My personal beneficiary planner - American Senior Benefits

1 My personalbeneficiary plannercompliments ofFIRST 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 _____m single m Married m WidoW/WidoWer m divorcedWhere is your Marriage certificate? _____Maiden naMe _____spouse s naMe _____phone # _____ eMail _____nuMber of children _____children s naMes: _____phone # _____ _____ phone # _____ _____ phone # _____ _____ phone # _____ how to use this planning tool to keep everything your loved ones will need in one place: using your personal beneficiary plannerThis unique beneficiary planner has been designed to help you keep the right information available for a family member or friend.

2 It organizes: Important Contacts Insurance Policies Important Documents Financial InformationMarital and faMily statuscurrent eMployMent status: m actively Working m retiredCurrenT or LasT empLoyer s name: _____address _____ city_____ state _____ Zip _____phone #_____ faX # _____eMail _____are you a veteran? m veteran m non-veteranif you are a veteran, provide serial # _____branch of service _____ rank at discharge _____discharge date _____ discharge place _____Where are your Military discharge papers?

3 _____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 _____eMployMentMilitary servicepetsWhere are your legal docuMents? _____attorney s naMe _____ address _____city_____ state _____ Zip _____phone #_____ faX # _____eMail _____did this attorney handle your Will?

4 M yes m no Where are your Medical records? _____doctor s naMe _____ address _____city_____ state _____ Zip _____phone #_____ faX # _____eMail _____Where are your taX forMs? _____accountant s naMe _____ address _____city_____ state _____ Zip _____phone #_____ faX # _____eMail _____do you have a Will? m yes m no Where is your Will? _____ _____do you have a safe deposit boX? m yes m no boX # _____Where is your safe deposit boX? _____address _____city_____ state _____ Zip _____Where is your boX key?

5 _____attorneypriMary care physicianaccountantiMportant docuMentsinsuranceList all Life, Health, Disability, Homeowner s and Auto PoliciesWhere 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.

6 _____ contact _____type of policy_____policy # _____ aMount $ _____address _____city_____ state _____ Zip _____phone #_____ user id _____Website _____ passWord _____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 _____bank accountsList All Major and Department Store Credit Cards Where are your credit cards and stateMents?

7 _____comPaNy _____ account # _____address _____city_____ state _____ Zip _____phone #_____ user id _____Website _____ passWord _____comPaNy _____ account # _____address _____city_____ state _____ Zip _____phone #_____ user id _____Website _____ passWord _____comPaNy _____ account # _____address _____city_____ state _____ Zip _____phone #_____ user id _____Website _____ passWord _____Where are your stateMents and account inforMation? _____ _____tyPe _____ account # _____comPaNy _____ contact _____address _____city_____ state _____ Zip _____phone #_____ user id _____Website _____ passWord _____tyPe _____ account # _____comPaNy _____ contact _____address _____city_____ state _____ Zip _____phone #_____ user id _____Website _____ passWord _____credit cardsreceivablesWhere are your stateMents and account inforMation?

8 _____ DeBT Type _____ account # _____comPaNy _____ contact _____address _____city_____ state _____ Zip _____phone #_____ user id _____Website _____ passWord _____DeBT Type _____ account # _____comPaNy _____ contact _____address _____city_____ state _____ Zip _____phone #_____ user id _____Website _____ passWord _____Where are your stateMents and account inforMation? _____InvesTmenT Type _____ account # _____comPaNy/broker _____ contact _____address _____city_____ state _____ Zip _____phone #_____ user id _____Website _____ passWord _____InvesTmenT Type _____ account # _____comPaNy/broker _____ contact _____address _____city_____ state _____ Zip _____phone #_____ user id _____Website _____ passWord _____InvesTmenT Type _____ account # _____comPaNy/broker _____ contact _____address _____city_____ state _____ Zip _____phone #_____ user id _____Website _____ passWord

9 _____investMents stocks, bonds & Mutual fundsdebtsWhere are your stateMents and account inforMation? _____PlaN tyPe _____ account # _____comPaNy/broker _____ contact _____address _____city_____ state _____ Zip _____phone #_____ user id _____Website _____ passWord _____PlaN tyPe _____ account # _____comPaNy/broker _____ contact _____address _____city_____ state _____ Zip _____phone #_____ user id _____Website _____ passWord _____PlaN tyPe _____ account # _____comPaNy/broker _____ contact _____address _____city_____ state _____ Zip _____phone #_____ user id _____Website _____ passWord _____Where is your

10 Mortgage/lease agreeMent/deed? _____prImary resIDenCe m rent m oWn select one: m landlord m bank or Mortgage co. comPaNy _____ contact _____address _____city_____ state _____ Zip _____phone #_____ faX # _____Website _____user id _____ passWord _____real estateretireMent plans, investMents & pension plansyour vehiclesWhere is your Mortgage/lease agreeMent/deed? _____properTy Type:_____ account # _____comPaNy _____ contact _____address _____city_____ state _____ Zip _____phone #_____ faX # _____Website _____user id _____ passWord _____ProPerty tyPe _____ account # _____comPaNy _____ contact _____address _____city_____ state _____ Zip _____phone #_____ faX # _____Website _____user id _____ passWord _____Be sure to include all recreational is your registration/inspection/title?