Financial Planning Worksheet
CONFIDENTIAL
Name
*
First Name
Last Name
Joint Name
First Name
Last Name
Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Annual Budget
Housing Expenses
Rows
Amount
Mortgage/Rent
Second Mortgage/Rent
Condo/Association Fees
Insurance
Taxes
Other
*If other, please explain
Entertainment Expenses
Rows
Amount
Travel
Hobbies
Membership Dues
Other
*If other, please explain
Transportation Expenses
Rows
Amount
Car Payment 1
Car Payment 2
Auto Insurance
Other
*If other, please explain
Savings
Rows
Amount ($)
Percent (%) of Salary (Optional)
Retirement Contributions (i.e. 401(k), 403(b), 457, IRA, etc.)
Employer Match
Taxable
Tax-Deferred
Tax-Exempt
Other
Other
*If other, please explain
Sources of Income
Rows
Amount
Salary 1
Salary 2
Social Security 1
Social Security 2
Pension 1
Pension 2
Other
Other
*If other, please explain
Assets/Liability (Personal property, businesses, debt)
Rows
Brief Description
Account Location (i.e. bank or debtor)
Current Value
Amount Owed
Debt Maturity Date
Interest Rate
Home
Personal Property
Business
Toys
Other assets
Student Loans
Credit Card
Personal Loans
Business Loans
Other Liability
*If other, please explain
Account Summary (Bank Accounts, Annuities, Life Insurance Policies)
Rows
Account Owner
Account No.
Account or Product Type (i.e. CD, checking, etc.)
Market (Benefit) Value
Bank or Ins. Co Name
Bank Accounts
1
2
3
4
Annuities/Life Insurance
1
2
3
4
(Optional) Upload statements from investment accounts and insurance policies.
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All information is strictly confidential. Securities offered through Avantax Investment Services℠, Member FINRA,SIPC. Advisory services offered through Avantax Advisory Services℠, 408 W. Michigan Ave, Jackson, MI 49201.
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