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ED MADRO B.A. Econ., CPCA
          Consultant
          edward.madro@investorsgroup.com
          (403) 220-9654




1-866-424-6392




                                                   Head Office:                                        Québec Office:
                                                   447 Portage Avenue
                                                   Winnipeg, Manitoba R3C 3B6
                                                                                                       2001 University Street
                                                                                                       Suite 2000
                                                                                                                                                                                                                    Legacy Planning
         Investors Group Financial Services Inc.                                                       Montréal, Québec H3A 2A6


                                                   For information, call toll-free 1 888 746-6344, or fax (204) 956-7688.
                                                                                                                                                                                      Your Name                     3 Your Personal Records Organizer
                                                   In Quebec, 1 800 661-4578, or fax (514) 843-5205.

                                                   www.investorsgroup.com



                                                                                                                                                                                      Date Completed/Last Updated
                                                   Written and published by Investors Group as a general source of information only. It is not intended as a solicitation to buy or
                                                   sell specific investments, nor is it intended to provide tax, legal or investment advice. Readers should seek advice on their
                                                   specific circumstances from an Investors Group Consultant.

                                                   ™ Trademark owned by IGM Financial Inc. and licensed to its subsidiary corporations.                                                                                                    Investors Group Financial Services Inc.
                                                   “Legacy Planning - Your Personal Records Organizer” © Investors Group Inc. 2011 MP1157 (11/2011)
Personal Records
                                                  MY NET WORTH STATEMENT
                           Assets              (What you own)                                 Current amount
                           Liquid assets       Cash on hand                                   $ _______________________________
                                               Chequing/savings/broker accounts               $ _______________________________
                                               Canada Savings Bonds                           $ _______________________________
                                               Term deposits/investment certificates          $ _______________________________
                                               Other                                          $ _______________________________
                           Marketable assets   Government/corporate bonds                     $ _______________________________
                                               Common shares                                  $ _______________________________
                                               Preferred shares                               $ _______________________________
                                               Mutual funds                                   $ _______________________________
                                               Real estate investments                        $ _______________________________
                                               Other (business interest, farm, etc.)          $ _______________________________
                                                                                              $ _______________________________
                                                                                              $ _______________________________
                                                                                              $ _______________________________
                                                                                              $ _______________________________
This booklet is            Long-term assets    Cash value of life insurance (also
                                               indicate amounts to be received as death
designed to help you                           benefit by your estate upon your death)        $ _______________________________
organize, in one handy                         Registered Retirement Savings/Income Plans     $ _______________________________
                                               Other (pensions/profit sharing plans, etc.)    $ _______________________________
location, important
                           Personal assets     Personal residence                             $ _______________________________
information about your                         Recreation property                            $ _______________________________
personal and financial                         Vehicles                                       $ _______________________________
                                               Household furnishings/equipment                $ _______________________________
affairs. You’ll find it                        Other (art, coins, jewelry, etc.)              $ _______________________________
provides a convenient                          Total assets                                   $
record and will be easy    Liabilities         (What you owe)                                 Current amount
to update. As well, it
                           Short-term debt     Charge accounts/credit cards                   $ _______________________________
will help your survivors                       Loans/Lines of credit                          $ _______________________________
wind up your personal                                                                         $ _______________________________
                                               Taxes (income/property tax owing)              $ _______________________________
affairs after your
                                               Other (life insurance loans, etc.)             $ _______________________________
death. Keep this                               Unpaid bills                                   $ _______________________________
record in a safe place     Long-term debt      Home mortgage                                  $ _______________________________
                                               Other property mortgage                        $ _______________________________
along with your other                          Other (line of credit, margin account, etc.)   $ _______________________________
important papers.                              Total liabilities                              $
Let your family know                           NET WORTH:
where it’s kept.                               Total assets minus total liabilities           $




