Final Wishes Planner - Physicians Mutual

1 Final Wishes Planner A listing of your personal Wishes and records Final Wishes Planner For: Dear Friend, This Final Wishes Planner is a gift to you _____. and your family from Physicians Life Insurance Company. It's a convenient tool that will help you record all your Final Wishes and ensure Date Completed: your loved ones know what they are when they're needed. _____. By taking the time to record this important information, you can help lift the many responsibilities of making Final decisions from the ones you love. If you have life insurance, please be sure to let your beneficiary(ies) know. Completing this guide is a great way to put all your notes in one place. Once you have the Planner completed, simply give it to someone you trust or keep it with your other important documents, so it can be there when your loved ones need it.

2 Sincerely, Mark Nelson Vice President PMW-0011 Physicians Mutual , 2017. Personal Information Final Arrangements This information will be important for your Are your services pre-planned? q Yes q No family. It can help them get started and provide If yes, contact: the details they'll need along the way. _____. Name _____. Name (legal) (maiden). ( ). _____. Phone Number _____. Address My pre-planning documents are located: _____ _____. City State ZIP. _____. _____. Date of Birth State & County of Birth If your service isn't pre-planned, please complete the following: _____. Social Security Number (or where it can be found) My funeral home preference: _____. _____. Education/Degree _____. _____. Occupation I wish to be: buried q cremated q Burial Wishes : ( , cemetery, location, ashes).

3 _____. Mother's Full Maiden Name _____. _____ _____. Father's Full Name _____. _____. Person Who Will Handle My Affairs/Beneficiary I have purchased a plot: q Yes q No _____ My plot location: Attorney _____. _____. Completed By:_____ _____. Date:_____ _____. 1. PMW-0011 Physicians Mutual , 2017. Memorial Service Request Things I Would Like My place of worship: at the Service: My favorite flowers: _____. Name of Church, Synagogue, House of Worship _____. _____. religious Contact _____. _____ Songs or music I like: Address/Phone Number _____. Memorials should go to: ( , Humane Society, Red Cross, Cancer Society) _____. _____ _____. _____ My favorite readings, psalms or verses: _____ _____. My ceremony preferences: ( , no ceremony, _____. graveside ceremony, open/closed casket, wake, funeral mass, memorial service, rosary) _____.

4 _____ Special requests or prayers: _____ _____. _____ _____. _____ _____. Obituary information: ( , degrees, honors) _____. _____ Special quotes or poems I like: _____ _____. _____ _____. _____ _____. _____ _____. 2. PMW-0011 Physicians Mutual , 2017. Memorial card: q Yes q No Other People to Be Notified Would you like military honors? What people or organizations do you want q Yes q No notified if something happens to you? ( , friends, doctor, clubs). _____. _____. _____ Name/Relationship Other special notes or requests: ( , jewelry, _____. Phone Number clothing, personal items to be buried with). _____. _____ Name/Relationship _____ _____. Phone Number _____. _____. Name/Relationship _____. _____. _____ Phone Number _____ _____. Name/Relationship _____.

5 _____. Phone Number _____. My address book/contact list is located: _____. _____. _____. _____ People I would like as pallbearers: _____ _____. _____ _____. _____ _____. _____ _____. _____ _____. _____ _____. 3. PMW-0011 Physicians Mutual , 2017. Family Notes: ( , siblings in order of birth, Location of Important Papers preceded in death by, special mentions). I have a will or trust: q Yes q No _____ It is located: _____ _____. _____ The combination for my safe is known by: _____ _____. _____ Keys for my lockbox are located: _____ _____. _____ I have a life insurance policy(ies) and the papers are located: _____. _____. _____. _____. _____. My beneficiary(ies) are: _____. _____. _____. _____. _____. _____. _____. My birth certificate, marriage certificate, My beloved pets and who I wish to care for them: divorce documents, military discharge papers, tax returns and other important documents _____ are located: _____ _____.

6 _____ _____. _____ _____. _____ _____. _____ _____. 4. PMW-0011 Physicians Mutual , 2017. I have a mortgage or deed to my home: Place where I keep bank statements, deeds, q Yes q No Lender: or other important financial records: _____ _____. I have an auto registration/title: q Yes q No _____. _____ _____. I have retirement account records: _____. q Yes q No _____. _____. _____. I have checking or savings accounts: q Yes q No Where? (facility names). _____. _____. _____. Place where I keep my current bills: _____. Passwords for my online accounts, computers and phones are located: _____. _____. _____. _____. _____. 5. PMW-0011 Physicians Mutual , 2017.