Draft will request form

Your Personal Information

First Name:

Middle Name:

Last Name:

Identity Number:

Cell Number:

Smoking Status:

Smoking Non Smoking

Education:

Employment:

Monthly Salary:

Do you need an Afrikaans Will?

Yes No

Your Estate Inheritances

Who do you want to inherit your general estate? Please provide the details of your beneficiaries?

For example: 100% to my spouse; or 50% to my Spouse, 50% equally between my two Children.

Is there something specific you want to leave to someone, other than your general estate? If so, please specify to whom and what?

For example: Life insurance payable to my estate; or my primary residence; or my jewellery and to whom.

Your Last Wishes

What are your burial wishes?:

Do you wish to be an organ donor?

Yes No

Do you wish to have the Living Will option?

Yes No

What are your last wishes?

Questions relating your Child or Children

Do you have minor children?

Marketing Information

Who referred You?

If no person, where did you hear about espress-O-will:

Recipient Details

Note that this request will automatically be sent to Capital Legacy, together with the recipient details you enter below. Please also confirm your return email address

Email Contact 1:

Email Contact 2:

Your return email address: