Patricia Wright & Associates

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Marital Status

Single Couple

Power of Attorney Required?

Yes No

Full Name
AKA

Birth Date

Occupation

Place of Birth

Name of Spouse

Occupation	Date of Marriage
Spouse DOB	Place of Birth

Address

Phone No. (Home)

Work Phone

Marital particulars (previous marriages or common law relationships, separation agreements)

Advice given (wills variation, estate administration, disinheriting spouse or child, gift declarations, joint tenancies, etc.)

Name(s) of children from this marriage
Child 1 Name	DOB
Child 2 Name	DOB
Child 3 Name	DOB

Name(s) of children from previous marriages
Husband (name)	Wife (name)

Child 1 Name	DOB
Child 2 Name	DOB
Child 3 Name	DOB

Predeceased Children
Child 1 Name	DOB
Child 2 Name	DOB


Executor Name	Relationship
Alternate Executor	Relationship

General Distribution of Estate

Specific bequests of chattels/cash bequests to charities, relatives, and friends.

Division of Estate
To each other	Yes No
Alternate, equally to children	Yes No
Gift over to children of children	Yes No

Alternate distribution if spouse and children predecease you or no spouse/children

% to his family as follows

% to her family as follows

Guardian Information

Primary Guardian
Alternate Guardian
Relationships

Funeral Arrangements

Spouse 1 Arrangements

Spouse 2 Arrangements

General Information Regarding Estate

Do you own a company?	Yes No
Is it incorporated?	Yes No

Please describe any real estate you own. For example, principal residence, recreational properties, or investment properties.

Do you own any property outside British Columbia? Outside of Canada? If yes, please describe below.

Please outline any bank accounts or holdings.

Please outline any insurance policies.

Please outline any RRSPs, mutual funds, or investment portfolios.

Please outline any money currently owed to you.

Liabilities

Mortgages

Other

Approximate Net Worth

Do you have any safety deposit boxes?

Yes No

Please describe its location and relevant contents.

General Remarks

Representation Agreement

Power of Attorney

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