My personal beneficiary planner - American Senior Benefits

My personal beneficiary planner

compliments of

Using your personal beneficiary planner

How to use this planning tool to keep everything your loved ones will need in one place:

This unique beneficiary planner has been designed to help you keep the right information available for a family member or friend. It organizes:

? Important Contacts ? Important Documents

? Insurance Policies ? Financial Information

FIRST NAME __________________________________________ MIDDLE NAME_________________________________ LAST NAME____________________________________________________________________________________________ CURRENT Address____________________________________________________________________________________ City________________________________________ State _______ Zip_________________________________________ DRIVER'S LIC. NO. _________________________________ Social Security No._____________________________ Where are your License and SSN Card? ___________________________________________________________ Date of Birth _____________________________________ Place of Birth_________________________________ WHERE IS YOUR BIRTH CERTIFICATE? __________________________________________________________________ HOME PHONE # ________________________________________CELL PHONE # ________________________________ EMAIL ____________________________________________________ PASSWORD ________________________________

MARITAL and Family status

m Single m Married m Widow/Widower m Divorced Where is your Marriage Certificate? _____________________________ Maiden Name_____________________________________________________

Spouse'S NAME________________________________________________________________________________

PHONE # __________________________________ EMAIL______________________________________________

Number of Children _________________________________________________________________________

Children's Names: ________________________________Phone #___________________________________

___________________________________________________ Phone #__________________________________

___________________________________________________ Phone #__________________________________

___________________________________________________ Phone #__________________________________

EMPLOYMENT Current Employment Status:

m Actively Working m Retired

Current or Last Employer's Name:____________________________________________

Address______________________________________________________________________________

City________________________________________ State _______ Zip__________________________

PHONE #__________________________________________ FAX #______________________________

EMAIL_________________________________________________________________________________

MILITARY SERVICE

Are you a Veteran?

m Veteran

m Non-Veteran

If you are a Veteran, provide Serial #__________________________________________________

Branch of Service____________________________________________________________________

Rank at Discharge____________________________________________________________________

Discharge Date ______________________________________________________________________

Discharge Place______________________________________________________________________

Where are your Military Discharge Papers?____________________________________________

PETS

Pet's Name______________________________________________________________ Type of Animal/Breed _____________________________________________________

Medication___________________________________________________________________________

Pet's Name__________________________ Type of Animal/Breed________________________

Medication___________________________________________________________________________

Other Important Information AND COMMENTS:

Animal Hospital ______________________________________________________________________

Where are your Pet's Medical Records?_______________________________________________

Veterinarian's Name__________________________________________________________________

Address______________________________________________________________________________

City________________________________________ State _______ Zip__________________________

PHONE #__________________________________________ FAX #______________________________

EMAIL_________________________________________________________________________________

ATTORNEY Where are your Legal Documents?__________________________________

Attorney's Name____________________________________________________

Address______________________________________________________________________________

City________________________________________ State _______ Zip__________________________

PHONE #__________________________________________ FAX #______________________________

EMAIL_________________________________________________________________________________

Did this Attorney handle your will?

m Yes m No

Primary Care Physician

Where are your Medical Records?______________________________ DOCTOR's Name________________________________________________

Address________________________________________________________

City________________________________________ State _______ Zip__________________________

PHONE #__________________________________________ FAX #______________________________

EMAIL_________________________________________________________________________________

ACCOUNTANT Where are your TAX FORMS?_____________________________________

ACCOUNTANT's Name___________________________________________ Address______________________________________________________________________________ City________________________________________ State _______ Zip__________________________ PHONE #__________________________________________ FAX #______________________________

EMAIL_________________________________________________________________________________

IMPORTANT DOCUMENTS

Do you have a will?

m Yes m No

Where IS YOUR WILL?_________________________________________

_____________________________________________________________

m m DO you have a safe deposit box?

Yes

No

BOX #_______________________

Where is your Safe Deposit Box? ______________________________________________________

Address______________________________________________________________________________

City________________________________________ State _______ Zip__________________________

Where is your Box Key?________________________________________________________________

INSURANCE

List all Life, Health, Disability, Homeowner's and Auto Policies

Where are your policies?__________________________________________

Insurance Co. ____________________________________ Contact_______________________________

Type of Policy__________________Policy # ___________________ Amount $_______________________

Address______________________________________________________________________________________

City________________________________________ State _______ Zip__________________________________

PHONE #__________________________________________ User id_____________________________________

website _________________________________________ Password___________________________________

Insurance Co. ____________________________________ Contact_______________________________

Type of Policy__________________Policy # ___________________ Amount $_______________________

Address______________________________________________________________________________________

City________________________________________ State _______ Zip__________________________________

PHONE #__________________________________________ User id_____________________________________

website _________________________________________ Password___________________________________

Insurance Co. ____________________________________ Contact_______________________________

Type of Policy__________________Policy # ___________________ Amount $_______________________

Address______________________________________________________________________________________

City________________________________________ State _______ Zip__________________________________

PHONE #__________________________________________ User id_____________________________________

website _________________________________________ Password___________________________________

BANK ACCOUNTS

List all Checking, Savings, Money Market and CDs

Where are your Statements and Account Information?______________________________

Bank/Credit Union ____________________________________ Contact________________________

Type of account________________________ account #_________________________________________

Address______________________________________________________________________________________

City________________________________________ State _______ Zip__________________________________

PHONE #__________________________________________ User id_____________________________________

website _________________________________________ Password___________________________________

Bank/Credit Union ____________________________________ Contact________________________

Type of account________________________ account #_________________________________________

Address______________________________________________________________________________________

City________________________________________ State _______ Zip__________________________________

PHONE #__________________________________________ User id_____________________________________

website _________________________________________ Password___________________________________

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download