KWB Wealth Intake Form

    • 1

      Wealth Manager Contact Info

    • 2

      Client Information

    • 3

      Decision-Makers

    • 4

      Beneficiaries

    • 5

      End-of-Life Decisions

    • 6

      Burial Wishes

    • 7

      Schedule Of Assets

    1/7

    Wealth Manager Contact Info

    Wealth Manager Information

    0%

    Client Information [Strictly Confidential]

    Never marriedDivorcedWidowedMarried
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo

    16%

    Decision-Makers

    The name of the person(s) that you want to be the decision maker concerning your estate upon your death:
    The name of the person(s) that you want to raise a child that is under 18 (if applicable):

    Advanced Health Care Directive

    The name of the person(s) that you want to make any major medical decisions on your behalf:

    Power of Attorney for Fiances

    The name of the person(s) that you want to make any major financial decisions on your behalf:

    33%

    Beneficiaries

    Indicate if you want to make any charitable gifts prior to funds being split among beneficiaries:

    Or

    Indicate how you want your estate distributed among your beneficiaries:
    State any specific concerns (not already mentioned) that you have regarding the distribution of your estate:

    50%

    End-of-Life Decisions

    (a) Choice NOT to Prolong Life(b) Choice to Prolong Life
    (a)
    I do not want my life to be prolonged if (1) I have an incurable and irreversible condition that will result in my death within a relatively short time, (2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or (3) the likely risks and burdens of treatment would outweigh the expected benefits.
    (b)
    I want my life to be prolonged as long as possible within the limits of generally accepted health care standards.
    YesNo
    YesNo
    YesNo

    66%

    Burial Wishes

    CrematedBuried
    If cremation, I would like my ashes disposed as follows:
    If cremation, I would like my ashes disposed as follows:
    I have already made arrangements at:

    83%

    Schedule of Assets

    Indicate if you want to make any charitable gifts prior to funds being split among beneficiaries:

    Type of Asset

    LAST 4# OF ACCOUNT(S)

    (address, city, state) (need copy of deed)
    (beneficiaries listed)
    (cash, annuities, notes due you)
    (sole proprietorship, partnerships, closely held corporation, etc.)
    (IRA, 401k, etc.) (beneficiaries listed)
    (autos, R.V., boat) (year, make/ model)
    (jewelry, furniture, antiques)

    100%