Declaration of Estate Form

Client*

Account #*

Balance

Email*

Is the above account covered by Life Insurance or Payment Protector Insurance? YesNo

Given Name*

Middle Initial

Surname*

Date of Death (YYYY-MM-DD)*

Place of Death:

City*

Province*

Has the estate been probated? YesNo

If yes, in what Province?

Have the funeral expenses been paid? YesNo

Executor/Administrator/Personal Rep:

Full Name*

Address

Phone*

Email*

Copy of will to verify named executor (supported file types: png,jpg,pdf,docx - maximum file size: 1MB)

Barrister/Solicitor:

Full Name

Phone

Email

Real Estate Property

Address

Value and Equity

Is the above property in Joint Tenancy? YesNo

Investments and Assets

RSP/RRSP

Beneficiary Assignment

Mutual Funds

Beneficiary Assignment

Stocks/Bonds

Beneficiary Assignment

G.I.C.

Beneficiary Assignment

Checking/Savings

Beneficiary Assignment

Is the bank account a joint account? YesNo

Have the CPP Death Benefit been received and disbursed? YesNo

If not, what is the residual amount?

Cash on Hand

Life Insurance

Beneficiary Assignment

Vehicle (make/model/year)

Description of Additional Liabilities

Creditors and/or debts not mentioned above such as personal debts, crown debts, Canada Customs Revenue Agency, etc including amounts owed.

Payment of Outstanding Debt

What sources of funds are available for payment of the outstanding debt?

What is the proposed amount?

Date of Payment (YYYY-MM-DD)

Additional Information

Authorization

I hereby acknowledge the estate’s liability to the above-mentioned account and affirm that the information provided is correct and complete.
Confidentiality of the above information is guaranteed by the privacy act. Should you have questions or concerns contact one of our representatives at 1-888-797-7727.

Date (YYYY-MM-DD)*

Full Name*

Choose one*

By checking this box and clicking "Submit", I hereby acknowledge the estate’s liability to the above-mentioned account and affirm that the information provided is correct and complete.

Real Estate Property

Investments and Assets

Description of Additional Liabilities

Payment of Outstanding Debt

Authorization

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