Please complete all sections of this form before returning it.  Part A deals with information we need in order to advise you fully.  Part B deals with your specific wishes and instructions.

Please fully complete all sections, ticking boxes to indicate "yes" and leave blank to indicate "no".  In this form “partner” refers to husband, wife or partner of either sex.
PART A
1. You and Your Family

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* Your details:

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* Are you:

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* Your partners details:

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* Is your partner:

2. Marriage, Civil Partnership Registration or Cohabitation

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* Place and date of marriage or Civil Partnership Registration

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* Have either of you been married or been a Registered Civil Partner before?

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* What year did you begin cohabitating?

3. Domicile

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* Have you ever lived outside England or Wales? If so, gives details below:

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* Details:

4. Children

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* Do you have any children? If yes, please give further details below. 

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* Child 1 Details:

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* Child 2 Details:

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* Child 3 Details:

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* Child 4 Details:

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* Please include details of any further children below:

5. Dependents

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* Is there anybody whom you are maintaining or have an obligation to maintain?

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* Please provide details:

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* Is there anyone who you think might make a claim on your estate, but whom you do want to benefit from your Will?

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* Please provide details:

6. Disabilities

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* Do any of your children or dependents have physical or learning disabilities?

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* Please provide details:

7. Will

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* Have you made a Will before?

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* If so, where is the original held?

8. Financial - Your Home

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* Is your home:

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* If so, give details below:

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* If your answer was 2., do you hold it as:

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* What is the approximate value of your home?

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* Where are the Title Deeds of your home?

9. Your Mortgage

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* Do you have a mortgage?

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* The name of your mortgage lender:

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* The amount of your mortgage:

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* Is it:

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* Is there insurance in place to repay the mortgage on your death?

10. Other Land and Buildings

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* Do you own any other land or buildings in the UK?

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* If so, give details below:

11. Foreign Assets

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* Do you own any land or buildings outside the UK?

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* If yes, give details below:

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* Do you own any other assets outside the UK?

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* If yes, give details below:

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* Do you have a Will outside the UK dealing with foreign assets? if so, please let us have a copy with a translation if possible.

12. Business

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* Do you have a business?

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* If yes, give the name and type of business:

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* Is it:

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* Please give details of your interest in the business:

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* Do you have shares in the company?

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* Please give further details of Capital £ and Partners or Directors Loan Account:

13. Savings, Investments and Other Assets

Please list below your main savings/investments, approximate values, and whether they are held in your name, your partners name, or jointly. Include life assurances payable on death. 

PLEASE NOTE: Jointly owned assets generally pass to the joint owner automatically and cannot be given away by Will. 

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* Do you have any savings or investments? If yes, please give details below:

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* Investment Details:

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* Investment Details:

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* Investment Details:

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* House contents, personal chattels, jewellery, cars etc.

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* House contents, personal chattels, jewellery, cars etc.

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* House contents, personal chattels, jewellery, cars etc.

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* Please provide details of any further savings and investments below. 

14. Pensions

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* Do you have a pension (other than State Pension)

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* If a lump sum is payable on death, do the benefits form part of your estate on your death?

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* Or are they nominated to a beneficiary / written in trust?

15. Lifetime Gifts

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* Have you made any gifts worth over £3,000 per annum in total, in any of the last 7 years?

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* Have you received any gifts worth over £3,000 per annum in total, in any of the last 7 years?

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* In either case, list below the date, name/relationship of the recipient or donor, type and value of gift. 

Gift 1

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* Gift 2

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* Gift 3

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* Gift 4

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* Please provide details of any further gifts below:

16. Trusts

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* Are you a beneficiary of any  trust?

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* Have you created any trusts (including life policies or investment bonds written in trust)?

17. Joint Assets

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* Do you own any assets jointly with anybody other than your partner?

18. Future Inheritance

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* Do you expect to inherit from parents, relatives or anybody else in the near future?

19. Promises

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* At any time have you promised anyone, or led them to believe, they will inherit anything on the event of your death?

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* If yes, please give details:

20. Additional Information

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* Please advise us of the practitioner and company name of the following (if applicable):

21. Enduring or Lasting Power of Attorney and Advanced Decision

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* Have you made an Enduring or Lasting Power of Attorney?

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* Have you made an Advance Decision (Living Will)?

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 50% of survey complete.

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