1. Personal information
Client Information
Full Name:
Identity Number:
Contact Number:
Email Address:
Residential Address:
Spouse/Partner Information
Full Name:
Identity Number:
Date of Marriage (if applicable):
Contact Number:
How married (if applicable):
Children & Dependents
Name & Date of Birth:
Name & Date of Birth:
Name & Date of Birth:
2. Assets Schedule
Immovable Property
Address & Description:
Ownership Type (Sole/Joint):
Estimated Value:
Movable Property
Description:
Estimated Value:
Shares & Investments
Shares in Portfolio
Investment Account Provider:
Estimated Value:
Shares in Private Company
Company Name:
Percentage Owned:
Estimated Value:
Bank Accounts
Offshore Assets
Description & Location:
Estimated Value:
3. Policies
Retirement & Pension
Provider Name:
Estimated Fund Value:
Living Annuities
Provider Name:
Estimated Fund Value:
Life Insurance Policies
Provider Name:
Beneficiary:
Income Protection Policies
Provider Name:
Monthly Cover Amount:
4. Liabilities
Home Loan / Bond
Bank Name:
Outstanding Balance:
Credit Cards
Bank Name:
Outstanding Balance:
Loans
Loan Provider:
Outstanding Balance:
Loan Accounts
Creditor Name:
Amount Outstanding:
5. Trusts
If Yes, please supply the trusts name:
6. Your Intentions & Wishes
Please describe any specific wishes for your estate distribution:
7. People Who May Manage Your Affairs
Private Banker
Name:
Contact Details:
Financial Advisor
Name:
Contact Details:
Accountant
Name:
Contact Details:
8. Other
Income tax number:
Medical aid details:
Arms and ammunition details (firearm licences)
9. Checklist of Required Documents
Please attach copies of the following:
Current will
Identity document (Client, Spouse & Children)
Birth certificates (if no IDs available)
Marriage certificate (if applicable)
Trust deed & letters of authority (if applicable)
Submit
