Estate Planning Worksheet PDF

Estate Planning Worksheet
This questionnaire is designed to help us determine what estate planning tools will best assist you to
achieve your goals. It captures the information needed to proceed with estate planning. Please complete
as fully as you can; contact us with any questions you may have.
When you are ready, we invite you to contact a Houser Henry & Syron legal advisor who can discuss the
worksheet with you and your next steps. You can reach our firm at 416.362.3411 or
info@houserhenry.com. We recommend an in-person meeting because of the sensitive nature of the
completed worksheet. All of your answers and information will be kept strictly confidential.
Personal Information
(For a couple, please indicate clearly which assets and details relate to which spouse)
Spouse 1 Spouse 2
Your full name:
Also known as:
Address:
Home Telephone:
Alternate or Cellular:
Fax:
Email:
Correspondence Information:
a) If different from above, a) a)
please provide details.
b) If copies to be sent to b) b)
another person/ address,
please provide details.
Occupation:
Name of business:
Business phone:
Date and place of birth:
Citizenship
(List all countries)
Residence for income tax

purposes:
Marital status:
If unmarried, are you planning Yes ☐ No ☐ Yes ☐ No ☐

to marry in the near future?
Date and place of marriage:
145 King St. W, Suite 2701, Toronto, Ontario, Canada M5H 1J8 | 416.362.3411 | www.houserhenry.com
Estate Planning Worksheet Houser Henry & Syron LLP | 2
Do you have a marriage

contract? If so, please give
details
Have you been married more

than once?
Full name(s) of ex-spouse(s):
Please give details of any

divorce decrees or
dissolutions (Do you have any
obligation to support
anyone?)
Did you have a marriage or

cohabitation contract? If so,
please give us a copy.
Do you have any physical or

mental illnesses or
disabilities?
Children of Present Union:
Full Name: Age Marital Children Dependent Health Address

Status (No./Age)
Spouse 1’s Children:

Status (No./Age)
Spouse 2’s Children:

Status (No./Age)
Full names and addresses of any other person who you support (other than your spouse or children):
Name and Relationship: Address: Who provides support Date of Birth:

Spouse 1, Spouse 2 or both?
Full names and addresses of other persons or charities who you would like to benefit from your Will (e.g.
parents, brothers, sisters, friends, charities):
Spouse 1
Full Name: Relationship Age Health Address Children

(No./Age)
Spouse 2
Full Name: Relationship Age Health Address Children

(No./Age)
Do any of the intended beneficiaries have special needs (e.g. any disabilities)?
Do you have a financial planner, investment advisor, accountant and/or life insurance agent? Please send
us their details.
If your current Will was prepared by another solicitor, please provide us with a copy.
Existing Estate Planning Documents

(If you have any of the following documents, please provide details)
Spouse 1 Spouse 2
Wills:
Have you made mutual or mirror

Wills with anyone?
Power of Attorney for Property:
Power of Attorney for Personal

Care:
Inter Vivos Trusts:
Agreements binding on the
Estate:
Have you been appointed
executor of someone’s estate or
trustee of a trust?
Who has your current original estate planning documents?
Assets
Where asked to assign a value, kindly provide your best estimate.
Safety Deposit Boxes:
Location: Box Number: Registered Name: Location of Key: General

Description of
Contents
Real Estate
1. Principal Residence
Street Address or location:
Registered Owners:
Current Market Value:
Encumbrances (Mortgages, etc.):
Equity:
Acquisition Cost and Date:
Have you granted any option to anyone

to buy your real estate?
Do you have any options to buy any

other real estate?
2. Other (such as cottage, condominium in Florida, income producing property, etc.)
Street Address or location:
Registered Owners:
Current Market Value:
Encumbrances (Mortgages, etc.):
Equity:
Acquisition Cost and Date:
If property is rented:
Tenant’s name:
Address:
Amount of rent:
Date rent payment is due:
Length of lease:
If property is out of the jurisdiction, who

acts as your local solicitor:
Insurance Policies, Annuities, RRSPs, RESPs, RIFS and Pensions:
No. of Policy: Type: Issued By: Registered Beneficiary: Approximate

