Questionnaire

BACKGROUND INFORMATION OF TESTATOR/TESTATRIX

1. Name on birth certificate:

2. Name on S.I.N. Card:

3. Commonly known as:

4. Residential Address:

5. Phone Number Home:

Office:

FAX:

E-Mail:

6. Date of Birth:

7. Marital Status: (Circle one only)

Single, Married, Common Law, Separated, Divorced, Widow(er)

8. RELATIVES OF TESTATOR/TESTATRIX

1. Name of Spouse (include maiden name if applicable)

2. Name and age of children (include maiden name if applicable)

3. Name of parents, if living (maiden name of mother)

Father

Mother

4. Name and age of brothers and sisters (include maiden name, if applicable)

C. Name of Executors

D. Beneficiaries
Per stirpes (per branch): means assets are transferred to children and/or grandchildren beneficiaries, if one of these beneficiaries dies before the testator/testatrix.

Per capita (per head): means that only surviving beneficiaries get to share in the proceeds of the estate.

1. Who inherits bulk of assets (please circle only one)
Spouse Children Grand children Parents Siblings

2. Additional beneficiaries in the event of common disaster to both the testator/testatrix and first beneficiaries (this item can be discussed further)

a) Children
b) Some of the children
c) Parents
d) Siblings
e) Combinations of parents and children

3. Additional beneficiaries in the event of common disaster to both spouses and all their children (this also can be discussed)

a) 50% to the siblings of the testator/testatrix and 50% to those of his/her spouse
b) Equal shares to the siblings of the testator/testatrix and to those of his/her spouse
c) Includes the parents in scenario A or B
d) Excludes the parents in scenario A or B
e) Share of parents if scenario C is chosen (eg. 50% of 50% to parents of testator/testatrix and same for parents of his/her spouse)
f) Per stirpes
g) Per capita

E. NAMES OF GUARDIANS FOR CHILDREN

F. LIST OF FUNERAL INSTRUCTIONS (circle the ones that suit you)

a) I wish to donate any organ or tissue for transplant purposes;

aa) I wish to donate my remains for medical research purposes to the university chosen by my Executor;
__________________________________________________________________________

b) I ask that my remains be exposed for a short period of time;

bb) I ask that there be no wake for my body for any period of time;
__________________________________________________________________________

c) I ask that my remains be buried in the same cemetery plot as my spouse, if applicable;

cc) I ask that my remains be cremated and that my ashes be buried in the same cemetery plot as my spouse, if applicable;

ccc) I ask that my remains be cremated and that my ashes be deposited in an urn, which will be exposed in a niche in a crematorium, if applicable;

cccc) I leave the choice of burying or cremating my remains, along with the disposal of my ashes, if applicable, to the Executor
__________________________________________________________________________

d) I ask that a funeral service be held in a Catholic church or chapel, in the presence of my remains;

dd) I ask that a funeral service be held, without the presence of my remains or ashes, if applicable, in a Catholic church or chapel;

ddd) I ask that there be a commemorative mass during the month following my death, in a Catholic church or chapel;

dddd) I ask that there be a gathering with a buffet immediately after my funeral or commemorative mass for my family and friends;
__________________________________________________________________________

e) I ask that my Executor follow the funeral arrangements I will have made prior to my death, if applicable;

f) I ask that my funeral expense be modest.
__________________________________________________________________________

G. POWERS OF ATTORNEY (FOR PROPERTY AND FOR PERSONAL CARE)

1. Primary attorney

2. Secondary attorney(s) (specify if conditions)

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