Insurance & Guardianship Applicant 1 * First Name Last Name Applicant 2 First Name Last Name Do you have health insurance? * Yes No If yes, who is your current insurance carrier? Name of carrier and member ID Do you have life insurance? * Yes No If yes, what is your coverage, who does it cover and who is the carrier? Do you plan to add your adopted child(ren) as a beneficiary to your life insurance policy? Yes No Do you have a legal will? * Yes No If yes, when was your will finalized? Regardless if you do or do not have a legal will, who do you plan to assume guardianship of your child(ren) should you be unable to care for them: * Provide name, address, age, relationship and occupation of guardian(s) you have selected. Electronic Confirmation * Mark this box if Applicant 1 believes the above information to be true and correct. Mark this box if Applicant 2 believes the above information to be true and correct. Date * MM DD YYYY Thank you! This will be uploaded to your secure Google Drive file.
