SINGLE WILL APPLICATION FORM

Full Name(s) and Surname *

As it appears on the identity document

Identity Number *

Date of Birth *

Marital Status *

Please select one

Select One *

Physical Address *

Address 1

Address 2

City

State / Province

(copy) (copy) (copy)

Zip / Postal Code

Country

Email *

Postal Address

Address 1

Address 2

(copy)

City

(copy)

State / Province

(copy) (copy) (copy) (copy)

Zip / Postal Code

(copy)

Country

Contact Number *

(###) ### ####

List of Assets *

Including approximate values

List of Liabilities *

Including approximate values

Would You Like To Make Use Of A Testamentary Trust In Your Will? If So, Kindly Briefly State The Purpose Of The Trust

Nominated Executor(s) *

Special Wishes (If Relevant)

Cremation

Special Wishes (If Relevant)

Living Will

Special Wishes (If Relevant)

Registered Organ Donor

Additional Information And / Or Special Requests Which Your Will Draftsman Must Be Aware Of