Online Will Form

Your personal details:

* Full name:
* Residential address:
* Phone (hm):
Phone (wk):
Mobile:
* Email:
Occupation:

Your spouse or partner details (if applicable):

Full name of spouse/partner:
Occupation:

Executors: (more information)

Details of your first choice/s:

Full Name	Address	Relationship to you (if any)

Details of your next choice/s (if applicable):

Full Name	Address	Relationship to you (if any)

Specific Bequest: (more information)

What are you gifting	Who is to receive it (full name)	Relationship to you (if any)

Residuary estate (after any specific gifts): (more information)

First level:

What share (if more than one)	Who is to receive it (full name)	Relationship to you (if any)

Second level (if all of the above die before you):

What share (if more than one)	Who is to receive it (full name)	Relationship to you (if any)

Guardians: (more information)

Who is appointed (full name/s)	Relationship to you (if any)

Super Fund details:

Name of Fund	Postal address of fund	Your member number

Funeral arrangements:

Who do you want to make your funeral arrangements?:

Any instructions you would like to give about your funeral arrangements
(eg cremation or burial):

Enduring Power of Attorney: (more information)

Would you like to make an Enduring Power of Attorney: No Yes

If yes, please also provide:

Full Name	Address of attorney/s

Feedback:

Any comments or feedback you have about our online will service.

* I agree to be contacted by a representative of Denise Maxwell, Solicitor. No Yes