The Office of Gift Planning

Estate Gift Intention Form

I/We am/are pleased to advise Northeastern University (the University) that I/we have provided for a future gift to benefit the University through a provision in my/our estate plans. I/We wish to have my/our estate gift intention recognized by the University. For these reasons, I/we am/are providing the University with the following estimate and information regarding my/our estate gift.

I/We direct that my/our estate gift be used for the following purpose:*

At this time, I/we estimate that my/our estate gift will have a value of approximately (USD):*

I/We have made provisions for my/our estate gift to be transferred to the University through one or more of the following estate plan vehicles (please check all that apply):*

Please describe the estate plan vehicle:*

The contact information of my/our estate planning attorney, executor(s) and/or Trustee(s) is as follows:*

The contact information for the Plan Administrator or Insurance Company for my/our Retirement Plans and/or Life Insurance Policy is as follows:*

The University acknowledges that my/our future gift remains fully revocable.

May the university include your name(s) with other donors in a publication or donor listing?*

Name*

Legal Street Address*

City*

State*

ZIP*

Date of Birth*

Today's Date*

Preferred Phone Number*

Preferred Email Address*

Name

Legal Street Address

City

State

ZIP

Date of Birth

Today's Date

Preferred Phone Number

Preferred Email Address

I consent to my submitted data being stored in accordance with our privacy policy

This field should be left blank