SECTION 1. PERSONAL INFORMATION

Title :
Surname:
First Name:
Other Names:
Residential Address:
GenderMaleFemale
Telephone:
Email address:

SECTION 2. BENEFICIARY DETAILS

A

Full Name:
Date
Telephone:
Relationship:
GenderMaleFemale

INSURANCE POLICIES:

Name of insurer:
Policy No:
Policy Type:
Beneficiar(ies) and proportion: r:

C

Name:

Residential Address:
Telephone:
Nationality:
GenderMaleFemale

SECTION 4. PRIMARY GUARDIAN (where you have a child(ren) below the age of 18 years)
The person chosen should be willing to assume this responsibility should the unplanned happen. The other parent of the child should legally be the primary guardian except you can provide sufficient reason why he or she should not. The reason will be included in your will document)

Name:
Relationship:
Residential Address:
Telephone:
Nationality:
GenderMaleFemale

E
FIXED ASSETS:

Property Description (Property Type, Building style, Beacon :
Number, Survey Plan Number Registration Number etc :
Property Address/Location

F MOVEABLE ASSETS (Cars, personal property etc):

Type of Moveable Asset:
Unique Identifier (Registration Number, Maker, Model, Color etc.):
Beneficiar(ies) and proportion:

NAMING YOUR TRUST:
It's common to name your trust as defaulted below. However, you may give your trust its own unique name:
It should end with the word Trust.

Name Trust:

G
DETAILS OF OTHER INVESTMENTS:

Type of Investment:
Investment Account Number:
Description/ Additional Information: :
Beneficiar(ies) and proportion:

H
RESIDUAL ASSETS

(Assets not contained above to which you may acquire or become entitled to afterwards):

SECTION 3. PERSONAL REPRESENTATIVES

C

Full Name:
Date
Telephone:
Relationship:
GenderMaleFemale

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SECTION 5. LIST OF ASSETS
If the space provided is insufficient

A
SHARES/STOCKS

Company:
Name & Address of Stockbroker:
No of Units:
CSCS NO:

BANK DETAIL

Bank Name & Branch:
Account Name:
Bank Verification No:
Account type:

C
DETAILS OF RETIREMENT SAVING ACCOUNT(RSA):

RSA Number:
Limited. I affirm that I am aware and take cognizance of my rights under the relevant data protection laws in Nigeria and other terms detailed in the data protection and privacy policy of PAC Trustees Limited available on www.pactrustees.com/privacypolicy. I authorize and consent that any person who may have, or hereafter acquire, any information about my records may disclose such information to PAC Trustees.

Instruction form completed and consent given on …