Please type up & and email back 1. Your Full Name: _____ 2. Spouse's Full Name: First Last ___ 3. Your Address: ____ 4. Cell: ______ 5 Your email __ 6. PRIMARY Choice of Executor/Personal Representative in Power of Attorney: Name: ______ 7. SECOND Choice of Executor Name: Name: ______ 8 In the Will- Who do you want to get your assets & who gets if beneficiary died: Beneficiary (1) _______________________ Relationship _______________ Beneficiary (2) _______________________ Relationship _______________ Beneficiary (3) _______________________ Relationship _______________ Referred by __ If Legal Plan Metlife what is member ID ____ If ARAG or Legalease or UAW, type case # : ___ Any Specific Bequests of Money and Property : _______________________ Email questions or concerns do you have: ___ Are any children or beneficiaries under age 18? __ Save as word doc or text with your name and email back with your name in subject line. We also use this form if someone only needs a Power of Attorney |