Financial Planning Questionnaire
We're excited to help you strengthen your financial future. Please complete this form and submit PRIOR to our scheduled appt. Collect any documentation (account statements, mortgage statements, life insurance policies, etc.). We look forward to learning about you and implementing a plan that is specific to your family's needs.
Household Information
Client 1
*
Mr.
Mrs.
Ms.
Prefix
First Name
Middle Name
Last Name
What is your preferred name?
Nickname
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Client 2
Mr.
Mrs.
Ms.
Prefix
First Name
Middle Name
Last Name
What is your preferred name?
Nickname
Phone Number
Please enter a valid phone number.
Email
example@example.com
Date of Birth
-
Month
-
Day
Year
Home Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Who referred you (if applicable)?
First and Last name
Relationship Status
*
Please Select
Single
Married
Lifepartner
Divorced
Separated
Widowed
Anniversary
-
Month
-
Day
Year
Date
Children
Beneficiary Election
Primary and Contingent
Primary Beneficiary 1
*
Primary Beneficiary 2
Contingent Beneficiary 1
Contingent Beneficiary 2
Cash Flow
Income, Taxes, and Expenses
Client 1 Employment
*
Work Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Client 2 Employment
Work Address
Street Address
Street Address Line 2
City
State
Zip Code
Regular Income
Annually
Client 1 Income
*
Client 2 Income
Tax Planning
Income Taxes: Did you receive a tax refund last tax year?
Income Taxes: Did you pay taxes last tax year?
Income Taxes: How do you file your Taxes?
Cash Flow Expenses
Monthly
Base Monthly Expenses - Minus Mortgage/Medical/Debt Service
Health / Medical
Mortgage or Rent Expenses
Mortgage Type and Origination Date
Debt Service
Debt Management
Loans
Assets
Real Estate
Taxable Assets
Tax Deferred Assets
Tax Advantaged
Anticipated Inheritance
Insurance
Insurance Policies
Preservation of Wealth
Do you have anything in place to preserve your wealth?
Retirement Goals
In A Perfect World What Age Would You Retire?
How Much Money Would You Like In Retirement Each Year?
How Much Money Can You Save On A Monthly Bases Comfortably For Your Retirement?
Dreams & Goals
*
Short Term (1-3 Years)
Mid Range (4-7 Years)
Long Term (7+ Years)
Make a Major Purchase
Build Retirement Wealth
Buy a New Home
Build Up Savings
Reduce or Pay Off Mortgage
Education Funding
Alt Income in Case of Disability or Death
Help Support Aging Parents
Pay Off Credit Cards/Debits
Start a Business
Travel Internationally
Travel Domestically
Other Dreams & Goals
Statements
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Risk Tolerance
Which of the following best describes your primary investment objective?
Wealth Accumulation
Wealth Maintenance
Wealth Distribution
Approximately how many years do you expect to continue to invest your assets in the stock market?
0-3 Years
3-5 Years
6-10 Years
11-15 Years
>15 Years
Assuming you are investing $100,000 and can choose from the five hypothetical portfolios shown in the table below. Thedollar values for each portfolio represent two possible returns – low and high – after one year. Assuming there is an equalchance of achieving either result (low or high), indicate which portfolio represents the maximum risk/return trade-off youwould be willing to accept.
Portfolio A: High-Value $160,000; Low- Value $55,000
Portfolio B: High-Value $150,000; Low- Value $65,000
Portfolio C: High-Value $135,000; Low- Value $75,000
Portfolio D: High-Value $125,000; Low- Value $85,000
Portfolio E: High-Value $115,000; Low- Value $95,000
Please indicate the level of risk with which you are most comfortable:
1 - Lowest
2
3
4
5 - Medium
6
7
8
9
10 - Highest
How long are you prepared to wait for your account to return to its original value after a down market?
18 Months - 2 Years
2-3 Years
3-5 Years
>5 Years
My current income and future income (salary, pension, etc...) is:
Very Secure/Stable
Mostly Secure/Stable
Secure/Stable
Somewhat Secure/Stable
Not Secure/Stable
How able are you to handle financial emergencies with assets outside of your investments account(s)?
Very Able
Mostly Able
Able
Somewhat Able
Not Able
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