Created
November 1, 2010 20:04
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a survey DSL as valid ruby syntax
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include Survey::DSL | |
survey 'Finances Questionnaire' do | |
q "Do you have a Durable Power of Attorney for Finances?" do | |
yes do | |
a "Who is the designated agent for handling your finances?" do | |
field 'Full Name' | |
phone 'Phone Number' | |
email 'Email' | |
field 'Address' | |
field 'Relationship' | |
end | |
a "Where are the Power of Attorney documents stored?" do | |
field 'Originals' | |
field 'Copies' | |
end | |
end | |
no | |
dont_know | |
end | |
q "Do you have a Will?" do | |
yes do | |
a "Who is the executor of your Will?" do | |
field 'Full Name' | |
phone 'Phone Number' | |
email 'Email' | |
field 'Address' | |
field 'Relationship' | |
end | |
a "Where are the Will documents stored?" do | |
field 'Originals' | |
field 'Copies' | |
end | |
end | |
no | |
dont_know | |
end | |
q "Do you have a Living Trust?" do | |
yes do | |
a "Who is the successor trustee of your Living Trust?" do | |
field 'Full Name' | |
phone 'Phone Number' | |
email 'Email' | |
field 'Address' | |
field 'Relationship' | |
end | |
a "Where are the Living Trust documents stored?" do | |
field 'Originals' | |
field 'Copies' | |
end | |
end | |
no | |
dont_know | |
end | |
q "Do you have a bank account?" do | |
yes do | |
a "List the details for each bank account", :many => true do | |
field "Name of Bank" | |
phone "Phone Number" | |
email "Email" | |
field "Address" | |
field "Type of Account" | |
secret "Account Number" | |
field "Other Authorized Signers on This Account" | |
field "Location where bank statements are stored" | |
q "Is this Account Payable on Death?" do | |
yes; no; dont_know | |
end | |
end | |
end | |
no | |
end | |
q "Do you have a Brokerage Account?" do | |
yes do | |
a "List the details for each brokerage account", :many => true do | |
field "Name of Brokerage Firm" | |
field "Name of Your Broker" | |
phone "Phone Number" | |
email "Email" | |
field "Address" | |
field "Type of Account" | |
secret "Account Number" | |
field "Other Authorized Signers on This Account" | |
field "Location where brokerage statements are stored" | |
end | |
end | |
no | |
end | |
q "Do you have a safe deposit box?" do | |
yes do | |
a "List the details for each safe deposit box", :many => true do | |
field "Name of Bank" | |
phone "Phone Number" | |
email "Email" | |
field "Address" | |
secret "Safe Deposit Box Number" | |
field "Who else is authorized to access this safe deposit box?" | |
secret "Where are the keys to your safe deposit box?" | |
end | |
end | |
no | |
end | |
q "Do you have a life insurance policy?" do | |
yes do | |
a "List details for each life insurance policy", :many => true do | |
field "Name of Insurance Company" | |
field "Name of Insurance Agent" | |
phone "Phone Number" | |
email "Email" | |
field "Address" | |
field "Policy Number" | |
field "Owner of the Policy" | |
field "Type of Policy" | |
text "Coverage Details" | |
field 'Location where ORIGINAL life insurance documents are stored' | |
field 'Location where COPIES of life insurance documents are stored' | |
end | |
end | |
no do | |
a "Would you like to have a life insurance policy?" do | |
radio 'Yes', 'No' | |
end | |
end | |
end | |
q "Do you own or lease motor vehicles?" do | |
yes 'Yes, I own' do | |
a "List the details for each motor vehicle that you own", :many => true do | |
field 'Make of Vehicle' | |
field 'Model' | |
year 'Year' | |
field 'Vehicle Identification Number' | |
field 'Location of the Title' | |
field 'Do you have a Transfer of Death Paper?' | |
end | |
end | |
yes 'Yes, I lease' do | |
a "List the details for each motor vehicle that you lease", :many => true do | |
field 'Make of Vehicle' | |
field 'Model' | |
number 'Year' | |
field 'Vehicle Identification Number' | |
field 'Location of Lease Documents' | |
end | |
end | |
no | |
end | |
q "Do you have a financial interest in a business?" do | |
yes do | |
a "List the details for each business", :many => true do | |
field 'Name of the Business' | |
field 'Business Structure' | |
field 'State' | |
number 'Percentage of Ownership or Number of Shares' | |
currency 'Approximate Value of the Business' | |
