Confidential Statement of Planned Gift Provision

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Name*

Prefix First Middle Last Suffix

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email*

Wake Forest Class Year

Relationship to University (if non-alumni)

Type of Provision

WFU Federal Tax ID #56-0532138

I have made provision for Wake Forest University in my estate plan as follows:*

Outright bequest in my Will

Provision in my Will of specific percent of the rest and remainder of my estate

Provision in the Will of the survivor of my spouse and myself

Trust with Wake Forest as a final beneficiary

Beneficiary of my IRA

Beneficiary of my Life Insurance

Beneficiary of my Retirement Plan

Other

Add details about the type of commitment or other comments

Dollar Amount or Percentage*

Percent of Estate*

I estimate the present value for Wake Forest University to be:*

Spouse's Date of Birth*

Please include the ages of income beneficiaries or describe other conditions:*

Hidden

Dollar Amount or Percentage*

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Dollar Amount or Percentage*

If this provision is restricted to a specific area/fund of the University, please indicate:*

THIS IS NOT A BINDING LEGAL DOCUMENT. Your signature simply verifies that you believe this information is correct as of the date you signed this form. Wake Forest University recognizes the value of a future gift, as well as the provision creating the gift, may change over time. If possible, please consider notifying us of any future changes in your charitable plans for Wake Forest University.

Date*

Date of Birth*

Signature*

By typing your name in this field, you are electronically signing this document.

Joint Signature, if applicable, along with date of birth

By typing your name in this field, you are electronically signing this document.

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