Personal Information Organizer - Cigna
Personal Information Organizer
Your source to record all personal information in one convenient place.
Table of Contents
Personal Information.............................................................................................................3 Important Contacts................................................................................................................4 Important Document Directory............................................................................................6 Family Documents..................................................................................................................6 Financial Documents.............................................................................................................6 Legal Documents...................................................................................................................6 Other Documents...................................................................................................................6 Financial Information.............................................................................................................7 Insurance................................................................................................................10 Legal...............................................................................................................................12 Supplemental Information..................................................................................................14 Pre-Planning of Funeral and Burial Arrangements...........................................................17
HELPFUL HINT: While this document seems long, few people will need to complete every field on every page. You may also be able to attach documents, or indicate where information is located, to save time in completing all fields.
Once completed, keep in a secure location and make sure your estate executor or other responsible party knows this document exists.
Personal/Family Information
NAME ADDRESS CITY DATE OF BIRTH (use MM/DD/YY format) SOCIAL SECURITY NUMBER
STATE
ZIP CODE
THIS DOCUMENT WAS LAST UPDATED ON
Family
Spouse/Partner
NAME (including maiden name) DATE OF BIRTH (use MM/DD/YY format)
SOCIAL SECURITY NUMBER
First Child
NAME ADDRESS
CITY PHONE NUMBER
STATE DATE OF BIRTH (use MM/DD/YY format) SOCIAL SECURITY NUMBER
ZIP CODE
Second Child
NAME ADDRESS
CITY PHONE NUMBER
STATE DATE OF BIRTH (use MM/DD/YY format) SOCIAL SECURITY NUMBER
ZIP CODE
Other Dependent - Relationship:
NAME
ADDRESS
CITY
STATE
PHONE NUMBER
DATE OF BIRTH (use MM/DD/YY format) SOCIAL SECURITY NUMBER
ZIP CODE
3
Important Contacts
Attorney Information
NAME ADDRESS
CITY
PHONE NUMBER
STATE
ZIP CODE
Landlord Information
NAME ADDRESS
CITY PHONE NUMBER
STATE
ZIP CODE
Financial Planner Information
NAME ADDRESS
CITY PHONE NUMBER
STATE
ZIP CODE
Accountant Information
NAME ADDRESS
CITY PHONE NUMBER
STATE
ZIP CODE
Tax Preparer
NAME ADDRESS
CITY PHONE NUMBER
STATE
ZIP CODE
4
Important Contacts, cont'd.
Primary Care Physician Information
NAME
ADDRESS
CITY
STATE
PHONE NUMBER
Specialist Physician Information - Specialty:
NAME ADDRESS
CITY
STATE
PHONE NUMBER
Specialist Physician Information - Specialty:
NAME ADDRESS
CITY
STATE
PHONE NUMBER
Other Contact:
NAME
ADDRESS
CITY
STATE
PHONE NUMBER
ZIP CODE ZIP CODE ZIP CODE ZIP CODE
Other Contact:
NAME ADDRESS
CITY PHONE NUMBER
STATE
ZIP CODE
5
Important Document Directory
FAMILY DOCUMENTS Social Security Card Driver's License Number Birth Certificate Passport/Visa Marriage Certificate Pre-Nuptial Agreement Divorce Decree Adoption Document(s) Military Discharge/Military ID Green Card/Naturalization Papers
LOCATION
FINANCIAL DOCUMENTS Deeds/Titles to Property Life Insurance Document(s) Auto Insurance Document(s) Home Insurance Document(s) Health Insurance Document(s) Loan Document Retirement Benefit Statement(s) Investments and Savings Document(s) State & Federal Income Tax Returns Employer/Union Benefits Information
LOCATION
ESTATE PLANNING Will Living Will Power of Attorney HIPAA Document(s) Trust Name Change Letter of Instruction
LOCATION
OTHER DOCUMENTS
LOCATION
6
Financial Information
Safety Deposit Box
LOCATION OF SAFETY DEPOSIT BOX KEYS NAME OF INSTITUTION ADDRESS
Savings Account
ACCOUNT NUMBER BANK NAME/LOCATION BANK PHONE
Savings Account (additonal)
ACCOUNT NUMBER BANK NAME/LOCATION BANK PHONE
Checking Account
ACCOUNT NUMBER BANK NAME/LOCATION BANK PHONE
Checking Account (additional)
ACCOUNT NUMBER BANK NAME/LOCATION BANK PHONE
Checking Account (additional)
ACCOUNT NUMBER BANK NAME/LOCATION BANK PHONE
ACCOUNT HOLDER WEBSITE/PASSWORDS LOCATION OF STATEMENTS
SAFETY DEPOSIT BOX NUMBER PHONE
ACCOUNT HOLDER WEBSITE/PASSWORDS LOCATION OF STATEMENTS
ACCOUNT HOLDER WEBSITE/PASSWORDS LOCATION OF STATEMENTS
ACCOUNT HOLDER WEBSITE/PASSWORDS LOCATION OF STATEMENTS
ACCOUNT HOLDER WEBSITE/PASSWORDS LOCATION OF STATEMENTS
7
Financial Information, cont'd.
Social Security Account Information
ACCOUNT NUMBER BANK NAME/LOCATION
BANK PHONE
ACCOUNT HOLDER WEBSITE/PASSWORDS LOCATION OF STATEMENTS
Loan Information
LENDER ACCOUNT NUMBER/WEBSITE/PASSWORDS
AMOUNT OF LOAN
LOCATION OF STATEMENTS
MONTHLY PAYMENT OF
DEBTOR DATE OF LOAN (use MM/DD/YY format) QUARTERLY PAYMENT OFI INTEREST RATE COLLATERAL
DUE DATE
Loan Information (additional)
LENDER
ACCOUNT NUMBER/WEBSITE/PASSWORDS
AMOUNT OF LOAN
MONTHLY PAYMENT OF
LOCATION OF STATEMENTS
DEBTOR DATE OF LOAN (use MM/DD/YY format) QUARTERLY PAYMENT OFI INTEREST RATE COLLATERAL
DUE DATE
Real Estate Information
LOCATION OF PROPERTY DOCUMENTS PROPERTY OWNER LEGAL DESCRIPTION PROPERTY ADDRESS MORTGAGE OWNER MORTGAGE OWNER ADDRESS
TYPE OF PROPERTY PROPERTY VALUE
PHONE
Retirement Fund
LOCATION OF STATEMENTS/WEBSITE/PASSWORDS
ACCOUNT NUMBER
ACCOUNT OWNER
VALUE
AS OF
Investment Account
LOCATION OF STATEMENTS/WEBSITE/PASSWORDS
ACCOUNT NUMBER
ACCOUNT OWNER
VALUE
AS OF
8
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