Financial Needs Analysis Data Collection
A Financial Needs Analysis is the first step in your journey to financial success. With this document we can establish where you are currently and where you would like to be. Please fill out this form to the best of your ability so we can understand better how you can improve on what you are already doing in your financial house.
Are you filling this form as an individual or a couple?
Individual
Couple
Name
First Name
Last Name
Email
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
Primary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Spouse's Name
First Name
Last Name
Spouse's Email
example@example.com
Spouse's Primary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Spouse's Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Retirement
{Name1:first}
: I would like to retire by age
*
{Name2:first}
: I would like to retire by age
*
{Name1:first}, have you always lived in Canada?
Yes
No
{Name2:first}, have you always lived in Canada?
Yes
No
{Name1:first}, how many years have you been in Canada?
{Name2:first}, how many years have you been in Canada?
In today's dollars, assuming no mortgage or kids, how much would you need in retirement? ($ per month)
Retirement Assets & Contributions
Do you contribute monthly to savings of any kind? (Including work Group RRSP/pension)
Yes
No
If yes, how much do you contribute monthly? (Total of all contributions added together)
{Name1:first}, do you have a Tax-Free Savings Account?
Yes
No
If so, where do you have it?
How much have you saved?
{Name2:first}, do you have a Tax-Free Savings Account?
Yes
No
If so, where do you have it?
How much have you saved?
{Name1:first}, do you have an RRSP account?
Yes
No
If so, where do you have it?
How much have you saved
{Name2:first}, do you have an RRSP account?
Yes
No
If so, where do you have it?
How much have you saved
How much combined total savings do you have? (Include RRSP, TFSA, pension, stocks, investments, etc.)
As a couple, how much combined total savings do you have? (Include RRSP, TFSA, pension, stocks, investments, etc.)
Income
{Name1:first}, what is your monthly gross pay (before taxes)?
How often do you get paid?
Weekly
Biweekly
Monthly
Other
{Name2:first}, what is your monthly gross pay (before taxes)?
How often do you get paid?
Weekly
Biweekly
Monthly
Other
Children's Education
Number of children under 18
Amount of Child Tax Benefit received monthly:
Total money saved for educational purposes so far:
Monthly contributions to education fund:
How much would you hope to contribute to the overall cost of education (i.e. 25%, 50%)
25%
50%
75%
100%
Other
How much do you plan to save for education?
Benefits
{Name1:first}, do you have a current will (updated within the last year)?
Yes
No
Do either you have a current will (updated within the last year)?
Yes
No
{Name1:first}, do you have Disability Insurance/Critical Illness?
Yes
No
Do either of you have Disability Insurance/Critical Illness?
Yes
No
If so, through what policy?
Work Policy
Personal/private policy
{Name1:first}, do you have Health & Dental Benefits?
Yes
No
{Name2:first}, do you have Health & Dental Benefits?
Yes
No
If so, through what policy?
Work policy
Personal/private policy
Insurance Needs
{Name1:first}, do you smoke? (Any kind including vape, cigarettes, nicorettes)
Yes
No
Do you have Personal Life Insurance you pay for?
Yes
No
How much do you pay in premium per month?
What is the Total Coverage?
Company Name
{Name2:first}, do you smoke? (Any kind including vape, cigarettes, nicorettes)
Yes
No
{Name2:first}, do you have Personal Life Insurance you pay for?
Yes
No
How much do you pay in premium per month?
What is the Total Coverage?
Company Name
{Name1:first}, do you have Group/Work insurance you pay for?
Yes
No
What is your Total Coverage for this policy?
{Name2:first}, do you have Group/Work insurance you pay for?
Yes
No
What is your Total Coverage for this policy?
OTHER MONTHLY COMMITMENTS
Do you have any other monthly commitments (i.e. spousal or child support, elderly care etc.)?
Yes
No
Total Monthly Amount towards these commitments:
ASSETS AND LIABILITIES
Do you own a home?
Yes
No
Home Value:
Mortgage Interest Rate
Mortgage Balance
Mortgage Renewal Date
-
Month
-
Day
Year
Date
Do you have Mortgage Insurance?
Yes
No
How much do you pay in premium?
How often you pay this premium?
Biweekly
Monthly
Other
Company Name
DEBT MANAGEMENT
(I.e. Student Loan, Car Loan, Credit Card, Line of Credit, etc.).
All Fixed Loans Total Amount (i.e. Car Loan, Student Loan)
Monthly Payment Fixed Loans
Total from All Other Debts (i.e. Credit Cards, Line of Credit)
Monthly Payment for All Other Debts
Form Submission
Thank you for taking the time to complete this form.We appreciate the opportunity to work with you and your family. We assure that your information will remain confidential and will only be used in preparation of your own financial needs analysis, and will only be shared with your representative, the branch manager and/or trainer.By clicking NEXT and writing your full name, you confirm that the information is correct, and you agree to the above uses for the information.
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