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TrustCounsel Client Intake
  • First Name*:  

  • Middle Name*:  

  • Last Name*:  

  • Address*:  

  • City*:  

  • State*:  

  • Zip*:  

  • Phone*:  

  • Email*:  

  • Birthday (day/month/year)*:  

  • Gender*:  

  • Citizenship*:  

  • Occupation*:  

  • Employer*:  

  • Marital Status*:  

  • Date of Marriage:  

  • Spouse First Name:  

  • Spouse Middle Name:  

  • Spouse Last Name:  

  • Spouse Citizenship:  

  • Spouse Occupation:  

  • Spouse Employer:  

  • Child 1 Name:  

  • Child 2 Name:  

  • Child 3 Name:  

  • Child 4 Name:  

  • Child 5 Name:  

  • Child 1 Birthday (day/month/year):  

  • Child 2 Birthday (day/month/year):  

  • Child 3 Birthday (day/month/year):  

  • Child 4 Birthday (day/month/year):  

  • Have you lived in a community property state (AZ, CA, ID, LA, NM, NV, TX, WA, WI) while married?:  

  • Child 1 Relationship or Parent:  

  • Child 2 Relationship or Parent:  

  • Child 3 Relationship or Parent:  

  • Child 4 Relationship or Parent:  

  • Child 5 Relationship or Parent:  

  • Your Accountant's Name:  

  • Your Financial Advisor's Name:  

  • Your Life Insurance Agent's Name:  

  • PLANNING OBJECTIVES - Please identify the reasons you are considering planning or areas you would like to learn more about: Pets, guns, high value retirement accounts (over $250K), business ownership, elderly or disabled beneficiary, spend summer or winte:  

  • Preserve & Maximize Assets - Please identify your reasons/interests: Minimize or eliminate estate taxes upon your death (35% of your assets and life insurance benefits), reduce estate administration costs through probate avoidance, avoid or limit claims o:  

  • Protect Yourself and Your Spouse - Please indicate your reasons/interests: Protection from malpractice or creditor claims, guardianship proceedings, probate delays.:  

  • Protect Your Children or Beneficiaries - Please indicate your reasons/interests: Protection from financial predators, claims of divorced spouses, malpractice claims, creditors' claims, stress and delays of probate, financial immaturity and loss of inherit:  

  • Do you have a will, trust, or other estate planning document? (If yes, please furnish copies.)*:  

  • Are you making payments pursuant to a divorce or property settlement order? If yes, please furnish a copy.*:  

  • Have you and your spouse signed a pre- or post-marriage contract? If yes, please furnish a copy.*:  

  • INCOME - Your earned monthly income.*:  

  • INCOME - Spouse's earned monthly income.:  

  • INCOME - Your joint monthly income.:  

  • ASSETS - Please list any interest in real estate including your family residence, vacation homes, time shares or vacant land. List address, ownership (joint, community, separate, tenant in common), market value and equity.*:  

  • ASSETS - Personal property. List major personal effects such as jewelry, collections, antiques, furs and all non-business property. State item, ownership and market value.*:  

  • ASSETS - Bank & Savings Accounts. List Checking Account (CA), Savings Account (SA), Certificates of Deposit (CD), Money Market (MM), the name of the bank, owner on account and the balance. DO NOT INCLUDE IRAs or 401(k)s here.*:  

  • ASSETS - Stocks & Bonds. List all stocks and bonds you own. If held in a brokerage, lump them together under each account. Include the name of the bank, owner on account and the value.*:  

  • ASSETS - Life Insurance Policies & Annuities. List term, whole life, split dollar, group life, annuity. Include insurance company, type, face amount (death benefit), whose life is insured, who own the policy, current beneficiaries, who pays the premium, a*:  

  • ASSETS - Retirement Plans. Pension (P), Profit Sharing (PS), H.R.10, IRA, SEP, 401(k). Describe the types of plans and their current values.*:  

  • ASSETS - Business Interests. General and limited partnerships, sole proprietorships, privately owned corporations, professional corporations, oil interests, farm and ranch interests. Give a description of each interest, who has the interest, your ownershi*:  

  • ASSETS - Money owed to you. Include mortgages or promissory notes owed to you. Include the name of the debtor, date of note, maturity date, who funds are owed to and the current balance owed.*:  

  • ASSETS - Anticipated inheritance, gift or lawsuit judgments. Include gifts or judgments you expect to receive at some time in the future.*:  

  • ASSETS - Other. Please include all other property not included above.*:  


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