Owner: Value of Benefit
to Estate:
 Are any RRSPs locked in? Yes ☐ No ☐
Money on Deposit:
Name and Address of Type and Number of Ownership (jointly?): Approximate Amount:
Bank or Depository: Account:
If you have a Tax Free Savings Account, does it have a designated beneficiary? Yes ☐ No ☐
If so, who is it? ______________________________________________________________________
Should the joint owner of any bank accounts above inherit the balance of that account on your
death? Yes ☐ No ☐
Shares, Bonds, Debentures, Guaranteed investment certificates:

(Approximate current market value of Portfolio): $
Description including Acquisition Cost and Approximate Current Physical Location:

Number: Date: Value:
Interests in private businesses (whether partnerships, incorporated or unincorporated):

If these interests will form a substantial part of your estate, they will require special planning.
Legal name of Corporation or other entity: Approximate Value of share or other interests:
Are any of your shares subject to any restrictions on transfer?
 Are any of your shares subject to a buy-sell agreement? Is it up to date?
 If there is a buy-sell agreement, is there sufficient insurance or other money available to fund the
purchase of your shares on death?
 If you have shares in one or more private corporations or partnerships, are the records of the
corporation or partnership up to date?
 If you have an interest in a private company and you were to pass away or become incapacitated,
what would happen to the corporation or partnership? Who would manage the corporation or the
partnership? What help would they need?
 Who has signing authority on the bank accounts of the business? Is there someone other than you
who could sign?
 Do you have a written succession plan for your business?
Please provide copies of all relevant agreements
Does anyone owe you money? (If so, please give details):
Debtor Name: Creditor’s Name: Approximate Value Security and Other

loan: Terms
Automobile, Boats and Recreational Vehicles:
Description: Approximate Value: Ownership:
Rewards Points Plans:
Plan Issuer: Approximate Value: Ownership:
Memberships / Sports Ticket Subscriptions:
Description: Approximate Value: Ownership:
Digital Assets (example, Facebook):
Description: Should Executor have Access?

Facebook Yes ☐ No ☐
LinkedIn Yes ☐ No ☐
Twitter Yes ☐ No ☐
Instagram Yes ☐ No ☐
Email Accounts Yes ☐ No ☐
Other: Yes ☐ No ☐
Household and personal effects (heirlooms, jewellery, etc.) (Approximate total value):
$
Other Assets
Do you have any of these?
☐ Contingent of vested interest in a trust (Please provide copy of relevant documents); or
☐ Power of appointment (Please provide copy of relevant documents); or
☐ Tax sheltered investments; or
☐ Royalties; or
☐ Foreign assets (Please indicate where)
Total Value of Assets $
Debts
Where asked to assign a value, kindly provide your best estimate.
Debts including Mortgages, Liens and Business Debts:
Creditor: Debtor: Principal Maturity: Interest:
Income and Income Tax

Income Investment Total Income Tax
Income Tax Arrears Arrears
Current year
Partner
Previous Year
Partner
Contingent Liabilities and Any Other Indebtedness:
Description Approximate Value
 Do you have any household accounts payable?
____________________________________________________________________________________
 Do you have any loans on life insurance policies?
____________________________________________________________________________________
Total Value of Debt $
Summary
Total approximate value of assets $
Total approximate value of debts $
Approximate net value of estate (assets minus debts) $
Details to Consider for Your Will
 Who do you want to appoint as estate trustees (formerly called “executors”) and backups in case the
persons you appoint cannot act?
Proposed Estate Trustees
Name: Address:
Proposed Backup Estate Trustees
Name: Address:
Have you asked your proposed estate trustees if they would help? Yes ☐ No ☐
If you are appointing more than one estate trustee, will they work well
together? Yes ☐ No ☐ Not sure ☐
 Who do you want to appoint as guardians for your minor children, if any, and backups in case the
persons you appoint cannot act?
Proposed Guardians
Name: Address:
Proposed Backup Guardians
Name: Address:
 Do you have any instructions regarding your burial?
 Do you wish to give specific personal items to individuals? If so, please clearly describe the item(s)
and the recipient(s).
Item Description Recipient
 Do you wish to give cash legacies to individuals or charities? If so, please state the intended
recipient(s) and amount(s).
Amount of Legacy Recipient
 Who will inherit the residue (remaining property / balance) of your estate?
Residual Beneficiaries
Name: Current Age: Share:
Alternate Residual Beneficiaries
Name: Current Age: Share:
 If your beneficiaries are under age 18, at what age or ages will they receive their shares?
 If you, your spouse and your children all pass away before the estate is distributed, who will receive
the balance remaining?
 Will the executors be entitled to compensation? If so, please describe.
If you would like to explore this further, please let us know and we will send you our client advisory on
Executors’ compensation.
 Have you considered granting a power of attorney for property? Who would be the person or persons
to handle matters relating to your property? If that person is unable to act, who would you appoint as
a backup person? If you appoint more than one person as your attorney or back up attorney, should
they act alone or together?
Attorney for Property
Name: Address:
Backup Attorney for Property
Name: Address:
 When would you want your power of attorney for property to be effective?
Date you sign ☐ or
Upon your written direction or a doctor’s note that you cannot manage your affairs ☐
 Do you have an interest in any business(es) which you would want your appointed attorney to
manage? If so, please note the name of the business.
 Have you made gifts to others?
Date of Gift Form of Gift To Whom Made Value
 Have you considered making gifts or loans to friends and relatives or making charitable gifts?
 Have you considered granting a power of attorney for personal care? Who would be the person to
handle matters relating to your personal care? If that person is unable to act, who would you appoint
as a backup person? If you appoint more than one person as your attorney or back up attorney,
should they act alone or together?
Attorney for Personal Care
Name: Address:
Backup Attorney for Personal Care
Name: Address:
Do you foresee anyone challenging your will or powers of attorney? If so, why?
Is there any estrangement or tension within the family? If so, please describe.
Would you like us to keep your original Will and Powers of Attorney in our Wills vault?
Is there an urgency to complete / update your Will and Powers of Attorney? If so, what is the
deadline?
Please note any additional details or comments regarding the distribution of your estate.
Thank you for completing this worksheet. © HHS 2017
Follow up Questions
(To be completed at our initial discussion)