                                                                                                                                  15
Loan Agreements or promissory notes are located:
     Debtors and Creditors                                                                    People To Be Contacted
     People who owe you money
                                                                                              Next of kin
     Name:
                                                                                              Name:                    Name:
     Amount:                 Date:
                                                                                              Relationship to you:     Relationship to you:
     Demand/Maturity date:            Trust Funds                                             Telephone:               Telephone:
     Address:                         Are you a beneficiary of any trusts?                    Address:                 Address:
                                      ❑ Yes        ❑ No
                                      Purpose:
     Name:                                                                                    Name:                    Name:
                                      Trustees are:
     Amount:                 Date:                                                            Relationship to you:     Relationship to you:
                                      Trust papers are located:                               Telephone:
     Demand/Maturity date:                                                                                             Telephone:
                                                                                              Address:                 Address:
     Address:
                                      Amount $:



                                      Are you a trustee of any trusts?
     People to whom you owe money
     (other than previously listed)   ❑ Yes        ❑ No
     Name:                            Purpose:

     Amount:                 Date:    Trust papers are located:

     Demand/Maturity date:

     Address:

                                      Income Tax
                                      Your tax advisor is:
     Name:
                                      Telephone:
     Amount:                 Date:
                                      Address:
     Demand/Maturity date:

     Address:
                                      Your tax records and supporting data are located:




14                                                                                        4                                                   3
Banking Institution:
    Other People To Be Contacted                                               Residence & Real Estate                               Building cost figures (December 31, 1971 value
                                          Telephone:
    Executor or Liquidator (in Quebec):                                                                                              plus capital improvements to date):
                                          Address:                               Type of        Title is      Is there a Mortgage
                                                                               real estate      held by       mortgage? is held by
    Telephone:                                                                  (e.g. house,   (circle one)   (circle one)           Mortgage insurance policy:
                                                                                condo, etc.)
    Address:
                                          Banking Institution:
                                                                                                  you            yes
                                          Telephone:                                            spouse            no
                                          Address:                                                joint
    Employer/Business Office:                                                                                                        Personal Property
                                                                                                  you            yes
                                                                                                                                     List all vehicles you own:
                                                                                                spouse            no
    Telephone:
                                          Investors Group Consultant:                             joint
    Address:
                                                                                                  you            yes
                                          Telephone:                                            spouse            no                 Vehicle registrations are located:

                                          Address:                                                joint
    Lawyer:
                                                                                                  you            yes                 Bill of sale and insurance papers are located:
    Telephone:
                                                                                                spouse            no
    Address:
                                          Person(s) to whom you have granted                      joint
                                          power of attorney:
                                                                                                                                     Are household furnishings insured?
                                                                               Where are the following located?
    Notary (for Quebec residents):
                                          Telephone:                                                                                 ❑ Yes      ❑ No
                                                                               Certificates of title:
                                          Address:                                                                                   Bills of sale, an inventory of and insurance
    Telephone:                                                                                                                       policies for household furnishings are located:
                                                                               Copy of mortgages:
    Address:
                                          Others
                                          Name:                                Property insurance policies:                          Jewelry, stamp collections, coin collections,
    Accountant:                                                                                                                      appraisal documents, etc. are located:
                                          Telephone:
    Telephone:                                                                 Land surveys:
                                          Address:
    Address:                                                                                                                         Collections/heirlooms/items of special value:

                                                                               Property tax receipts:
                                          Name:
                                          Telephone:
                                                                               Leases:
                                          Address:




4                                                                                                                                                                                      13
Bank Accounts                                Safety Deposit Box                       Living Will                                 Have you informed your

