CONFIDENTIAL QUESTIONNAIRE

CONFIDENTIAL QUESTIONNAIRE

PERSONAL INFORMATION

"*" indicates required fields

NAME*
*Click Drop-Down Menu to Select Status
MM slash DD slash YYYY
*Click Drop-Down Menu to Select State
*Click Drop-Down Menu to Select State
ADDRESS*
*Employed, Student, Retired, Homemaker, Business Owner, Not Employed
*Required if employed.
*Required if employed.
EMPLOYER ADDRESS
*Required if employed.
*Required if retired.
*Required if retired.

LEGAL DOCUMENTS

WILL*
LIVING WILL*
POWER OF ATTORNEY*
HEALTHCARE POWER OF ATTORNEY*
PRIMARY OR CONTINGENT*
MM slash DD slash YYYY
PER STIRPES*
*If a Beneficiary dies before you do, their share of your estate will automatically and evenly go to their child or children.
PRIMARY OR CONTINGENT
MM slash DD slash YYYY
PER STIRPES
*If a Beneficiary dies before you do, their share of your estate will automatically and evenly go to their child or children.

DOCUMENT DELIVERY

ONLINE ACCESS*
*Required if answered 'YES' to Online Access.
STATEMENTS
*Required if answered 'YES' to Online Access.
TAX REPORTING
*Required if answered 'YES' to Online Access.
PROSPECTUSES
*Required if answered 'YES' to Online Access.
TRADE CONFIRMATIONS
*Required if answered 'YES' to Online Access.
REPORTS & PROXIES
*Required if answered 'YES' to Online Access.
OTHER CORRESPONDENCE
*Required if answered 'YES' to Online Access.

TRUSTED CONTACT

TRUSTED CONTACT
*A Trusted Contact is similar to an Emergency Contact used in other industries.
ADDRESS
*Required if a TRUSTED CONTACT was named.
*Required if a TRUSTED CONTACT was named.
*Required if a TRUSTED CONTACT was named.