Financial Plan Intake Form
Congratulations on wanting to compete a comprehensive financial plan! This is a great first step to understanding where you are (financially) and where you want/need to get to. This form (wizard) will gather all the information we need to start the planning process and get you on track to becoming financially independent!
About You
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Employment Status
Please Select
Employed
Retired
Homemaker
Business Owner
Other
Occupation
Income
Gross income from employment per year?
Other Income
Gross income from other sources (non-investment)
State of Residence?
For tax purposes.
Are you Married?
Yes
No
Co-Client Info
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Employment Status
Please Select
Employed
Retired
Homemaker
Business Owner
Other
Occupation
Income
Gross income from employment per year?
Other Income
Gross income from other sources (non-investment)
Tax Filing Status?
Please Select
Married filing joint
Married filing separately
Single
Head of Household
Please upload a copy of your latest tax return(s).
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Do you have kids?
Please Select
Yes
No
Yes, but they are grown and don't need to be included in our plan
Tell us about your kids (how many, ages, and goals surrounding them (like college funding or a legacy))?
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What's important about Money to You?
It is important for us to understand your goals and values surrounding money. Give these questions a shot for us, please...
Imagine you have enough money to satisfy all of your needs, both now and in the future. Would you change your life and, if so, how would you change it?
You are back in your current financial situation. Your doctor tells you that you have 5 to 10 years to live, and you will feel fine up until the end. Would you change your life and, if so, how would you change it?
Imagine that your doctor tells you that you have just one day to live. You look back on your life and ask what did you fail to experience, who is the person that you did not become, and what did you neglect to do?
What is the best investment you have ever made?
What is the worst investment you have ever made?
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Goals
Goals can be subjective and will most likely change over time. Give us your current thoughts on some basic goals as a starting framework...
At what age would you like to retire, or become financially independent (work optional)?
How much money (take home, in your pocket, after-tax) would you like to have per month (in today's dollars) in retirement?
Do you plan to move to another state or country in Retirement? If so, what state or country would you move to?
Do you think you will have any supplemental income in retirement, like part-time work? If so, please describe where you envision this income would come from and how much you think it would be.
How do you envision retirement? The more detail you can provide, the better...
Do you want to provide for your children's (or grandchildren's) education (or other financial goal someday? Tell us about it...
Tell us about any other goals you may have? (buying a second home, daughters wedding, purchasing a business, world travel, RV, etc.)...
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Social Security Benefits
If available, provide your Social Security estimates from ssa.gov
Have your Social Security Benefits already started?
Yes
No
I am not sure
If you are receiving Social Security now, how much do you get monthly?
How much Social Security will you get at full retirement age?
The number from the top right corner of the front page of your Social Security statement. (which you can find at www.ssa.gov.
Is Co-Client eligible for Social Security Benefits?
Yes
No
I am not sure
If Co-Client is receiving Social Security now, how much do they get monthly?
How much Social Security will Co-Client get?
The number from the top right corner of the front page of your Social Security statement. (which you can find at www.ssa.gov.
How do I check my social security account & statement?
Please upload a copy of your Social Security Statement(s) from ssa.gov
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Visit ssa.gov now
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Investments
Identify all the resources that you have to fund your goals. Don't worry about determining the exact amounts, reasonable estimates are fine here. If available, provide your investment statements by uploading them below. If you are able to upload your statements, there is no need to fill in this section.
Upload Investment Statements here
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Your Investments
Current Value
Annual Additions
Retirement Plans (e.g., 401k, 403b)
Traditional IRA
Roth IRA
529 Savings Plan
Annuities
HSA
Taxable / Brokerage
Other:
Do you have access to a retirement plan (like a 401(k) at work)?
Yes
No
Not Sure
Does your workplace retirement plan have a Roth option?
Yes
No
Not Sure
If your workplace retirement plan has a Roth option, are you contributing to it?
Yes, all my contributions go towards Roth
Yes, but only some of my contributions go to the Roth option
No, my contributions go to the traditional (pre-tax) option
I am not sure where my money goes?
How much do you contribute to your workplace retirement plan? Do you get a match?
Co-Client's Investments
Current Value
Annual Additions
Retirement Plans (e.g., 401k, 403b)
Traditional IRA
Roth IRA
529 Savings Plan
Annuities
HSA
Taxable / Brokerage
Other:
Does Co-Client have access to a retirement plan (like a 401(k) at work)?
