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Life Planning Checklist
This form can be completed online and printed. This information is not saved online.
We highly recommend that you review and update all information on this checklist every year on your birthday.
In the event I become seriously ill or die, I have completed/updated the following information for the use of my loved ones. I hope this Life Planning Checklist makes life a little easier for you at a difficult time. This Life Planning Checklist is not intended to act as a legal document, nor is it my intent that this document shall amend or modify any legal document that I have previously executed or subsequently execute.
Date:
Full Legal Name:
Nickname (also known as):
Current address:
Current phone number:
Social security number (you may want to fill
in only the last four digits):
Date of birth:
Place of birth:
State residency (e.g., where you vote,
driver’s license, address on tax return):
Primary Contact Information – if I become seriously
ill or die, my primary contact should be (name,
relationship, address, and phone number):
Primary care physician’s name & phone number: Specialist’s name, specialty & phone number: Specialist’s name, specialty & phone number:
Specialist’s name, specialty & phone number:
Optometrist/Ophthalmologist’s name & phone
number:
Dentist’s name & phone number:
Health insurance plan name, phone number & ID#:
Optical insurance plan name, phone number & ID#:
Dental insurance plan name, phone number & ID#:
Medications & dosages:
Allergies:
_________________________________________________________________________
KEY CONTACTS (name, address and office phone number)
Name:
Address:
Office Phone Number:
Accountant/CPA:
Attorney:
Banker(s)/bank branch(es):
Clergy:
Credit Card Company(s):
Funeral director/funeral home:
Home health care provider or nursing home (preferred):
Hospital (preferred):
Human resources contact (current or prior employment):
Insurance agent/property and casualty:
Investment advisor/financial planner:
Landscaping/property management:
Life insurance agent:
Neighbors (who may have a key to the house, security codes, will collect the mail, water the plants, etc.):
Service providers (plumber, electrician, HVAC, telephone, cable/satellite, exterminator, garbage, etc.):
_________________________________________________________________________
Pet(s)
Pet(s) name(s):
Veterinarian name & phone number:
Special considerations/instructions:
_________________________________________________________________________
IMPORTANT DOCUMENTS
[ General items – documents that should be readily available ]
Adoption papers
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Birth certificate _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Driver’s license _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Marriage certificate _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Passport/citizenship _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Prenuptial agreement _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Safe and combination/key _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Safe deposit box(es) and keys _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Social security card _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Other: _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
[ Investment Documents ]
529 college saving plans _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Alternative investments _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Bearer bonds (not in an account) _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Beneficiary forms _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Company retirement plans _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Cost basis documentation _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Investment account statements _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Investment club documents _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Stock certificates (not in an account) _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Other company benefits _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Other: _________________________________________________________________________
Name of document:
Exists:
Location/Comments :
[ Insurance and annuity documents ]
Accident insurance
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Annuity policies
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Auto insurance
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Group life policies
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Homeowner’s insurance
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Life insurance policies
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Mortgage insurance
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Specific illness coverage
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Travel insurance
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Veteran’s benefits
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Other:
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
[ Personal financial documents ]
Appraisal of personal property
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Checking account statements
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Credit card statements
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Buy/sell or partnership agreement
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Deferred compensation agreement
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Federal/state gift tax returns
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Federal/state/local income tax returns
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Loans outstanding (owed by you)
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Medical bills/records
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Mortgage documents
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Motor vehicle title(s)
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Pending legal issues
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Promissory notes (owed to you)
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Property tax records
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Real estate deeds
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Rental and/or lease agreements
Saving/money market statements
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Other:
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
[ Estate documents ]
Durable/financial power of attorney
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Last will and testament
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Letter of instructions to executor
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Will to Live/Health Care Power of Attorney
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Trust documents
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Other:
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
[ Other documents ]
Cemetery plot deed
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Military discharge papers
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Prepaid funeral documentation
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Other:
_________________________________________________________________________
Name of document:
Exists:
Location/Comments :
Oftentimes physicians want to know the health history of parents and grandparents. Many times this information is unavailable. For the benefit of current and future generations, please list major/chronic health problems that you and your loved ones have suffered from, including age of onset, treatment and severity:
_________________________________________________________________________
Burial instructions
Funeral home/director’s name and phone number:
Cremation or burial and location:
Eulogy to be given by:
Flowers:
Hymns::
Officiate (pastor/priest/rabbi/etc.):
Pallbearers:
Scripture to be read:
Wording on memorial:
_________________________________________________________________________
Obituary
I would like to have the following information included in my obituary::
Spouse:
Date of marriage:
Children of this marriage:
Children of previous marriage/other children:
Grandchildren:
Greatgrandchildren:
Father’s name:
Mother’s name:
Other family members:
Religious affiliation:
Military service:
Fraternal or civic organizations:
In lieu of flowers, please send donations to
Other relationships, personal information or accomplishments
_________________________________________________________________________
Memories We’d like to share from the heart
The people, places, events, organizations and causes that have meant the most to me, for the following reasons, are:
The things or accomplishments that I am most proud of are:
The actions, words or events that I regret the most are:
The words of wisdom/sentiment that I would like to share with my loved ones are
The hopes and dreams that I hold for my loved ones are
Note: You may want to give a printed copy to a trusted loved one, or tell them where it is. You may want to give it to them in a sealed envelope with instructions to open only in case of serious illness or death. To guard against identity theft, please make sure that all copies of this document are kept in a secure place and do not send a completed version by email.
If you would like to give family members an electronic copy of your personal documents, e.g., last will & testament, powers of attorney, etc., you can scan your documents and covert them into a PDF format, which can easily be viewed or printed. This Life Planning Checklist is provided courtesy of:
Victory Investment Strategies
501 N. Nolan River Road, Cleburne, TX 76033
Tel : 8176456800 Fax : 8176456690
Email: joel.victory@
Securities and Advisory services offered through LPL Financial.
A registered investment advisor. Member FINRA & SIPC.
501 N. Nolan River Road, Cleburne, TX 760334524
Tel : 8176456800 Toll Free: 8668106800 Fax : 8176456690
Email: joel.victory@
Securities and Advisory services offered through LPL Financial. A registered investment advisor. Member FINRA & SIPC.
The LPL Financial representative associated with this website may discuss and/or transact securities and insurance with residents of the following states: AR, CT, GA, IN, LA, MD, NE, NY, OK ,TX and WA.
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