Beneficiary
Planner
compliments of
Colonial Penn Life Insurance Company
399 Market Street • Philadelphia, PA 19181
SM
How to Use Your
Beneficiary Planner
T
his unique Beneficiary Planner has been prepared for
you by Colonial Penn Life Insurance Company as a
service to you. It has been specially designed to make it
very easy for you to tell a family member or friend where things are…
and what your wishes may be after you pass away. This helpful planning
guide provides room for you to fill in such vital information as…
◆
Where your important papers are;
◆
What needs to be taken care of;
◆
What bills need to be paid or accounts cancelled;
◆
And much more.
Please take some time to complete the information in this valuable
resource guide. (If you need additional room in specific areas, you
can add a sheet of paper.) Then, be sure to go over the information
with a trusted family member or friend, put this guide in a safe place,
and tell that person where the safe place is for their future reference.
We also recommend that you review the information periodically and
keep it up-to-date.
Preparing this information is a helpful way for you to get organized.
Plus, it will be a great help to your family, your friends, and even
your pets.
Full Name
Address
City
State Zip
Social Security No.
Date of Birth Place of Birth
Mother’s Maiden Name
More About You and Your Family
Single
❑
Married
❑
Widow/Widower
❑
Divorced
❑
Name of Spouse
Maiden Name
Number of Children
More About You and Your Family
continued
Children’s Names
Phone #
Phone #
Phone #
Phone #
About Your Employment
Actively Working
❑
Retired
❑
Employer
Address
City State Zip
Employer
Address
City
State Zip
About Your Military Service
If you are a veteran, provide serial #
Branch of Service Rank at Discharge
Date and Place of Discharge
Where are your Discharge Papers?
About Your Important Documents
Do you have a will? No
❑
Yes
❑
Where do you keep it?
Do you have a safe deposit box? No
❑
Yes
❑
Box #
Location of safe deposit box (bank, address)
Location of box key
About Your Important Documents,
continued
Where is your Birth Certificate?
Where is your Marriage Certificate?
About A Few Important People
Your attorney’s name, address, phone:
Your doctor’s name, address, phone:
Your accountant’s name, address, phone:
About Your Insurance
List all life, health, disability, homeowner’s, and auto policies.
Where are your policies?
Insurance Co.
Type of Policy
Address
Policy # Amount
Phone # Contact
Insurance Co.
Type of Policy
Address
Policy # Amount
Phone # Contact
Insurance Co.
Type of Policy
Address
Policy # Amount
Phone # Contact
About Your Bank/Credit Union Accounts
List all checking, savings, money market, and certificate of deposit accounts.
Bank or Credit Union
Address
Type of Account Account #
Phone # Contact
Bank or Credit Union
Address
Type of Account Account #
Phone # Contact
Bank or Credit Union
Address
Type of Account
Account #
Phone #
Contact
About Your Credit Cards
List all MasterCard, Visa, American Express, Discover, and
department store card accounts.
Company
Address
Account # Phone #
Company
Address
Account # Phone #
Company
Address
Account # Phone #
Company
Address
Account # Phone #
Company
Address
Account #
Phone #
About What Others Owe You
Include all Money, Objects, Mortgages and other debts owed to you.
Debt Type Account #
Company
Address
Phone # Contact
Debt Type Account #
Company
Address
Phone # Contact
About What You Owe Others
Include other debts, personal loans, notes, car loans and leases, etc.
Debt Type Account #
Company
Address
Phone #
Contact
Debt Type Account #
Company
Address
Phone # Contact
About Your Investments—
Stocks, Bonds and Mutual Funds
Investment Name
Account #
Company or Broker
Address
Phone # Contact
About Your Investments,
continued
Investment Name
Account #
Company or Broker
Address
Phone # Contact
Investment Name
Account #
Company or Broker
Address
Phone # Contact
Investment Name
Account #
Company or Broker
Address
Phone #
Contact
About Your Retirement Investments,
Plans and Pensions
Include all IRAs, Annuities, Keoghs, 401(K) Plans, Employee Stock Option Plans,
Pensions, and VA plans.
Plan Type
Account # Company
Address
Phone # Contact
Plan Type Account # Company
Address
Phone # Contact
Plan Type Account # Company
Address
Phone # Contact
About Your Real Estate
Primary Residence Rent
❑
Own
❑
Address
City
State Zip
Location of Deed
Landlord
❑
Bank or Mortgage Co.
❑
Name
Address
City State Zip
Phone # Contact
Other Real Estate Be sure to include all income property, time shares,
vacation homes, condos, commercial property, land, and the like.
Property Type
Account #
Company
Address
Phone #
Contact
Property Type Account #
Company
Address
Phone # Contact
About Your Vehicles
Be sure to include cars, trucks, boats, RV’s, etc.
Vehicle
Make
Model Year
Located At
Vehicle Make
Model Year
Located At
Vehicle Make
Model Year
Located At
ABOUT YOUR PETS
Pet’s Name_______________________________________________________
Favorite Food/Treats________________________________________________
Medication________________________________________________________
Pet’s Name_______________________________________________________
Favorite Food/Treats________________________________________________
Medication________________________________________________________
Other Important Information and comments:
_________________________________________________________________
_________________________________________________________________
Vet’s Name_____________________Phone #____________________________
Address___________________________________________________________
City__________________________________State_____Zip________________
ABOUT YOUR SPECIAL REQUESTS OR WISHES
(funeral wishes, people to notify, etc.)
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
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Notes
BN-14683-1102
© 2001, Colonial Penn Life Insurance Company.
This document is designed only to help you. It is in no way a legal document of any kind.
