Last Will and testament & power of attorney

Please fill out any information that applies to you as best as you can. 

• Your Information

• Full Name *
  First Name Middle Name Last Name
• Surname at birth and/or any previous name(s)
• Date of Birth
  - Month - Day Year
• Address

  Street Address
  Street Address
  City	Province / State
  Zip Code	Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia South Sudan Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands Isle of Man US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country

• Phone (Home)
  - Area Code Phone Number
• Phone (Work)
  - Area Code Phone Number
• Phone (Cell)
  - Area Code Phone Number
• E-mail *
• How would you like to receive correspondences from our office?
  by e-mail by mail by fax
• Are there any restrictions on how we contact you (please specify)
• How did you hear about us?
  Website FaceBook Newspaper Yellowpages LindkedIn Internet Article On Site Signage Event Google/Search Engine Family/Friend Professional Referral
  
• Name of person who referred you?
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• Will and Power of Attorney

• It is very important for you to have a valid Will and Power of Attorney. Would you like to be contacted to discuss a new Will and Power of Attorney? If yes, a member of our firm will contact you. *
  Yes, please contact me. No, I am not interested.
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• Your Partner/Spouse

• Full Name *
  First Name Middle Name Last Name
• Surname at birth and/or any previous name(s)
• Date of Birth *
  - Month - Day Year
• Address

  Street Address
  Street Address Line 2
  City	State / Province
  Postal / Zip Code	Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia South Sudan Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Transnistria Pridnestrovie Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands Isle of Man US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country

• Phone
  - Area Code Phone Number
• E-mail
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• Relationship Information

• Date you started dating
  - Month - Day Year
• Date you started living together
  - Month - Day Year
• Do you anticipate that you will be married in the future?
  Yes No
• Date of upcoming marriage (if known)
  - Month - Day Year
• Your current marital status
  Single Separated Divorced Common-law Widow(er)
• Name(s) of previous spouse(s)
• Partner/Spouse's current marital status
  Single Separated Divorced Common-law Widow(er)
• Name(s) of previous spouse(s)
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• Children

• Child(ren) you and your partner/spouse have together

  	Full Name	Age	Date of Birth (mm/dd/yy)	School & Grade/Year

• Children you have with someone else

  	Full Name	Age	Date of Birth (mm/dd/yy)	School & Grade/Year

• Name(s) of other parent(s)
• Children your partner/spouse has with someone else

  	Full Name	Age	Date of Birth (mm/dd/yy)	School & Grade/Year

• Name(s) of other parent(s)
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• Employment

• A. You

• Employer
• Position/Title
• Years with current employer
• Annual Salary
• Is there a pension?
  Yes No
• What is your educational background?
• Graduated high school when?
• Graduated college when?
• What degree?
• Graduated university when?
• What degree?

• B. Partner/Spouse

• Employer
• Position/Title
• Years with current employer
• Annual Salary
• Is there a pension?
  Yes No Unsure
• What is their educational background
• Graduated high school when?
• Graduated college when?
• What degree?
• Graduated university when?
• What degree?
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• Life Insurance

• Do you have a life insurance policy?
  Yes No
• What is the amount of coverage?
• Does your partner/spouse have a life insurance policy?
  Yes No Unsure
• What is the amount of coverage?
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• YOU - Property Owned and Debts Accumulated Prior to Cohabitation

  Property owned and debts accumulated by you prior to cohabitation
• Property

  	Location	Use (ex. cottage, Vacant land, etc.)	Estimated Value ($)	Debt ($)

• Vehicles

  	Year/Make/Model	Name(s) registered in	Estimated Value ($)	Debt ($)

• Investments (i.e. RRSPs, stocks, bonds, life insurance with cash value, pensions (except CPP, etc.))

  	Type (i.e. RRSP)	In whose name	Value ($)

• Debts, Loans, Credit Cards & Credit Lines

  	Bank or Credit Type (ex. VISA, line of credit)	Balance ($)	In whose name?	Loan used for?

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• PARTNER/SPOUSE - Property Owned and Debts Accumulated Prior to Cohabitation

  Property owned and debts accumulated by your partner/spouse prior to cohabitation
• Property

  	Location	Use (ex. cottage, Vacant land, etc.)	Estimated Value ($)	Debt ($)

• Vehicles

  	Year/Make/Model	Name(s) registered in	Estimated Value ($)	Debt ($)

• Investments (i.e. RRSPs, stocks, bonds, life insurance with cash value, pensions (except CPP, etc.))

  	Type (i.e. RRSP)	In whose name	Value ($)

• Debts, Loans, Credit Cards & Credit Lines

  	Bank or Credit Type (ex. VISA, line of credit)	Balance ($)	In whose name?	Loan used for?

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• BOTH - Property Acquired and Debts Accumulated After Cohabitation

  Property owned and debts accumulated by you and your partner/spouse since cohabitation
• Property

  	Location	Use (ex. cottage, Vacant land, etc.)	Estimated Value ($)	Debt ($)

• Vehicles

  	Year/Make/Model	Name(s) registered in	Estimated Value ($)	Debt ($)

• Investments (i.e. RRSPs, stocks, bonds, life insurance with cash value, pensions (except CPP, etc.))

  	Type (i.e. RRSP)	In whose name	Value ($)

• Debts, Loans, Credit Cards & Credit Lines

  	Bank or Credit Type (ex. VISA, line of credit)	Balance ($)	In whose name?	Loan used for?

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• Your Issues

• Please indicate any questions for which you are seeking legal advice, as well as if you perceive it to be low or high conflict.
• Submit
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