     Be sure to list all your bank accounts, so   Do you have a safety deposit box?        Do you have a “Living Will”                 ❑   Doctor
     your Executor, Liquidator or family can
                                                  ❑ Yes       ❑ No                         (if allowed in your province)?              ❑   Next of kin
     find the money you have in these
                                                  Location:
                                                                                           ❑ Yes ❑ No                                  ❑   Living Will representative
     accounts.
                                                                                           If so, where is your Living Will kept?      ❑   Mandatary or representative
                                                                                                                                           (for residents of Quebec)
                                                  Names of others who have access to it:
     Banking Institution                                                                                                               Funeral Arrangements
     Branch:                                                                               For Quebec residents: Do you have a         Have you made funeral arrangements?
     Account #:                                                                            “Mandate in Anticipation of Incapacity”
                                                  Location of the keys:                                                                ❑ Yes ❑ No
     ❑ Savings       ❑ Chequing      ❑ Joint                                               ❑ Yes ❑ No
                                                                                                                                       Funeral home & address:
     If joint, who is joint owner?                                                         If so, where is such a document kept?
                                                  List of contents is located:


                                                                                                                                       Telephone:
     Branch:                                                                               To whom have you given authority to
                                                  Location:                                make medical decisions on your behalf?      Have you set out instructions in your
     Account #:                                                                                                                        Will?
     ❑ Savings       ❑ Chequing      ❑ Joint                                                                                           ❑ Yes ❑ No
                                                  Names of others who have access to it:
     If joint, who is joint owner?                                                                                                     In a letter?
                                                                                           Organ Donation                              ❑ Yes ❑ No
                                                                                           Do you want to donate your organs or        They are located:
                                                  Location of the keys:
     Branch:
                                                                                           body for transplant, medical research
                                                                                           or education?
     Account #:
                                                  List of contents is located:             ❑ Yes ❑ No
     ❑ Savings       ❑ Chequing      ❑ Joint                                                                                           Do you own a cemetery plot?
                                                                                           If yes, explain:
     If joint, who is joint owner?                                                                                                     ❑ Yes ❑ No
                                                                                                                                       Have you provided for its ongoing care?

                                                                                           Have you explained this in your             ❑ Yes ❑ No
                                                                                           ❑ Will and/or Living Will                   The plot is located:

                                                                                           ❑ Organ donor card
                                                                                           ❑ Driver’s license/Provincial Health Card
                                                                                                                                       The deed to it is kept:




12                                                                                                                                                                               5
Your Will                                                      Pension Plans                         Are you a subscriber to a Registered
                                                                                                         Education Savings Plan (RESP)?
    Do you have a Will?             ❑ Yes    ❑ No                  Are you a member of a
                                                                   Registered Pension Plan?              ❑ Yes        ❑ No
    The original is located:

    A copy is located:
                                                                   ❑ Yes        ❑ No                     Account #:

                                                                   Account #:                            Carrier name & address:
    The Will was dated/last updated:
                                                                   Carrier name & address:
                                                                                                         Beneficiary:

    Personal Records                                               Beneficiary:
    Date of Birth:                                                                                       Do you have a Registered Retirement
    Place of Birth:                                                Account #:                            Income Fund (RRIF)?

    Birth certificate is located:                                  Carrier name & address:               ❑ Yes        ❑ No
                                                                                                         Account #:
    Social Insurance/Social Security Number:
                                                                   Beneficiary:                          Carrier name & address:

    Citizenship Papers
                                                                                                         Beneficiary:
    Passport          ❑ Yes     ❑ No                               Do you have a Registered Retirement
                                                                   Savings Plan (RRSP)?
    They are located:
                                                                   ❑ Yes        ❑ No                     Are you a member of a Deferred Profit
    Marriage / Divorce Certificates
                                                                   Account #:                            Sharing Plan (DPSP)?
    Marriage certificate            ❑ Yes   ❑ No                                                         ❑ Yes        ❑ No
                                                                   Carrier name & address:
    Divorce certificate         ❑ Yes       ❑ No                                                         Account #:
    Located:                                                                                             Carrier name & address:
                                                                   Beneficiary:



                                                                   Account #:                            Beneficiary:
    Current Military Service                       ❑ Yes    ❑ No   Carrier name & address:               Information about this plan is located:
    Discharge Papers are located:

    Country of enlistment:
                                                                   Beneficiary:
    Veteran’s Number:

    Do you leave a military pension?          ❑ Yes        ❑ No




6                                                                                                                                                  11
Policy Number:
     Investments                                                                         Previous Employers                            Memberships
                                         Carrier name & address:
     Investment Funds                                                                    Start with the first and put the current or   List all memberships in clubs,
                                                                                         most recent employer last                     associations, subscriptions
     ❑ Yes ❑ No
     ❑ Acquired by gift or inheritance
     Name of fund:                       Do you receive income from them?                Employer:                                     Name:
     Account #:                          ❑ Yes      ❑ No                                 Year:                                         Address:
     Advisor’s name & address:           Information about these annuities is located:   Address/Location:


     Registered owner(s):                                                                                                              Name:
                                         Bonds & Government investments                  Employer:                                     Address:
     Name of fund:                       ❑ Yes ❑ No                                      Year:
                                         ❑ Acquired by gift or inheritance
     Account #:                                                                          Address/Location:
                                         The form is:
     Advisor’s name & address:                                                                                                         Name:
                                         Registered to:
                                                                                                                                       Address:
                                         Bearer:
     Registered owner(s):                                                                Employer:
                                         or co-registered with:
                                                                                         Year:
                                         Serial numbers:
     Name of fund:                                                                       Address/Location:                             Name:
                                         The bonds are located:
     Account #:                                                                                                                        Address:
     Advisor’s name & address:
                                         Securities
                                         Do you own any stocks or bonds?                 Employer:
     Registered owner(s):
                                         ❑ Yes ❑ No                                      Year:                                         Domestic Contracts
                                         ❑ Acquired by gift or inheritance               Address/Location:                             Do you have a:
     Annuity Contracts                   Information about them is located:                                                            Co-habitation agreement? ❑ Yes❑ No
     ❑ Yes ❑ No                                                                                                                        Pre-nupital agreement? ❑ Yes ❑ No
     ❑ Acquired by gift or inheritance   Are any of your securities pledged for                                                        Marriage Contract? ❑ Yes ❑ No
     Policy Number:                      loans?
                                                                                                                                       Separation Agreement? ❑ Yes ❑ No
     Carrier name & address:             ❑ Yes      ❑ No
                                                                                                                                       Divorce Order? ❑ Yes ❑ No
                                         With whom:
                                                                                                                                       The original is located:




10                                                                                                                                                                          7
Financial Commitments                      Charitable Gift                    Life Insurance                      Disability Insurance

    Rent or Mortgage Payments                  For:                               Policies you own on your life:      Company:

    Amount $                                   Address:                           Company:                            Policy Number:

    Due Date:                                                                     Policy Number:                      Policy is located:

    Lender/Address:                                                               Policy is located:
                                               For:                               Beneficiary:                        Company:

                                               Address:                                                               Policy Number:

                                                                                                                      Policy is located:
    Outstanding loans/lines of credit/credit                                      Company:
    or charge cards/business                                                      Policy Number:
    loans/guarantees
                                               Contractual Obligations            Policy is located:                  Company:
    Amount $
                                               For:                               Beneficiary:                        Policy Number:
    Due Date:
                                               Located:                                                               Policy is located:
    Lender/Address:
                                                                                  Policies you own on others:
                                               For:                               Company:                            Hospital & Medical Insurance
                                               Located:                           Policy Number:                      Company:
    Amount $
                                                                                  Policy is located:                  Policy Number:
    Due Date:
                                               For:                               Name of Insured:                    Policy is located:
    Lender/Address:
                                               Located:

                                                                                  Company:                            Company:

                                               For:                               Policy Number:                      Policy Number:
    Amount $
                                               Located:                           Policy is located:                  Policy is located:
    Due Date:
                                                                                  Name of Insured:
    Lender/Address:
                                               Other financial obligations                                            Out of Province Travel Insurance
                                               or commitments (auto lease,
                                                                                  Policies others own on your life:   Company:
                                               support/maintenance obligations)
                                                                                  Company:                            Policy Number:
    Amount $                                   For:
                                                                                  Policy Number:                      Policy is located:
    Due Date:                                  Located:
                                                                                  Policy is located:
    Lender/Address:
                                               For:                               Owner of Policy:

                                               Located:




8                                                                                                                                                        9

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Legacy planning - just in case!

