Client Registration Form - Estate Administration

First Name of Deceased

Last Name of Deceased

Date of Birth of Deceased

IRD Number of Deceased

Please advise if possible.

Executor 1 | First Name

Executor 1 | Last Name

Executor 1 | Previous Name/s

Executor 1 | Date of Birth

Executor 1 | Phone Number

Executor 1 | Email

Executor 1 | Occupation

Executor 1 | IRD Number

Executor 1 | Citizenship

Executor 1 | Street Address Line 1

Executor 1 | Street Address Line 2

Executor 1 | Street Address Town/City

Executor 1 | Street Address Postcode

Executor 1 | Street Address Country

Executor 1 | Postal Address Line 1

If different from street address.

Executor 1 | Postal Address Line 2

Executor 1 | Postal Address Town/City

Executor 1 | Postal Address Postcode

Executor 1 | Postal Address Country

Executor 2 | First Name

Executor 2 | Last Name

Executor 2 | Previous Name/s

Executor 2 | Date of Birth

Executor 2 | Phone Number

Executor 2 | Email

Executor 2 | Occupation

Executor 2 | IRD Number

Executor 2 | Citizenship

Executor 2 | Street Address Line 1

Executor 2 | Street Address Line 2

Executor 2 | Street Address Town/City)

Executor 2 | Street Address Postcode

Executor 2 | Street Address Country

Executor 2 | Postal Address Line 1

If different from street address.

Executor 2 | Postal Address Line 2

Executor 2 | Postal Address Town/City

Executor 2 | Postal Address Postcode

Executor 2 | Postal Address Country

Billing Contact | First Name

Billing Contact | Last Name

Billing Contact | Email

First Name of contact person at NWM (if known)

Surname of contact person at NWM (if known)

How did you hear about us?

Referral Details E.g. Google, Facebook; Name of existing client or NWM staff member; Name of other company/professional.

Name of person who filled out this form.

Agreement to terms.

By ticking this box and submitting this form, the person completing this form agrees that: 1) all of the information set out in this form is true, correct and complete; 2) they are authorised to legally bind the people and the businesses/entities described in this form; and 3) each of the people and businesses/entities described in this form agree to the Norris Ward McKinnon Terms and Conditions which are available at nwm.co.nz/client-information.

Date