Line - Successor Agent #2

City - Successor Agent #2

State/Province - Successor Agent #2

Post Code - Successor Agent #2

Phone Number - Successor Agent #2

Email Address - Successor Agent #2

If you would like to list additional Successor Agents, please enter their information below:

Executors

Executor

First Name - Executor

Executor of the Will

Last Name - Executor

Address Line - Executor

City - Executor

State/Province - Executor

Post Code - Executor

Co-Executor (optional)

First Name - Co-Executor

Co-Executor of the Will | You can appoint co-executors if you'd like 2+ persons to act together

Last Name - Co-Executor

Address Line - Co-Executor

City - Co-Executor

State/Province - Co-Executor

Post Code - Co-Executor

If you would like to list additional Co-Executors, please enter their information below:

Successor Executor

First Name - Successor Executor

Successor Executor (ES)

Last Name - Successor Executor

Address Line - Successor Executor

City - Successor Executor

State/Province - Successor Executor

Post Code - Successor Executor

Successor Co-Executor

First Name - Successor Co-Executor

Successor Co-Executor (ES) | You can appoint successor co-executors if you'd like 2+ persons to act together

Last Name - Successor Co-Executor

Address Line - Successor Co-Executor

City - Successor Co-Executors

State/Province - Successor Co-Executors

Post Code - Successor Co-Executors

If you would like to list additional Successor Co-Executors, please enter their information below:

Trustee

First Name - Trustee

Trustee

Last Name - Trustee

Address Line - Trustee

City - Trustee

State/Province - Trustee

Post Code - Trustee

Co-Trustee

First Name - Primary Co-Trustee #2

Primary Co-Trustee #2 | You can appoint co-trustees if you'd like 2+ persons to act together

Last Name - Primary Co-Trustee #2

Address Line - Primary Co-Trustee #2

City - Primary Co-Trustee #2

State/Province - Primary Co-Trustee #2

Post Code - Primary Co-Trustee #2

If you would like to list additional Primary Co-Trustees, please enter their information below:

Successor Trustee

First Name - Successor Trustee

Successor Trustee (ST)

Last Name - Successor Trustee

Address Line - Successor Trustee

City - Successor Trustee

State/Province - Successor Trustee

Post Code - Successor Trustee

Successor Co-Trustee

First Name - Successor Co-Trustee #2

Successor Co-Trustee (ST) | You can appoint successor co-trustees if you'd like 2+ persons to act together

Last Name - Successor Co-Trustee #2

Address Line - Successor Co-Trustee #2

City - Successor Co-Trustee #2

State/Province - Successor Co-Trustee #2

Post Code - Successor Co-Trustee #2

If you would like to list additional Successor Co-Trustees, please enter their information below:

Standby Guardians

Primary Standby Guardian

First Name - SG

Standby Guardian (SG)

Last Name - SG

Address Line - SG

City - SG

State/Province - SG

Post Code - SG

2nd Standby Guardian

First Name - 2nd SG

Second Standby Guardian (SG)

Last Name - 2nd SG

Address Line - 2nd SG

City - 2nd SG

State/Province - 2nd SG

Post Code - 2nd SG

If you would like to list additional Standby Guardians, please enter their information below:

Additional Comments and/or Instructions