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Estate Planning Worksheet

Your full name:

Also known as:

Date and place of birth:

Residence for income tax

If unmarried, are you planning Yes ☐ No ☐ Yes ☐ No ☐

Date and place of marriage:

Do you have a marriage

Have you been married more

Full name(s) of ex-spouse(s):

Please give details of any

Did you have a marriage or

Do you have any physical or

Children of Present Union:

Full Name: Age Marital Children Dependent Health Address

Spouse 1’s Children:

Full Name: Age Marital Children Dependent Health Address

Spouse 2’s Children:

Full Name: Age Marital Children Dependent Health Address

Name and Relationship: Address: Who provides support Date of Birth:

Full Name: Relationship Age Health Address Children

Full Name: Relationship Age Health Address Children

Existing Estate Planning Documents

Have you made mutual or mirror

Power of Attorney for Personal

Who has your current original estate planning documents?

Safety Deposit Boxes:

Location: Box Number: Registered Name: Location of Key: General

Current Market Value:

Encumbrances (Mortgages, etc.):

Acquisition Cost and Date:

Have you granted any option to anyone

Do you have any options to buy any

2. Other (such as cottage, condominium in Florida, income producing property, etc.)

Street Address or location:

Current Market Value:

Encumbrances (Mortgages, etc.):

Acquisition Cost and Date:

Date rent payment is due:

If property is out of the jurisdiction, who

Insurance Policies, Annuities, RRSPs, RESPs, RIFS and Pensions:

No. of Policy: Type: Issued By: Registered Beneficiary: Approximate

 Are any RRSPs locked in? Yes ☐ No ☐

If so, who is it? ______________________________________________________________________

Shares, Bonds, Debentures, Guaranteed investment certificates:

Description including Acquisition Cost and Approximate Current Physical Location:

Interests in private businesses (whether partnerships, incorporated or unincorporated):

Are any of your shares subject to any restrictions on transfer?

 Are any of your shares subject to a buy-sell agreement? Is it up to date?

 Do you have a written succession plan for your business?

Please provide copies of all relevant agreements

Debtor Name: Creditor’s Name: Approximate Value Security and Other

Automobile, Boats and Recreational Vehicles:

Description: Approximate Value: Ownership:

Rewards Points Plans:

Plan Issuer: Approximate Value: Ownership:

Memberships / Sports Ticket Subscriptions:

Description: Approximate Value: Ownership:

Digital Assets (example, Facebook):

Description: Should Executor have Access?

Email Accounts Yes ☐ No ☐

☐ Contingent of vested interest in a trust (Please provide copy of relevant documents); or

☐ Power of appointment (Please provide copy of relevant documents); or