Yes
No
Not Sure
Does Co-Client's workplace retirement plan have a Roth option?
Yes
No
Not Sure
Is Co-Client contributing to the workplace Roth option?
Yes, all my contributions go towards Roth
Yes, but only some of my contributions go to the Roth option
No, my contributions go to the traditional (pre-tax) option
I am not sure where my money goes?
How much does Co-Client contribute to their workplace retirement plan? Do they get a match?
Any other information you would like to share about your investments, or other investments not captured by the chart above you would like to share (workplace stock plan, long-term incentives, bonuses, etc.)...
Upload your workplace retirement statement(s) here.
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Do you own a home? Tell us about it (value, mortgage details, payments, are you trying to accelerate the payoff, how long have you lived here, do you plan to sell or move, etc.)...
You can upload your mortgage statement here...
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Tell us about any other major debt you have (2nd mortgage, car loans, credit cards, student loans, etc.)...
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Concerns
Your Concerns
Client
Co-Client
Degree
Not having a paycheck anymore
High
Medium
Low
Running out of money
High
Medium
Low
Suffering investment losses
High
Medium
Low
Leaving money to others
High
Medium
Low
Spending too much
High
Medium
Low
Cost of health care or long-term care
High
Medium
Low
Curent or future health issues
High
Medium
Low
Dying early
High
Medium
Low
Living too long
High
Medium
Low
Getting Alzheimer's (or other illness)
High
Medium
Low
Going into a nursing home
High
Medium
Low
Being bored
High
Medium
Low
Too much time together
High
Medium
Low
Parents needing care
High
Medium
Low
Famly needs financial help
High
Medium
Low
Kids moving home
High
Medium
Low
Care for child with special needs
High
Medium
Low
Any other concerns you want to share?
Your Concerns
Check
Degree
Not having a paycheck anymore
High
Medium
Low
Running out of money
High
Medium
Low
Suffering investment losses
High
Medium
Low
Leaving money to others
High
Medium
Low
Spending too much
High
Medium
Low
Cost of health care or long-term care
High
Medium
Low
Curent or future health issues
High
Medium
Low
Dying early
High
Medium
Low
Living too long
High
Medium
Low
Getting Alzheimer's (or other illness)
High
Medium
Low
Going into a nursing home
High
Medium
Low
Being bored
High
Medium
Low
Too much time together
High
Medium
Low
Parents needing care
High
Medium
Low
Famly needs financial help
High
Medium
Low
Kids moving home
High
Medium
Low
Care for child with special needs
High
Medium
Low
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Retirement Income
Tell us about any retirement income you expect to receive other than your Social Security or investment income (Pensions, part-time work, rental properties, annuities, royalties, alimony, etc.).
Other Retirement Income - Pensions, part-time work, rental income, annuities, royalties, alimony, etc).
Description of Income
Monthly Income
Start Year
End Year
1
2
3
4
5
6
7
8
9
10
Co-Client's Other Retirement Income - Pensions, part-time work, rental income, annuities, royalties, alimony, etc).
Description of Income
Monthly Income
Start Year
End Year
1
2
3
4
5
6
7
8
9
10
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Extra Savings
Enter the maximum additional amount you could save each year above your existing annual savings:
How willing are you to save more?
Please Select
Not at all
Slightly
Somewhat
Very
Insurance(s)
Do you have any life insurance?
Yes
No
I am not sure
If you have life insurance, please tell us about any policies you have. (type, cost, when they started, if they end at a certain date, cash value (if any), how much insurance, etc).
Tell us about any disability insurance policies you (or co-client) own?
Tell us about any Long Term Care insurance you (or co-client) own?
Upload any insurance statements you have here...
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Some other questions...
Do you smoke?
Yes
No
Occasionally
Used to but not anymore
Does Co-Client smoke?
Yes
No
Occasionally
Used to but not anymore
How is your health (generally)?
Above Average
Average
Below Average
How is Co-Client's health (generally)?
Above Average
Average
Below Average
Might you become financially responsible for aging parents?
Do you have a Will and/or Trust?
Yes, my estate planning is in order
Yes, but my estate documents probably need to be updated
No, but I have been thinking about this
No, I am not even sure where to start
Is leaving a legacy important to you? Tell us about who you want to take care of once you have passed...
Anything else you would like us to know about or to consider in your plan?
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