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PRIORITIES
Please tell us about your family.
Do you have any financial responsibilities for parents, adult children, etc? Y N If yes, please explain:
Is anyone in your immediate family in need of custodial care/assisted living? Y N If yes, please explain:
What significant life events do you anticipate in the near future? (weddings, career change, health concerns, etc.)
What are your top financial priorities and concerns? 1
2 3 4 5
In order to construct a sustainable retirement plan, please indicate which concessions are you willing to consider by ranking the following options 1-5, with “1” being easiest to concede and “5” being the hardest to concede:
Client 1 Client 2
Reducing Spending to Increase Current Saving and Investment Assuming More Market Risk to Strive for Higher Returns Working Longer / Delaying Retirement
Client 1
WORK AND INCOME
Employer Position/Title Years w/company Base Salary Bonus/$$$
Retirement Plan Type(s) Annual Salary Deferral $ Traditional or Roth Company Matching % Company Profit Sharing
Defined Benefit/Pension Yes No
Deferred Compensation Yes No
Employee Stock Option Yes No
Employee Stock Purchase Yes No
If YES, provide details
Other Income Sources Annual Amount
Anticipated Promotions Anticipated Career Moves
Client 2 Employer Position/Title Years w/company Base Salary Bonus/$$$
Retirement Plan Type(s) Annual Salary Deferral $ Traditional or Roth Company Matching % Company Profit Sharing
Deferred Benefit/Pension Yes No
Deferred Compensation Yes No
Employee Stock Option Yes No
Employee Stock Purchase Yes No
If YES, provide details
Other Income Sources Annual Amount
4
Property #1 Property #2 Property #3
*primary, 2nd home, investment, rental, time share, vacation
REAL ESTATE
Description* Current Value 1st Mortgage % Rate Years Remaining 2nd Mortgage % Rate Years Remaining HOA FeesDo you have any plans to move, downsize, or relocate? Yes No If YES, please explain:
FINANCIAL ACCOUNTS
Account Type*
Owner(s)
Company/Institution
Current Value
Banks
*Checking, savings, money market, CD, IRA, annuities
Brokerage
*401k, 403b, 457, 529, annuities, deferred comp
Credit Unions
Other
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INSURANCE INFORMATION
Company Coverage Amount Type* Annual Premium $
Accidental Self Spouse Disability Self Spouse Group Life Self Spouse Life 1 Self Spouse Life 2 Self Spouse Life 3 Self Spouse Life 4 Self Spouse Long Term Care Self Spouse Umbrella/Liability Self Spouse
*Term, universal life, whole life, variable life
FINANCIAL PLANNING
Education
What extent do you plan on covering expected higher education expenses? Have other family members indicated they plan to help with those expenses? How much are you saving annually per child toward education expenses?
Retirement
Client 1 Client 2
How much are you saving annually towards retirement? What are your anticipated retirement ages?
“Before-Tax” $$ Annual Retirement Income Sources: Social Security Pensions Investments Annuities Insurance Other
Do you anticipate inheriting an estate? (Y/N)
Annual household income needed to cover fixed expenses?
Annual household income needed to cover discretionary spending?
Risk Management
8 Will
Trust Power of Attorney Advanced Medical Directive Health Care Power of Attorney Named Guardian for Minor Children When was the last formal review or update of these documents?
When was the last formal review or update of your IRA/401K beneficiaries? Do you anticipate philanthropic gifting as part of your estate?
Do you have any business ownership or succession planning concerns?
Other
What are the key factors in your life, upon which, you base your most important decisions?
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If you became incapacitated or passed away unexpectedly, does someone else know what to do?
Taxes & Estate
Who prepares your annual income tax return? Do you typically owe money or receive a refund? Do you have any capital losses to carry forward?
Are there any unique tax concerns for you or your family?
Please indicate Y/N for the following documents:
What other information would be important for us to know when making recommendations for your family?
How would you measure your satisfaction in working with our team?
What can we do to give you the confidence to introduce us to your family and friends?
