Client Instruction Form EPA

Your email address

Your title

Eg Mr or Mrs etc

Other title detail

E.g. "Professor"

Your first name

Your middle name

Your last name

Mobile Phone Number

Home Phone Number

Include prefix if outside Western Australia

Your date of birth

Address Line 1

eg Unit 1, 2 James Street

Address City

eg Duncraig

State/Province

eg Duncraig, Western Australia

Post Code

eg 6023

Country

eg Australia

Your occupation

eg Retired or Household Manager

Your partner's title

Other title detail

E.g. "Professor"

Your partner's first name

Your partner's middle name

Your partner's last name

Partner's mobile phone number

Your partner's email address

Your partner's date of birth

Your partner's occupation

Relationship to other will maker

eg Married or De facto or other relationship

How many children do you have

Check relevant box. Please include all children including any step children or children born to any other partner

First Name of First Child

Middle Name of First Child

Last Name of First Child

Address Line 1 of First Child

Address City of First Child

State/Province of First Child

Post Code of First Child

Country of First Child

Occupation of First Child

Date of birth of First Child

Relationship to First Child

Relationship to second child

Relationship to third child

Relationship to fourth child

Full name, address, occupation and date of birth of any other children

First Name of Executor

First executor if your partner cannot act or you don’t want them to act or you have no partner

Middle Name of Executor

Last Name of Executor

Guardian or Guardians for any children under 18

Relationship, full name, address and occupation & may be joint or alternate eg brother John James Smith 1 Red St, Como, Clerk alternate sister Mary Ellen Jones 2 Don St, Como, Secretary

Address Line 1 of First Executor

Address City of First Executor

State/Province of First Executor

Post Code of First Executor

Country of First Executor

Occupation of First Executor

Relationship to first executor

If you wish to appoint other executors as well please advise their full names, address, occupation and relationship to you (if any)

Executors to act jointly or as alternate

i.e. if the first cannot act

Specific gifts

eg "My Jewellery to my daughter Jane Smith"

Cremation or burial?

Organ donation?

Are you omitting a person who might contest the will?

eg spouse, child, step child or grandchild born to a child who has predeceased you?

Full name and relationship of person or persons omitted

Who do you wish to leave your estate to if your partner dies before you or if you have no partner?

Eg Equally between my children. Just leave blank if you are not sure how to distribute your estate as this can be discussed at the appointment

Approximate value of estate

Do you wish to incorporate Testamentary Discretionary Trusts in your Wills?

This is a type of trust created under a Will which is used to minimise tax and increase asset protection for your beneficiaries. Usually at least $500,000 should be available for each trust to warrant this inclusion.

Do you have a Self Managed Super Fund or a Family Trust?

If yes, provide details, if no leave blank.

Any other matters you wish to raise

eg "I have assets in another country that I wish to distribute via another will"

Do you need an Enduring power of Attorney?

Another person or persons to look after your financial and legal affairs if it is difficult or impossible for you to do so yourself.

Full names of each attorney (up to 4)

Please include all middle names. Normally this would be your partner, adult children, siblings or close trusted friends. If not already mentioned in this form, please also advise their address, occupation and relationship to you (if any). If unsure leave blank.

Do you need an Enduring Power of Guardianship?

I.e. Someone to deal with decisions about your healthcare, personal care and accommodation if you can't make those decisions yourself due to incapacity

Full names of each guardian

Please include all middle names. Normally this would be your partner, adult children, siblings or close trusted friends. If not already mentioned in this form, please also advise their address, occupation and relationship to you (if any). If unsure leave blank.

Do you need an Advanced Health Directive?

I.e. A non-resuscitation direction to your doctors if you are seriously ill, have no prospect of recovery and you are unable to speak for yourself due to incapacity

Who referred you to me?

Name of advisor and their business name or otherwise how you heard of me.

Instructions Form