Explore Meeting Questionnaire

Tell Us About You

All information is kept in strict confidence and is used to ensure I make the highest and best use of the time you invest with me.

Full Name 1*

PrefixFirst NameMiddle NameLast Name

Full Name 2

PrefixFirst NameMiddle NameLast Name

Date of Birth 1*

MonthDayYear

Date of Birth 2

MonthDayYear

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mobile Number 1*

Please enter a valid phone number.

Mobile Number 2

Please enter a valid phone number.

E-mail*

example@example.com

Occupation & Employer*

Formal Job Title

Are you married?*

YesNo

What is your gross annual income ?*

Please upload your most recent paystub.

Outside of your automated payroll savings (401k/403b, HSA), how much are you automatically saving each month? This includes savings accounts, money markets, IRAs, brokerage accounts, or any other accounts where you are saving cashflow each month.*

Do you smoke?*

YesNo

Dependents

	Name	Date of birth	Gender
Child 1
Child 2
Child 3
Child 4

What motivated you to get in touch with us ? (Please elaborate)*

Assets and liabilities*

	Current Value	Loan amount	Repayment	Purchase price	Interest Rate
Primary Residence
Vehicle
Bank Savings
Non-Retirement Investments
Investment Properties
401k/403b balances
Health Savings Accounts
529 Plans
Roth IRAs
Traditional IRAs
Life Insurance Cash Value
Credit Cards
Other Loan 1
Other Loan 2

Do you have any investment objectives? (Please elaborate)*

Do you have a will and/or trust?*

YesNo

If yes, when was it last reviewed ?*

Why is money important to you? In 20 years when you look back, what would have to happen for you to consider your financial planning a huge success? Elaborate as much as you can on both questions.*

Have you ever worked with a financial planner before? If so, what did you like about it and what do you think could have improved it?*

Protection Questionnaire

In each row, fill out only what is applicable. Remember, when filling this out it is better to be generally right rather than precisely wrong- we can always drill down on specifics to the extent we move forward in working together.

If you have Income protection, please indicate Benefit amount, waiting period and Benefit expiry age.

	Monthly Benefit (% or $)	Waiting period	Benefit expiry age
Personally Owned Income Disability Insurance
Income Disability Insurance through Work

If you have personally owned life insurance, please complete the details below.

	Death Benefit	Term Length	Monthly Premium	Year Purchased
Personally Owned Term Insurance
Personally Owned Whole Life Insurance
Personally Owned IUL, VUL, or UL

Do you have any Personal insurance objectives? (Please elaborate)*

Approximate days of Sick leave and annual leave ?

When working with a financial planner or advisor, which is the following is the MOST important?

Having a point person to rely onReducing taxesReaching a fully funded retirementGetting on top of cashflow to make sure you're maximizing your savingsGetting access to out-of-the-box wealth creation and wealth sustaining ideasKnowing the kids' college is paid forNot sure- isn't the job of the financial advisor to help me figure out what is most important?Maximizing investment returns