IMPORTANT HOUSEHOLD INFORMATION
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HUSBAND'S full name: |
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Social security number: |
Date of birth: |
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Driver's license#: |
Passport #: |
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Important medical information: |
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WIFE'S full name: |
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Social security number: |
Date of birth: |
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Driver's license#: |
Passport #: |
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Important medical information: |
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FAMILY MEMBERS |
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Name: |
SSN: |
Date of birth: |
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Important medical information: |
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Name: |
SSN: |
Date of birth: |
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Important medical information: |
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Name: |
SSN: |
Date of birth: |
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Important medical information: |
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Name: |
SSN: |
Date of birth: |
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Important medical information: |
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BANK:
Checking account number:
Savings account number: |
BANK:
Checking account number:
Savings account number: |
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MORTGAGE COMPANY:
Account/loan number: |
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Insurance |
Agent |
Telephone |
Policy number |
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Medical Insurance |
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Dental Insurance |
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Vision Insurance |
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Life Insurance |
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Disability Insurance |
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Homeowner’s/Rental |
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Auto Insurance |
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Flood Insurance |
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Regular prescription medication
Name of medication:
Prescription number:
Pharmacy: Telephone:
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Name |
Address |
Telephone |
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Lawyer |
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Accountant |
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Financial Advisor |
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SAFETY deposit box
Key location:
Location of box:
Contents:
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CREDIT CARD:
Account number
Customer Service phone #
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CREDIT CARD:
Account number
Customer Service phone #
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CREDIT
CARD:
Account number
Customer Service phone #
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CREDIT
CARD:
Account number
Customer Service phone #
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Utility |
Account number |
Customer Service telephone |
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Electricity |
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Natural Gas |
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Water |
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Cable television |
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Telephone |
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Trash pick-up |
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Document
Check List
(include
copies or originals with this record in a waterproof container in your 72-hour
kit)
___ Driver’s license
___ Social Security card
___ Passport
___ Visa
___ Birth certificate
___ Marriage certificate
___ Immunization records
___ Will
___ Legal contracts |
___ Car title
___ Real Estate title
___ Extra blank checks
___ Computer back-up CD’s
___ Household inventory
___ Family history and religious records
___ Extra car and house keys
___ Cash in small denominations
___ Emergency contact information |
Keep this record as safe as you would your wallet! Avoid identity theft!
Print
CFD Publications
