Financial Planning Questionnaire
Please review this form to determine what information you will need to complete the form. You can click "Save & Continue Later" at the bottom of the form to save the form and return later. Please enter a value for each field with an asterisk. If none, enter 0 or select "none". This form uses 2048-bit RSA Encryption.
Client #1
Name
*
E-mail
*
Phone Number
*
-
Date of Birth
*
-
Month
-
Day
Year
Retirement Age Goal
*
Life Expectancy
*
Spouse's Name
Number of Children
Financial Information
Client #1 Income
*
Total Household Income
*
Monthly Household Expenses
*
Annual Household Savings
*
Annual College Savings Goal
*
Assets
Residence
*
Automobiles
*
Personal Property
*
Investment Property
*
Other Assets
*
Liabilities
Residential Mortgage
*
Automobiles Loan Amount
*
Credit Cards
*
Other Liabilities
*
Social Security Information
Monthly Benefit At Full Retirement Age
*
Visit www.ssa.gov to look up your benefit
Insurance Information
Life Insurance Amount
*
Life Insurance Type
*
None
Term
Whole Life
Universal Life
Other
Disability Insurance Amount
*
Disability Insurance Type
*
None
Own Occupation
Any Occupation
LTC Insurance Amount
*
Investments Information
Risk Profile
*
Conservative
Moderately Conservative
Moderate
Moderately Aggressive
Aggressive
401(k) Value
*
Rollover IRA Value
*
ROTH IRA Value
*
SEP IRA Value
*
Inherited IRA Value
*
Brokerage Account Value
*
Savings Account Value
*
Other Investment Value
*
Client #2 - Spouse / Partner
Name
E-mail
Phone Number
-
Date of Birth
-
Month
-
Day
Year
Retirement Age Goal
Life Expectancy
Number of Children
Enter a number here if children are from a previous relationship
Social Security Information
Monthly Benefit At Full Retirement Age
Visit www.ssa.gov to look up your benefit
Insurance Information
Life Insurance Amount
Life Insurance Type
None
Term
Whole Life
Universal Life
Other
Disability Insurance Amount
Disability Insurance Type
None
Own Occupation
Any Occupation
LTC Insurance Amount
Investments Information
Risk Profile
Conservative
Moderately Conservative
Moderate
Moderately Aggressive
Aggressive
401(k) Value
Rollover IRA Value
ROTH IRA Value
SEP IRA Value
Inherited IRA Value
Brokerage Account Value
Savings Account Value
Other Investment Value
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