Client Intake Form - Wills New Client Form - Wills Title: * - Mr Mrs Miss Ms Dr Full Name: * Any aliases? If so, these will have to be included in your Will Date of Birth: Residential Address: * Postal Address: Mobile: * Work Phone: Home Phone: Fax: Email: * Occupation: How did you hear about us? Please tick more than one if applicable: * I was referred by someone I visited your website I received your newsletter I read one of your articles I received one of your brochures in the mail I purchased your book I purchased your eBook I live locally and noticed your signage Other Do you currently have a Will? If yes, your old Will will be revoked upon the signing of a new Will Yes No If yes, is the Will a Mutual Will? Yes No Spouse/Partner Full Name of Spouse/Partner: * Address of Spouse/Partner: Children (if any) from Current Spouse/Partner Child 1 - Name: Child 1 - Date of Birth: Child 1 - Age: Child 2 - Name: Child 2 - Date of Birth: Child 2 - Age: Child 3 - Name: Child 3 - Date of Birth: Child 3 - Age: Child 4 - Name: Child 4 - Date of Birth: Child 4 - Age: Children (if any) from Previous Spouse/Partner Child A - Name: Child A - Age: Child A - Is this child your dependent? Yes No Child A - Does this child have any special needs/other relevant details? Child A - Name of this child's other parent: Child B - Name: Child B - Age: Child B - Is this child your dependent? Yes No Child B - Does this child have any special needs/other relevant details? Child B - Name of this child's other parent: Child C - Name: Child C - Age: Child C - Is this child your dependent? Yes No Child C - Does this child have any special needs/other relevant details? Child C - Name of this child's other parent: Child D - Name: Child D - Age: Child D - Is this child your dependent? Yes No Child D - Does this child have any special needs/other relevant details? Child D - Name of this child's other parent: Step-Children (if any) Child i - Name: Child i - Date of Birth: Child i - Age: Child ii - Name: Child ii - Date of Birth: Child ii - Age: Child iii - Name: Child iii - Date of Birth: Child iii - Age: Child iv - Name: Child iv - Date of Birth: Child iv - Age: Executors Executor 1 - Name: Executor 1 - Address: Executor 1 - Phone Number: Executor 2 - Name: Executor 2 - Address: Executor 2 - Phone Number: Executor 3 - Name Executor 3 - Address: Executor 3 - Phone Number: How do you wish your executors to act? Executors can be joint or you can appoint one executor and a second executor in the event the first executor is unable or unwilling to act Jointly Successively Guardians Do you wish to appoint a guardian for your infant children? Yes No Guardian 1 - Name: Guardian 1 - Address: Guardian 1 - Phone Number: Guardian 2 - Name: Guardian 2 - Address: Guardian 2 - Phone Number: Funeral Arrangements Do you wish to insert a clause as to whether you wish to be buried or cremated? Yes No If so: Burial Cremation Specific details of where service is to be held? Thank you! Let us help you figure out your next move. Contact Us Now
