New Case Request

New Case Request
Financial Advisor Information
Advisor Name*
Advisor Email*

Client Information
Client 1
Name*
Date of Birth*

MonthDayYear
Retirement Age*
Gender

MaleFemaleN/A
State of Tax Residency
Would you like to add another client?*

YesNo
Client 2
Name*
Date of Birth*

MonthDayYear
Retirement Age*
Gender

MaleFemaleN/A
Beneficiary Information

Client 1 Income Information
Target Retirement Income (after tax)
Target Retirement Income is an after-tax amount and includes total annual expenses including mortgage/rent, property taxes, insurance, medical expenses, food and grocery, utilities, phone/cable/internet, etc.
Wages
Are you currently working?*

YesNo
Annual Wages/Income (before tax)*
Estimated Annual Increase (%)
Social Security
Are you currently collecting Social Security?*

YesNo
Projected annual benefits at age 67*
Current annual benefit*
Estimated COLA Increase (%)
Pension
Do you have a pension?*

YesNo
Are you currently collecting pension benefits?*

YesNo
What age will you start pension benefits?*
Projected annual pension benefits*
Current annual pension benefits*
Estimated annual increase (%)
Describe any pension survivorship benefits
Pension settlement amount
Other Incomes

Client 2 Income Information
Wages
Are you currently working?*

YesNo
Annual Wages/Income (before tax)*
Estimated Annual Increase (%)
Social Security
Are you currently collecting Social Security?*

YesNo
Projected annual benefits at age 67*
Current annual benefit*
Estimated COLA Increase (%)
Pension
Do you have a pension?*

YesNo
Are you currently collecting pension benefits?*

YesNo
What age will you start pension benefits?*
Projected annual pension benefits*
Current annual pension benefits*
Estimated annual increase (%)*
Pension settlement amount
Describe any pension survivorship benefits
Other Incomes

Portfolio Information
Monetary Assets*
Property and Other Assets
Liabilities
Deferred Assets (e.g., inheritances, sale of property, trusts with payout dates)

Having Enough for Retirement
We strive to make sure all plans have enough income for retirement needs, but please tell us about anything else we should know about your goals.
Additional Information*

Managing Taxes
Would you like us to analyze the potential benefits of a Roth IRA conversion?*

YesNo
Do you have any accounts with low cost basis holdings?*

YesNo
Holdings Information*
What would you like to do with these low cost basis holdings?*

Liquidate and incorporate proceeds into my portfolioDo not sellOther (specify in Additional Information below)
Additional Information

Charitable Giving
Year to begin giving*
Target charitable giving amount*
Charitable giving goal type*

Annual giving goalLifetime giving goal
Do you have other itemized Schedule A deductions?*

YesNo

Additional Information

Building Savings
Annual savings goal (total)*

Where would you like to direct your savings?

	Client 1	Client 2
Non-Qualified
Traditional IRA
Roth IRA
Retirement Plan
Other

Do you have a company-sponsored retirement plan with employer matching?

YesNo
Client 1 Matching %
Client 2 Matching %
Additional Information

Selling a Property
When do you plan to sell your property?*
What is your estimated profit from the sale?*
Additional Information

Paying off Debt
Debt Information*
How do you want to pay off your debt?*

Pay it off by a certain yearCreate an annual debt payment budget
Payoff year goal*
Annual debt budget goal*
Additional Information

Paying for Healthcare Expenses
When do you want to start planning for healthcare expenses?
Estimated annual out of pocket healthcare costs
Estimated annual Medicare premiums
Additional Information

Paying for Education Expenses
Education Expenses Information*
How would you like to budget for education expenses?*

Save to a new accountSave to an existing accountPay from plan income only
Account name
Additional Information

Travelling/Vacations
What is your desired travel/vacation budget?*
What year would you like to start travelling/vacations?*
How frequently will you travel/vacation?*

AnnuallyEvery # of years
Travel/vacation frequency (in years)
How many years should we budget for travel/vacations?
Additional Information

Paying for a Major Life Event
Type of event*
Estimated cost of event*
Estimated year event will occur*
Additional Information

Buying a Vehicle
When would you like to buy your new vehicle?*
How often would you like to buy a new vehicle?*

OnceEvery # of years
Vehicle purchase frequency (in years)
Estimated cost of vehicle*
Will you sell your old vehicle?*

YesNo
Estimated residual value
Additional Information

Purchasing a Property
Estimated year of purchase*
Estimated down payment amount*
Estimated annual cost of ownership*
Including mortgage payments, property taxes, utilities, etc.
Estimated mortgage period (in years)*
Additional Information

Retiring Early
Who plans to retire early?

Client 1Client 2
In what year would you like to retire early? (Client 1)*
In what year would you like to retire early? (Client 2)
Additional Information

Leaving an Inheritance
Will you provide gifts to heirs while living?*

YesNo
Gift amount (per year)*
Year to begin gifts*
Would you like to use life insurance for estate planning?*

YesNo
Client 1 premium per $100k*
Client 2 premium per $100k*
Additional Information

Affording Long-Term Care
Are you interested in using life insurance with a long-term care rider?*

YesNo
Client 1 premium per $100k*
Client 2 premium per $100k*
Are you interested in using annuities in a long-term care plan?*

YesNo
Preferred annuities*
Additional Information

Survivorship of a Spouse
Client 1 life expectancy*
Client 2 life expectancy*
Would you like to use life insurance for survivorship planning?*

YesNo
Client 1 premium per $100k*
Client 2 premium per $100k*
Additional Information

Planning Preferences
Use life insurance

NeverWhen recommendedAlways
Client 1 premium per $100k
Client 2 premium per $100k
Use annuities

NeverWhen recommendedAlways
Share of portfolio to invest in annuities (%)
Preferred annuities
Other planning instructions

Confirmation
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