[BPRR] Pre-Planning Client Information

Pre-Planning Client Information

Confidentiality and protection of your personal information is of the highest importance to our firm. We will not disclose any information about you to anyone without your permission.
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Hidden Field / Today's Date

MonthDayYear
Date
NOTE:
This questionnaire will assist us in collecting the preliminary information needed to start on your plan. It is not an exhaustive list of everything we need to know.

Once we examine your responses, we will need to reach back out to collect additional information. During this planning process, please make sure you routinely check your spam/junk email folders.
Client*

First NameLast Name
Client | Date of Birth*

MonthDayYear
Hidden Field / Client Age
Client | Are you currently married or will you include a co-client (Fiancée, Partner, etc.)?*

YesNo
Client | Do you have prior marriages?*

YesNo
Client Prior Marriages | Please provide more information on prior marriages (e.g. how long were you married to each spouse and whether that individual is alive or deceased). *
Example: Married to Joe for 11 years. Divorced in 1998. Joe is still alive.
Best Phone Number*
Please enter a valid phone number.
Alternate Phone Number
Please enter a valid phone number.
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Co-Client*

First NameLast Name
Co-Client | Date of Birth*

MonthDayYear
Date
Hidden Field / Co-Client Age
Co-Client | Do you have prior marriages?*

YesNo
Co-Client Prior Marriages | Please provide more information on prior marriages (e.g. how long were you married to each spouse and whether that individual is alive or deceased). *
Example: Married to Joe for 11 years. Divorced in 1998. Joe is still alive.
Client | Current Assets
Account Type, Where it's held, Value
Client | Are any of your accounts inherited?*

YesNo
Client | Inherited Accounts*
Client | Current Sources of Income (excluding retirement accounts and work income)
Examples: Rental houses, K1-partnerships, Agricultural
Client | Have you filed for Social Security?*

YesNo
Please rank the following Social Security filing consideration from most important {1} to least {3}
- Maximize guaranteed income for yourself
- Mitigate distribution needs from retirement savings
- Create a guaranteed income stream as early as possible
Please rank the following Social Security filing consideration from most important {1} to least {4}
- Maximize guaranteed income for yourself
- Maximize guaranteed income to the surviving spouse
- Mitigate distribution needs from retirement savings
- Create a guaranteed income stream as early as possible
Client | What date did you file?*

MonthDayYear
Client | Monthly Benefit Amount*
Client | Are you retired?*

YesNoSemi-Retired / Part time
Client | What is your annual salary? *
Client | When do you expect to retire?*
Month / Year
Client | Do you expect your earnings to change? *
Do you plan to start working part-time? Do you anticipate higher earnings for a period?
Client | Do you have a contributory retirement plan with your employer?*

YesNo
Client | How much do you contribute to your retirement plan annually?*
Client | How much does your employer contribute to your retirement plan annually?*
{Field Disabled} Client | How much do you contribute each year to your retirement plan? *
{Field Disabled} Client | What is your employer's yearly contribution to the plan? *
Client | Do you have an employer or private healthcare insurance plan?*

YesNo
Client | Please provide details of your healthcare insurance plan and the monthly cost.*
Client | Are you currently on Medicare?*

YesNo
Client | Will you have a supplemental plan in addition to Medicare?*

YesNo
Client | Do you have a supplemental plan in addition to Medicare?*

YesNo
Client | Please provide details of your supplemental plan and the monthly cost.*
Example: I hold a policy for $400/mo
Co-Client | Current Assets
Account Type, Where it's held, Value
Co-Client | Are any of your accounts inherited?*

YesNo
Co-Client | Inherited Accounts*
Co-Client | Current Sources of Income (excluding retirement accounts and work income)
Examples: Rental houses, K1-partnerships, Agricultural
Co-Client | Have you filed for Social Security?*

YesNo
Please rank the following Social Security filing consideration from most important {1} to least {4}
- Maximize guaranteed income for yourself
- Maximize guaranteed income to the surviving spouse
- Mitigate distribution needs from retirement savings
- Create a guaranteed income stream as early as possible
Co-Client | What date did you file?*

MonthDayYear
Co-Client | Monthly Benefit Amount*
Co-Client | Are you retired?*

YesNoSemi Retired/Part time
Co-Client | What is your annual salary? *
Co-Client | When do you expect to retire?*
Month / Year
Co-Client | Do you expect your earnings to change? *
Do you plan to start working part-time? Do you anticipate higher earnings for a period?
Co-Client | Do you have a contributory retirement plan with your employer?*

YesNo
Co-Client | How much do you contribute to your retirement plan annually?*
Co-Client | How much does your employer contribute to your retirement plan annually?*
{Field Disabled} Co-Client | How much do you contribute each year to your retirement plan(s)? *
{Field Disabled} Co-Client | What is your employer's yearly contribution to the plan? *
Co-Client | Do you have an employer or private healthcare insurance plan?*

YesNo
Co-Client | Please provide details of your healthcare insurance plan and the monthly cost.*
Co-Client | Are you currently on Medicare?*

YesNo
Co-Client | Will you have a supplemental plan in addition to Medicare?*

YesNo
Co-Client | Do you have a supplementary plan in addition to Medicare?*

YesNo
Co-Client | Please provide details of your supplementary plan (What is the monthly cost?)*
Example: I hold a policy for $400/mo
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Please use this link to reach our Retirement Budget Calculator,
which should open for you in a new browser window:

Budget Calculator
Which of these options applies to your primary residence?*

Mortgage on HomeOwn the HomeRenting
[Removed Field] Do you have a mortgage you would like included in the plan?

