Personal Information
Client #1: ___________________________________________________________________ Date of Birth: _______________________ U.S. Citizen? Yes No Occupation: __________________________________________________________________ Own a business? Yes No
Gender: Male Female Relationship to Client #2: Spouse Domestic Partner Other
Client #2: ___________________________________________________________________ Date of Birth: _______________________ U.S. Citizen? Yes No Occupation: __________________________________________________________________ Own a business? Yes No
Gender: Male Female Relationship to Client #1: Spouse Domestic Partner Other
Street Address: _____________________________________________City/State/Zip: _________________ Phone No.: ____________
Do you have a prenuptial or other written agreement regarding the division of assets between the two of you? Yes No
Children Children of:
Name: ________________________________________________________________________ Date of Birth: _________ Client #1 Client #2 Both Name: _________________________________________________________________________ Date of Birth: _________ Client #1 Client #2 Both Name: _________________________________________________________________________ Date of Birth: _________ Client #1 Client #2 Both Name: _________________________________________________________________________ Date of Birth: _________ Client #1 Client #2 Both
Grandchildren Grandchildren of:
Name: _________________________________________________________________________ Date of Birth: _________ Client #1 Client #2 Both Name: _________________________________________________________________________ Date of Birth: _________ Client #1 Client #2 Both Name: _________________________________________________________________________ Date of Birth: _________ Client #1 Client #2 Both Name: _________________________________________________________________________ Date of Birth: _________ Client #1 Client #2 Both
VLCM-43D VLNYCM-43B
Pacific Life Insurance Company is licensed to issue individual life insurance and annuity products in all states except New York.
Product availability and features vary by state. Individual life insurance and annuity products are available in New York through Pacific Life & Annuity Company.
EstatE Planning Fact FindEr
Personal Information 1 Income Information 5
Estimate Net Worth (Assets less Liabilities) 2 Life Insurance 5
Estimate Planning Goals 2 Qualified Plan/IRA Assets 5
Business Ownership 3 Current Estate Plan 6
Assets 4 Advisors and Fiduciaries 7
Table of Contents
Investment and Insurance Products: Not a Deposit — Not FDIC Insured
— Not Insured by any Federal Government Agency — No Bank Guarantee — May Lose Value
This fact finder is provided to help you and your insurance professional better understand your goals and objectives. Please return the information to your insurance professional and not to Pacific Life or Pacific Life & Annuity as we cannot and do not provide financial, legal or tax advice.
Estimated Net Worth (Assets less liabilities)
Client #1: ______________________________________________________________
Client #2: ______________________________________________________________
Combined: _____________________________________________________________
Estate Planning Goals
What do you want to do with your assets and/or business when you die:
Client #1:
Client #2:
What are your biggest concerns when it comes to your estate?
Client #1:
Client #2:
Do you have parents, siblings or children that have special needs or considerations?: Yes No If yes, what are they?
Client #1:
Client #2:
Do either of you have any continuing obligations under a divorce decree or property settlement?
Client #1:
Client #2:
Estate Planning Goals (continued)
Do you have any schools, charities, hospitals or other special organizations you want to remember in your estate planning?
Client #1:
Client #2:
The next questions will be about your assets and how they are owned. Before we start, what else do you want to tell me about your plans for your estate?
Client #1:
Client #2:
Business Ownership
Company Name: __________________________________________________ In business since: ___________________________
Entity: C Corp S Corp Limited Liability Company Partnership Sole Proprietor Other:
What type of business is it? (describe)______________________________________________________________________________
Who started the business?_______________________________________________________________________________________
Number of employees:____________ Annual Revenue: $___________________Annual Cash Flow: ___________________
Ownership: Client #1 Client #2 Both Percentage Ownership: 100% ________%
If less than 100%, who are the other owners and how much do they own? _________________________________________________
What are your plans for the business when you retire? _________________________________________________________________
If you become disabled, what happens to the business? ________________________________________________________________
Are any other family members involved in the business? _______________________________________________________________
How are the other family members affected if you die? ________________________________________________________________
In the event of your death, what happens to the business? ______________________________________________________________
Is there an existing buy-sell agreement? Yes No What type? ______________________________________________________
How is the purchase price determined? ____________________________________________________________________________
Business Ownership (continued)
If more than one company owned, complete the following:
Company Name: __________________________________________________ In business since: ___________________________
Entity: C Corp S Corp Limited Liability Company Partnership Sole Proprietor Other:
What type of business is it? (describe)______________________________________________________________________________
Who started the business?_______________________________________________________________________________________
Number of employees:____________ Annual Revenue: $___________________Annual Cash Flow: ___________________
Ownership: Client #1 Client #2 Both Percentage Ownership: 100% ________%
If less than 100%, who are the other owners and how much do they own? _________________________________________________
What are your plans for the business when you retire? _________________________________________________________________
If you become disabled, what happens to the business? ________________________________________________________________
Are any other family members involved in the business? _______________________________________________________________
How are the other family members affected if you die? ________________________________________________________________
In the event of your death, what happens to the business? ______________________________________________________________
Is there an existing buy-sell agreement? Yes No What type? _______________________________________________________
How is the purchase price determined? ____________________________________________________________________________
Assets
Asset Owner1 Market Value Liability Growth Rate
Residence Real Estate Securities Business Cash Vehicles
Personal Property
1 C1=Client #1, C2=Client #2, J=Joint Tenants, CP=Community Property, IT=Irrevocable Trust. If co-owned with other individuals or entities please indicate
percentage of ownership.
Income Information
Income Source Client #1 Client #2
Salary/Bonus Other Income Income Tax Bracket
Life Insurance
Insured Type2 Owner3 Death Benefit Surrender Value Annual Premium Beneficiary Client #1
Client #2 Joint
2 Type: Permanent, Term, Group Term, Survivorship
3 C1=Client #1, C2=Client #2, J=Joint Tenants, CP=Community Property, IT=Irrevocable Trust
Qualified Plan/IRA Assets
Plan 1
Qual Plan IRA Acct.
Plan 2
Qual Plan IRA Acct.
Plan 3
Qual Plan IRA Acct.
Plan 4
Qual Plan IRA Acct.
Participant Client #1 Client #2 Client #1 Client #2 Client #1 Client #2 Client #1 Client #2 Community Property
Plan Type Current Balance Beneficiary
Annual Contributions Continue Contributions for Years
Percent Increase in Contribution per Year Assumed Earnings Rate Defined Benefit Plan Benefit Amount Payable Number of Years Benefit Payable
Current Estate Plan
Client #1 Client #2
Existing wills? Yes No Yes No
When was your will last updated? ______________________________________________
Existing revocable living trust? Yes No Yes No
When was your revocable living trust last updated? _________________________________
Does your will or revocable trust establish a credit shelter trust or otherwise use your estate tax exemption amount?
Yes No Yes No Have you determined how your estate will be divided at death? (Use % of estate or specific $ amount)
Client #1
What are the provisions for Client #2? ____________________________________________________________________________
What are the provisions for the children? ___________________________________________________________________________
Do you want to equalize children’s inheritances? Yes No
Other: _____________________________________________________________________________________________________
Client #2
What are the provisions for Client #1? ____________________________________________________________________________
What are the provisions for the children? ___________________________________________________________________________
Do you want to equalize children’s inheritances? Yes No
Other: _____________________________________________________________________________________________________
Have you used any of your lifetime exemption amount? If yes, please indicate specific amount.
Client #1: _________________________________________ Client #2: ______________________________________________
Client #1 Client #2
Existing powers of attorney for financial matters? Yes No Yes No
Existing powers of attorney for health care? Yes No Yes No
Current Gifts:
Annual Amount: $ _______________________________ To Whom: ___________________________________________________
Made by: Client #1 Client #2 Both
Annual Amount: $ _______________________________ To Whom: ___________________________________________________
Made by: Client #1 Client #2 Both
Annual Amount: $ _______________________________ To Whom: ___________________________________________________
Made by: Client #1 Client #2 Both
Annual Amount: $ _______________________________ To Whom: ___________________________________________________
Made by: Client #1 Client #2 Both
Annual Amount: $ _______________________________ To Whom: ___________________________________________________
Made by: Client #1 Client #2 Both
Advisors and Fiduciaries
Attorney
Name: _________________________________________ Telephone Number: __________________________________________
Accountant
Name: _________________________________________ Telephone Number: __________________________________________
Guardians
Initial: _________________________________________ Telephone Number: __________________________________________
Successor: ______________________________________ Telephone Number: __________________________________________
Executors/Trustees
Initial: _________________________________________ Telephone Number: __________________________________________
Successor: ______________________________________ Telephone Number: __________________________________________
Notes
Pacific Life Insurance Company is licensed to issue individual life insurance and annuity products in all states except New York.
Product availability and features vary by state. Individual life insurance and annuity products are available in New York through Pacific Life & Annuity Company. Each company is solely responsible for the financial obligations accruing under the policies it issues,
and its product and rider guarantees are backed by that company’s financial strength and claims-paying ability.
Variable insurance products issued by Pacific Life Insurance Company and Pacific Life & Annuity Company are distributed by Pacific Select Distributors, Inc. (member FINRA & SIPC), a subsidiary of Pacific Life and an affiliate of Pacific Life & Annuity, and are available through licensed third-party broker-dealers. Pacific Life Insurance Company’s and Pacific Life & Annuity Company’s individual life insurance products are marketed exclusively through independent third-party producers, which may include bank-affiliated entities.
Life Insurance Division Address:
45 Enterprise, Aliso Viejo, CA 92656 (800) 800-7681 • www.PacificLife.com
Life Insurance Division Mailing Address:
45 Enterprise, Aliso Viejo, CA 92656 (888) 595-6996 • www.PacificLifeandAnnuity.com
VLCM-43D 15-21232-06 7/08
VLNYCM-43B 85-22118-03
Insurance Professional’s Name
State Insurance License Number (or affix your business card)
