1.	Your Full Name
2.	Your Full Address:
3.	Your Daytime Contact Number:
4.	Do you regard England or Wales as your home?	Yes No
5.	Do you pay taxes there?	Yes No
6.	Approximate value of your estate?
7.	Do you own property overseas?	Yes No
8.	Name(s) and address(es) of your executors	Appoint Jackson Barrett & Gass:
9.	Do you have children under 18?	Yes No
10.	If Yes, Childrens details
11.	Do you wish to appoint guardians?	Yes No
12.	If Yes, Guardians details
13.	Do you wish to leave somebody a gift of money>	Yes No
14.	If Yes, Money gift details
15.	Do you wish to leave somebody a gift (other than money)?	Yes No
16.	If Yes, Other gift details

Residue

"Residue" is what is left after gifts of money and objects, tax, funeral expenses, payment of any debts or mortgages, and administration costs.

17.	Do you initially wish to leave residue to a spouse/partner?	Yes No
18.	Who do you wish to receive the residue if you don't have a spouse/partner, or if they die before you?
19.	If you are leaving money to your children and one dies before you, do you want their share to be given to the survivor(s) or to your grandchildren?	Yes No
20.	If you choose grandchildren, do you wish to choose a specific age to receive the inheritance? (You can include this provision even if you do not have grandchildren at the moment)	Yes No
21.	Do you wish to choose another beneficiary, if for example your child/children die before you do, and you have no grandchildren? e.g. Another relative, a friend or a charity	Yes No
22.	Funeral Instructions - Do you wish to be buried or do you wish your body to be cremated with the ashes scattered?	Buried Cremated
23.	Would you like Jackson Barrett & Gass to be the firm who deals with your administration?	Yes No
24.	Would you like to prepare Lasting Powers of Attorney (LPAs)?	Yes No
25.	Would you like investment advice?	Yes No