YesNo
Current Home Value*
Original Purchase Price*
Annual Property Taxes*
Annual Homeowner Insurance*
Original Mortgage Amount*
Mortgage Amount Remaining*
Mortgage Origination Date*
MM / DD / YYYY
Mortgage Rate*
Mortgage Duration*
Ex: 15 year / 30 year / ARM
Regular Payment (Principal & Interest)*
Rent*
Renter's Insurance
Do you have Rental Properties?

No1 Property2 PropertiesMore than 2
Which of these options apply to your rental property?

Own the PropertyProperty under Loan
Which of these options apply to your second rental property ?

Own the PropertyProperty under Loan
Rental Property | Original Loan Amount
Rental Property | Loan Amount Remaining
Rental Property | Loan Origination Date
MM / DD / YYYY
Rental Property | Loan Rate
Rental Property | Loan Duration*
Ex: 15 year / 30 year / ARM
Rental Property | Regular Payment (Principal & Interest)*
Rental Property | Current Property Value
Rental Property | Original Purchase Price
Rental Property | Annual Property Taxes
Rental Property | Insurance
Would you like to include a vacation or secondary residence?

YesNo
Which of these options applies to your secondary residence?*

Mortgage on HomeOwn the HomeRenting
Current Home Value*
Original Purchase Price*
Annual Property Taxes*
Annual Homeowner Insurance*
Original Mortgage Amount*
Mortgage Amount Remaining*
Mortgage Origination Date*
MM / DD / YYYY
Mortgage Rate*
Mortgage Duration*
Ex: 15 year / 30 year / ARM
Regular Payment (Principal & Interest)*
Rent*
Renter's Insurance
For more accurate planning, you can use our detailed budget.

Otherwise, please enter your (net) monthly need in retirement below.
What is your household (net) monthly income need in retirement?
How much would you like to be deposited into your bank account on a monthly basis to live the lifestyle you want? This is the amount considering ALL streams of income on an after medicare, after tax basis.

Housing
Utilities

AnnualMonthly
Utilities
Internet & Phone

AnnualMonthly
Internet & Phone
Maintenance / Fees

AnnualMonthly
Maintenance / Fees
Home Improvement

AnnualMonthly
Home Improvement

{Hidden Collapse Bracket}

Food
Groceries

AnnualMonthly
Groceries
Dining Out

AnnualMonthly
Dining Out

{Hidden Collapse Bracket}

{Hidden Collapse Bracket}

Healthcare
Medical Services

AnnualMonthly
Medical Services
Medication & Supplies

AnnualMonthly
Medication & Supplies

{Hidden Collapse Bracket}

Personal Insurance
Life Insurance

AnnualMonthly
Life Insurance
Disability Insurance

AnnualMonthly
Disability Insurance
Long-term Care Insurance

AnnualMonthly
Long-term Care Insurance
Other Insurance

AnnualMonthly
Other Insurance
Please provide details on Other Insurance

{Hidden Collapse Bracket}

Personal Care
Clothing

AnnualMonthly
Clothing
Products & Services

AnnualMonthly
Products & Services

{Hidden Collapse Bracket}

Family Care
Alimony

AnnualMonthly
Alimony
Child Care

AnnualMonthly
Child Care

{Hidden Collapse Bracket}

{Hidden Collapse Bracket}
How much do you keep in liquid savings, outside of investment accounts? *
Example: $7000 as cash for emergent expenses.
Do you have other household debts?*

YesNo
Please provide details about household debts (creditor name, purpose of loan, current balance, interest rate, and monthly payment)*
Example: You've taken a loan against your 401k
[Removed Field] Please provide details about any savings set aside for purposes of retirement (type of account, balance, where the account is held, registration of account)
Example: Bob's Edward Jones IRA with balance of $275,000
Do client (or Co-Client) have pensions?

YesNo
Are any non-covered pensions? (attributable to earnings that did not pay into Social Security)

YesNo
In order to properly calculate WEP or GPO penalties, you must submit social security earnings records for whom will be receiving the non-covered pension.
Please provide details about any pensions (when will / did it start, survivorship options)
Example: Bob's FERS pension with 50% to survivor. Started June 2018
If you have a financial advisor, what do you pay in advisory fees?
Ex. Fee as 1.25%
Any additional information we should know?
If there is anything you believe that will allow us to understand your situation more completely, please tell us here.
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Secure Document Upload

Ensuring the privacy and security of your data is a top priority for us. You can rest easy knowing that we take every precaution to provide an online document upload service with high-grade security.

Please upload the most recent version of the following documents:
- Pension estimates (if any)
- Complete statements on IRAs, 401(k)s, or any other accounts set aside for retirement purposes
- Prior two years tax returns
- Social Security benefits estimate (find on mySSA account at SSA.gov)
- Social Security earnings record* (find on mySSA account at SSA.gov)
* The earnings record that we require is separate from the incomplete one found on page 2 of the benefits statement. To make the planning process as smooth as possible, please provide the full earnings records. You can find this info by logging into your mySSA account at SSA.gov and clicking the highlighted link in the example as below:
Cancelof
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