SPEF Estate Gift Intention Form

Full Name *

First Name Last Name

Date of Birth *

Month Day Year

Spouse Name

First Name Last Name

Spouse Date of Birth

Month Day Year

Chapter Affiliation *

Billing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

E-mail *

Type of Gift *

Will Living Trust Life Insurance Retirement Plan

If Other, Please List What Type of Gift

Description of Gift *

As of today, I estimate the value of this provision in my estate plan to be: *

Is this a "contingent" gift? (Sigma Pi is an alternate beneficiary and will only receive the gift under certain circumstances.) *

Yes No

If so, please list the contingencies.

Is this an unrestricted gift? *

Yes No

If not, please list the specific purpose that this gift should be used for.

Signature *

Clear