  • 1. ED MADRO B.A. Econ., CPCA Consultant edward.madro@investorsgroup.com (403) 220-9654 1-866-424-6392 Head Office: Québec Office: 447 Portage Avenue Winnipeg, Manitoba R3C 3B6 2001 University Street Suite 2000 Legacy Planning Investors Group Financial Services Inc. Montréal, Québec H3A 2A6 For information, call toll-free 1 888 746-6344, or fax (204) 956-7688. Your Name 3 Your Personal Records Organizer In Quebec, 1 800 661-4578, or fax (514) 843-5205. www.investorsgroup.com Date Completed/Last Updated Written and published by Investors Group as a general source of information only. It is not intended as a solicitation to buy or sell specific investments, nor is it intended to provide tax, legal or investment advice. Readers should seek advice on their specific circumstances from an Investors Group Consultant. ™ Trademark owned by IGM Financial Inc. and licensed to its subsidiary corporations. Investors Group Financial Services Inc. “Legacy Planning - Your Personal Records Organizer” © Investors Group Inc. 2011 MP1157 (11/2011)
  • 2. Personal Records MY NET WORTH STATEMENT Assets (What you own) Current amount Liquid assets Cash on hand $ _______________________________ Chequing/savings/broker accounts $ _______________________________ Canada Savings Bonds $ _______________________________ Term deposits/investment certificates $ _______________________________ Other $ _______________________________ Marketable assets Government/corporate bonds $ _______________________________ Common shares $ _______________________________ Preferred shares $ _______________________________ Mutual funds $ _______________________________ Real estate investments $ _______________________________ Other (business interest, farm, etc.) $ _______________________________ $ _______________________________ $ _______________________________ $ _______________________________ $ _______________________________ This booklet is Long-term assets Cash value of life insurance (also indicate amounts to be received as death designed to help you benefit by your estate upon your death) $ _______________________________ organize, in one handy Registered Retirement Savings/Income Plans $ _______________________________ Other (pensions/profit sharing plans, etc.) $ _______________________________ location, important Personal assets Personal residence $ _______________________________ information about your Recreation property $ _______________________________ personal and financial Vehicles $ _______________________________ Household furnishings/equipment $ _______________________________ affairs. You’ll find it Other (art, coins, jewelry, etc.) $ _______________________________ provides a convenient Total assets $ record and will be easy Liabilities (What you owe) Current amount to update. As well, it Short-term debt Charge accounts/credit cards $ _______________________________ will help your survivors Loans/Lines of credit $ _______________________________ wind up your personal $ _______________________________ Taxes (income/property tax owing) $ _______________________________ affairs after your Other (life insurance loans, etc.) $ _______________________________ death. Keep this Unpaid bills $ _______________________________ record in a safe place Long-term debt Home mortgage $ _______________________________ Other property mortgage $ _______________________________ along with your other Other (line of credit, margin account, etc.) $ _______________________________ important papers. Total liabilities $ Let your family know NET WORTH: where it’s kept. Total assets minus total liabilities $ 15
