• Fact Finder

    Fact Finder

    The information on this form is confidential. Please fill out form as completely as possible. Complete disclosure enables us to better make proper recommendations.

  • Personal Information

  •  - -
  • Format: (000) 000-0000.
  • What type of phone number is this?
  • Are you currently retired?
  •  - -
  • Marital Status

  • Spouse Information

  • Format: (000) 000-0000.
  • What type of phone number is this?
  • Are you currently retired?
  •  - -
  • Marital Status
  • Financial Strategies

    Financial Strategies

  • Retirement Strategies

    Please rate your level of concern with the following:
  • Knowing how much income, in today's dollars, you will need upon retirement:
  • Knowing how much income your current plan will provide upon retirement:
  • Having a systematic program for savings and investments:
  • Accumulating retirement funds without paying current taxes on any growth:
  • Reducing current taxation on a portion of your retirement income:
  • Your savings and investments maintaining their buying power:
  • Does your employer provide a retirement plan?
  • Does your spouse's employer provide a retirement plan?
  • Are you satisfied with your asset diversification?
  • Have you confirmed your Social Security earnings and benefits within the last 12 months?

  • Accumulation Strategies

    Please rate your level of concern with the following:
  • Providing funds for your children's college education:
  • Saving money for a new or second home:
  • Saving money for a special vacation:
  • Saving money for a special project or purchase:
  • Saving money to buy a business or practice:
  • Do you know how much money you will need for your accumulation goals?

  • Income Protection Strategies

    Please rate your level of concern with the following:
  • Paying off the mortgage and other debts in the event of death or disability:
  • Providing adequate income for your family in the event of death or disability:
  • Providing long-term care for yourself, your spouse, or your parents:
  • Does your company provide group term life insurance?
  • Does your company provide survivor's benefits for your spouse?
  • Does your company provide a disability income program?
  • Would you like to review your current insurance coverage?
  • Do you have healthcare insurance?
  • Will you be relying on investment assets for anticipated and unanticipated health costs?
  • Do you have long-term care insurance?
  • Is it federal or private sector coverage?
  • Do you have the entire policy?

  • Wealth Preservation Strategies

    Please rate your level of concern with the following:

  • Note: Mason & Associates, LLC does not provide legal, accounting, or tax advice. You should consult your own legal, accounting, or tax professional for such advice.

  • Having an up-to-date will:
  • Revocable Living Trust:
  • Financial Power of Attorney:
  • Medical Power of Attorney:
  • Advanced Medical Directive:
  • Medical Releases:
  • Reducing estate taxes that your heirs may have to pay:
  • Providing for the efficient transfer of assets to your heirs:
  • Managing an inheritance or potential inheritance:
  • Would you consider starting a gifting program to reduce the size of your estate?
  • Would you consider making charitable gifts?

  • Other Strategies

  • Do you have written financial goals?
  • Have you implemented a plan for achieving your goals?
  • Do you have a current inventory of your major assets?
  • Would you like a review of existing financial arrangements?
  • Is it important for you to have access to a team of financial professionals?
  • Would you like a comprehensive financial analysis?
  • If not, is there one or several areas that you would like to focus on?

  • Anticipated Changes

  • Check ALL that are likely to occur in the NEXT 12 MONTHS:
  • Financial Overview

    Financial Overview

  • Household Information

  • Annual Household Income
  • Types of Assets or Insurance
  • Total Liabilities

  • Investment Experience

    (in years)

  • Net Worth

  • Personal Residence

  • Annual Income

  • Documents Needed for Planning

    Documents Needed for Planning

    Please upload the documents below IN ADVANCE of your meeting. All information will be treated CONFIDENTIALLY. Don't worry if you don't have everything on hand right away. Once you submit the form you will receive a link to come back and resume uploading where you left off.

  • {payrollHeader}{primaryIncome}{spouseIncome}{ssHeader}{selfSocial}{spouseSocial}

    Income Tax Returns (Past Two (2) Years)
    {selfTax}{spouseTax}{benefitsHeader}{selfRetirement}{spouseRetirement}{selfInsurance}{spouseInsurance}{selfPension}{spousePension}{maritalHeader}{selfMarital}{spouseMarital}

    Insurance(s), Annuity Contracts, and Annual Statements
    {selfLife}{spouseLife}{selfDisability}{spouseDisability}{selfGroup}{spouseGroup}{selfAnnuities}{spouseAnnuities}{selfLongterm}{spouseLongterm}

    Savings and Investment Statements
    {selfThrift}{spouseThrift}{selfIras}{spouseIras}{selfMutual}{spouseMutual}{selfBrokerage}{spouseBrokerage}{self401k}{spouse401k}{self403b}{spouse403b}{selfPension207}{spousePension226}{selfVoluntary}{spouseVoluntary}{selfOther}{spouseOther}{mortgageStatements211}

    *** Be sure to have the following items available to you during your meeting:

      Driver's License
      VRS Member Benefit Profile (Available Online)
      Federal Employee Personal Statement of Benefits (EBIS) (Available Online from OPM)

  • Most Recent Payroll Stub(s), LES (ELS), Earnings/Annuity Statements

  • Tips for Best Document Quality:

    1. Ideally, use a scanner for the best quality.

    2. If you do not have a scanner, use a scanner app on your smartphone like the free Adobe Scan app for Android and iOS.

    3. If neither of the above options works, please take a photo of your documents on a flat, solid-colored surface like a table, countertop or floor in a well-lit area with no shadows over your documents.

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  • Current Social Security Statement(s)

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  • Income Tax Returns (Past Two (2) Years)

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  • Divorce Decree(s), Separation Agreement(s), Prenuptial Agreement(s)

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  • Company Benefits (Non-Federal)

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  • Insurance(s), Annuity Contracts, and Annual Statements

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  • Savings and Investment Statements

    Current statements preferred.
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  • Other Documents

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  • Should be Empty: