Financial Information

Financial Information
Client Name

First NameLast Name
Client 2 Name (if applicable)

First NameLast Name
Date

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Client 2 Phone Number
Please enter a valid phone number.
Email
example@example.com
Client 2 Email
example@example.com
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Family Information

	First Name	DOB	Age	Occupation	Salary	Commissions and Bonuses	Total Income
Client 1
Client 2
Child
Child
Child
Child

Loans and Debts

	Type	Unpaid Balance	Monthly Payment	Interest Rate %	Months left to pay
1.
2.
3.
4.
5.
6.

Car/Home/Umbrella Insurance

	Liability Limits	Uninsured/Underinsured Limits	Deductible	Annual Premium
Car
Home/Renter's
Umbrella

Life Insurance

	Year Purchased	Type/Company	Death Benefit	Annual Premium	Cash Value
Client 1
Client 2
Children

Disability and/or Long Term Care Insurance

	Type/Source	Annual Premium	Benefit Amount or %	Benefit Period	Waiting Period
Client 1
Client 2

Types of Savings and Investment Accounts:

Checking	Fined Annuities	403b/TSA	Corporate Bonds	Businesses
Savings	401k	Profit Sharing Plan	Stocks	Home
Money Markets	Roth 401k	Deferred Comp.	Variable Annuities	Real Estate
CD's	IRA	Government Bonds	Indexed Annuities	Tax Shelters
Savings Bonds	Roth IRA	Municipal Bonds	Mutual Funds	Other

Savings and Investments

	Ownership (client 1, client 2, joint, etc.)	Account Type	Current Value	Annual Personal Contribution	Annual Employer or Other Contribution	Additional Information for Account
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20,

Wills or Trusts?

YesNo
Year established
Is it up to date?

YesNo
Additional Notes or Comments:
Should be Empty: