The Physicians Committee
Personal Illustration Form

Personal Illustration

It takes time and effort to create an effective plan for the future. We would like to help you by creating a personal profile of the gift type that might best suit your needs and goals. In the meantime, feel free to contact us with any questions.

I'm not sure which gift plan works best for me. Please contact me.

I want to explore gifts that provide income to me and/or my beneficiaries. Specifically, I am interested in the following gift plan(s):

Charitable Gift Annuity

Deferred Gift Annuity

Charitable Remainder Unitrust

Charitable Remainder Annuity Trust

I want to explore:

How to make a Bequest.

Ways to give Real Estate.

Making a gift of Retirement Plan Assets.

Ways to pass assets to my heirs while minimizing my tax exposure (Charitable Lead Trusts).

Making a gift with Life Insurance.

Gifts of Partnership Interests, Closely-Held Stock, or other Tangible Personal Property.

Amount to illustrate:

Type of asset:

Estimated cost basis of asset:

Date of birth of income beneficiaries (if applicable):

Beneficiary #1

Beneficiary #2 (For charitable remainder trusts, more than two beneficiaries may be designated)

Please send my gift illustration by:

Regular mail Fax Email

Contact information:


Street address

Daytime telephone with Area Code

Apt. or Suite






Security Key*

To receive information on how planned gifts can benefit you and your family, just complete the form above and click the send button. Your request is strictly confidential and non-obligatory.