Financial Life Checkup

1

The questions that follow will help assess how satisfied you are currently with many aspects of your financial life.

Recommendations relating to this questionnaire will be based on the assumption that the answers to this questionnaire are complete, accurate and reflect your current situation. This form collects data for informational purposes only and does not supersede any data or information reported on official Cambridge forms.

Securities offered through Registered Representatives of Cambridge Investment Research, Inc., a broker-dealer, member FINRA/SIPC. Advisory services offered through Cambridge Investment Research Advisors, Inc., a Registered Investment Adviser. Cambridge and Simply Sophisticated Wealth Planning, LLC are not affiliated.

2

I am satisfied with my ability to meet my financial obligations

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

3

I am satisfied with the income provided by my current job or careerIf already retired, consider the level of income you are current receiving from various sources.

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

4

I am satisfied with my spending habits.

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

5

I am satisfied with the level of debt I carry.

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

6

I am satisfied with the extras that I am able to buy for myself and/or loved ones.

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

7

I am satisfied with the level and quality of insurance protection I currently have.

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

8

I know how I would pay for a need for care for myself or a family member if the need arises.

YESNO

9

I am satisfied with the amount of money I save and invest on a regular basis.

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

10

I am satisfied with the level of employee benefits I receive.

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

N/A Retired

N/A Unemployed

11

I am satisfied with my current investment choices .

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

12

I am satisfied with my style of personal bookkeeping and financial records management.

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

13

I am satisfied with my plans to fund my children's education.

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

N/A No children going to college, or already completed

14

I am satisfied my estate plan is complete and accurately reflects my wishes.

I don't have an estate plan set up

I set up my estate plan years ago and it should probably be reviewed and updated.

Completely satisfied

15

I am satisfied with my level of charitable giving.

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

16

I am satisfied with my level of financial literacy and education .

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

17

I am satisfied with how I respond emotionally to my personal finance issues and or market volatility.

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

18

I am satisfied with ability to communicate about my financial matters to people important to me.

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

19

I am satisfied that financial issues do not cause stress or strain in the relationships that are important to me.

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

20

I am satisfied with the feelings I have about my money life .

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

21

I am satisfied with the working relationships I have with my professional relationships (i.e. insurance agent, banker, lawyer, accountant, investment adviser)Feel free to add comments at the end.

Not at all satisfied

Somewhat satisfied, but it could improve

Completely satisfied

22

If there were 3 outcomes you hope to achieve through my relationship with you, what would they be?

23

What are the 3 most important areas of your financial life you would like to take action on right away?

24

General comments or additional questions to address

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Name* This field is required.

First Name

Last Name

26

Email* This field is required.

example@example.com

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Phone Number* This field is required.

Please enter a valid phone number.