  • 3. Loan Agreements or promissory notes are located: Debtors and Creditors People To Be Contacted People who owe you money Next of kin Name: Name: Name: Amount: Date: Relationship to you: Relationship to you: Demand/Maturity date: Trust Funds Telephone: Telephone: Address: Are you a beneficiary of any trusts? Address: Address: ❑ Yes ❑ No Purpose: Name: Name: Name: Trustees are: Amount: Date: Relationship to you: Relationship to you: Trust papers are located: Telephone: Demand/Maturity date: Telephone: Address: Address: Address: Amount $: Are you a trustee of any trusts? People to whom you owe money (other than previously listed) ❑ Yes ❑ No Name: Purpose: Amount: Date: Trust papers are located: Demand/Maturity date: Address: Income Tax Your tax advisor is: Name: Telephone: Amount: Date: Address: Demand/Maturity date: Address: Your tax records and supporting data are located: 14 4 3
  • 4. Banking Institution: Other People To Be Contacted Residence & Real Estate Building cost figures (December 31, 1971 value Telephone: Executor or Liquidator (in Quebec): plus capital improvements to date): Address: Type of Title is Is there a Mortgage real estate held by mortgage? is held by Telephone: (e.g. house, (circle one) (circle one) Mortgage insurance policy: condo, etc.) Address: Banking Institution: you yes Telephone: spouse no Address: joint Employer/Business Office: Personal Property you yes List all vehicles you own: spouse no Telephone: Investors Group Consultant: joint Address: you yes Telephone: spouse no Vehicle registrations are located: Address: joint Lawyer: you yes Bill of sale and insurance papers are located: Telephone: spouse no Address: Person(s) to whom you have granted joint power of attorney: Are household furnishings insured? Where are the following located? Notary (for Quebec residents): Telephone: ❑ Yes ❑ No Certificates of title: Address: Bills of sale, an inventory of and insurance Telephone: policies for household furnishings are located: Copy of mortgages: Address: Others Name: Property insurance policies: Jewelry, stamp collections, coin collections, Accountant: appraisal documents, etc. are located: Telephone: Telephone: Land surveys: Address: Address: Collections/heirlooms/items of special value: Property tax receipts: Name: Telephone: Leases: Address: 4 13
  • 5. Bank Accounts Safety Deposit Box Living Will Have you informed your Be sure to list all your bank accounts, so Do you have a safety deposit box? Do you have a “Living Will” ❑ Doctor your Executor, Liquidator or family can ❑ Yes ❑ No (if allowed in your province)? ❑ Next of kin find the money you have in these Location: ❑ Yes ❑ No ❑ Living Will representative accounts. If so, where is your Living Will kept? ❑ Mandatary or representative (for residents of Quebec) Names of others who have access to it: Banking Institution Funeral Arrangements Branch: For Quebec residents: Do you have a Have you made funeral arrangements? Account #: “Mandate in Anticipation of Incapacity” Location of the keys: ❑ Yes ❑ No ❑ Savings ❑ Chequing ❑ Joint ❑ Yes ❑ No Funeral home & address: If joint, who is joint owner? If so, where is such a document kept? List of contents is located: Telephone: Branch: To whom have you given authority to Location: make medical decisions on your behalf? Have you set out instructions in your Account #: Will? ❑ Savings ❑ Chequing ❑ Joint ❑ Yes ❑ No Names of others who have access to it: If joint, who is joint owner? In a letter? Organ Donation ❑ Yes ❑ No Do you want to donate your organs or They are located: Location of the keys: Branch: body for transplant, medical research or education? Account #: List of contents is located: ❑ Yes ❑ No ❑ Savings ❑ Chequing ❑ Joint Do you own a cemetery plot? If yes, explain: If joint, who is joint owner? ❑ Yes ❑ No Have you provided for its ongoing care? Have you explained this in your ❑ Yes ❑ No ❑ Will and/or Living Will The plot is located: ❑ Organ donor card ❑ Driver’s license/Provincial Health Card The deed to it is kept: 12 5