end | |
end | |
no | |
end | |
q "Do you have a non-financial assets of value (e.g., art)?" do | |
yes do | |
a "List the details for each asset", :many => true do | |
field 'Description' | |
field 'Location' | |
field 'Who you would like to receive it' | |
currency 'Approximate Value' | |
end | |
end | |
no | |
end | |
q "Do you have any mortgages?" do | |
yes do | |
a "List the details for each mortgage", :many => true do | |
field "Mortgage Holder" | |
currency "Balance Due" | |
currency "Payment Amount" | |
field "Payment Schedule" | |
date "Date Mortgage Balance is Due" | |
end | |
end | |
no | |
end | |
q "Do you have any loans?" do | |
yes do | |
a "List the details for each loan", :many => true do | |
field "Loan Holder" | |
currency "Balance Due" | |
currency "Payment Amount" | |
field "Payment Schedule" | |
date "Date Loan Balance is Due" | |
end | |
end | |
no | |
end | |
q "Do you have any credit card debt?" do | |
yes do | |
a "List the details for each credit card", :many => true do | |
field "Credit Card Issuer" | |
#field "Credit Card Number" | |
currency "Balance Due" | |
currency "Monthly Payment Amount" | |
date "Date Balance is Due" | |
end | |
end | |
no | |
end | |
q "Do you have any other liabilities?" do | |
yes do | |
a "List the details for each liability", :many => true do | |
field "Description of the Liability" | |
currency "Amount Due" | |
currency "Payment Amount" | |
field "Payment Schedule" | |
date "Date Balance is Due" | |
end | |
end | |
no | |
end | |
q "Do you provide financial support for children?" do | |
yes do | |
a "List the details for each child", :many => true do | |
field "Full Name of the Child" | |
phone "Phone Number" | |
email "Email" | |
field "Address" | |
currency "Amount of Financial Support (Monthly or Yearly)" | |
end | |
end | |
no | |
end | |
q "Do you provide financial support for parents?" do | |
yes do | |
a "List the details for each parent", :many => true do | |
field "Full Name of the Parent" | |
phone "Phone Number" | |
email "Email" | |
field "Address" | |
currency "Amount of Financial Support (Monthly or Yearly)" | |
end | |
end | |
no | |
end | |
q "Do you provide financial support for others?" do | |
yes do | |
a "List the details for each person", :many => true do | |
field "Full Name of the Person" | |
phone "Phone Number" | |
email "Email" | |
field "Address" | |
currency "Amount of Financial Support (Monthly or Yearly)" | |
end | |
end | |
no | |
end | |
q "Do you have personal belongings you wish to give to others?" do | |
yes do | |
a "List the details for each belonging", :many => true do | |
field "Description" | |
field "Location" | |
field "Who you would like to give it to" | |
field "Why you want them to have it" | |
end | |
end | |
no | |
end | |
q "Do you have income from your employer?" do | |
yes do | |
a "List the details for each employer", :many => true do | |
field "Name of Company" | |
field "Contact Person" | |
phone "Phone Number" | |
email "Email" | |
field "Address" | |
end | |
end | |
no | |
end | |
q "Do you have income from retirement funds?" do | |
yes do | |
a "List the details for each source of retirement income", :many => true do | |
field "Account Name" | |
field "Location of Account" | |
field "Contact Person" | |
phone "Phone Number" | |
email "Email" | |
field "Address" | |
currency "Payment Amount" | |
end | |
end | |
no | |
end | |
q "Do you have income from Social Security?" do | |
yes do | |
a "List the details for your Social Security income" do | |
currency "Payment Amount" | |
end | |
end | |
no | |
end | |
q "Do you have income from other sources?" do | |
yes do | |
a "List the details for each source of other income", :many => true do | |
field "Description" | |
field "Contact Person" | |
phone "Phone Number" | |
email "Email" | |
field "Address" | |
currency "Payment Amount" | |
end | |
end | |
no | |
end | |
q "Do you provide care for pets?" do | |
yes do | |
a 'Who would you like to take care of each pet?', :many => true do | |
field 'Pet Name' | |
field 'Full Name of Caretaker' | |
phone 'Phone Number' | |
email "Email" | |
field "Address" | |
text "Instructions for Care" | |
end | |
end | |
no | |
end | |
end |
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