Personal Declaration Questionnaire

Your first name*

Your email address for delivery*

PayPal Transaction ID*

Preferred language for your Declaration*

English

Español

Is there a special person in your life whom you would like included in your Personal Declaration?*

Yes

No

If you answered YES to the previous question, how would you like this person identified?

My wife

My husband

My partner

Other

Special person's first name (optional)

If you selected Other, how would you like this person identified? (optional)

If you have children, would you like them included in your Declaration?*

Yes

No

If you have grandchildren, would you like them included in your Declaration?*

Yes

No

Is there a particular personal circumstance or experience you would like reflected in your Declaration? (Optional — maximum three sentences)

Required Acknowledgment*

I have read and understand the information provided. I understand the nature and limitations of this personalized declaration and authorize Our Best for Him to use the information I provide to prepare my document.