  • 6. Your Will Pension Plans Are you a subscriber to a Registered Education Savings Plan (RESP)? Do you have a Will? ❑ Yes ❑ No Are you a member of a Registered Pension Plan? ❑ Yes ❑ No The original is located: A copy is located: ❑ Yes ❑ No Account #: Account #: Carrier name & address: The Will was dated/last updated: Carrier name & address: Beneficiary: Personal Records Beneficiary: Date of Birth: Do you have a Registered Retirement Place of Birth: Account #: Income Fund (RRIF)? Birth certificate is located: Carrier name & address: ❑ Yes ❑ No Account #: Social Insurance/Social Security Number: Beneficiary: Carrier name & address: Citizenship Papers Beneficiary: Passport ❑ Yes ❑ No Do you have a Registered Retirement Savings Plan (RRSP)? They are located: ❑ Yes ❑ No Are you a member of a Deferred Profit Marriage / Divorce Certificates Account #: Sharing Plan (DPSP)? Marriage certificate ❑ Yes ❑ No ❑ Yes ❑ No Carrier name & address: Divorce certificate ❑ Yes ❑ No Account #: Located: Carrier name & address: Beneficiary: Account #: Beneficiary: Current Military Service ❑ Yes ❑ No Carrier name & address: Information about this plan is located: Discharge Papers are located: Country of enlistment: Beneficiary: Veteran’s Number: Do you leave a military pension? ❑ Yes ❑ No 6 11
  • 7. Policy Number: Investments Previous Employers Memberships Carrier name & address: Investment Funds Start with the first and put the current or List all memberships in clubs, most recent employer last associations, subscriptions ❑ Yes ❑ No ❑ Acquired by gift or inheritance Name of fund: Do you receive income from them? Employer: Name: Account #: ❑ Yes ❑ No Year: Address: Advisor’s name & address: Information about these annuities is located: Address/Location: Registered owner(s): Name: Bonds & Government investments Employer: Address: Name of fund: ❑ Yes ❑ No Year: ❑ Acquired by gift or inheritance Account #: Address/Location: The form is: Advisor’s name & address: Name: Registered to: Address: Bearer: Registered owner(s): Employer: or co-registered with: Year: Serial numbers: Name of fund: Address/Location: Name: The bonds are located: Account #: Address: Advisor’s name & address: Securities Do you own any stocks or bonds? Employer: Registered owner(s): ❑ Yes ❑ No Year: Domestic Contracts ❑ Acquired by gift or inheritance Address/Location: Do you have a: Annuity Contracts Information about them is located: Co-habitation agreement? ❑ Yes❑ No ❑ Yes ❑ No Pre-nupital agreement? ❑ Yes ❑ No ❑ Acquired by gift or inheritance Are any of your securities pledged for Marriage Contract? ❑ Yes ❑ No Policy Number: loans? Separation Agreement? ❑ Yes ❑ No Carrier name & address: ❑ Yes ❑ No Divorce Order? ❑ Yes ❑ No With whom: The original is located: 10 7
  • 8. Financial Commitments Charitable Gift Life Insurance Disability Insurance Rent or Mortgage Payments For: Policies you own on your life: Company: Amount $ Address: Company: Policy Number: Due Date: Policy Number: Policy is located: Lender/Address: Policy is located: For: Beneficiary: Company: Address: Policy Number: Policy is located: Outstanding loans/lines of credit/credit Company: or charge cards/business Policy Number: loans/guarantees Contractual Obligations Policy is located: Company: Amount $ For: Beneficiary: Policy Number: Due Date: Located: Policy is located: Lender/Address: Policies you own on others: For: Company: Hospital & Medical Insurance Located: Policy Number: Company: Amount $ Policy is located: Policy Number: Due Date: For: Name of Insured: Policy is located: Lender/Address: Located: Company: Company: For: Policy Number: Policy Number: Amount $ Located: Policy is located: Policy is located: Due Date: Name of Insured: Lender/Address: Other financial obligations Out of Province Travel Insurance or commitments (auto lease, Policies others own on your life: Company: support/maintenance obligations) Company: Policy Number: Amount $ For: Policy Number: Policy is located: Due Date: Located: Policy is located: Lender/Address: For: Owner of Policy: Located: 8 9