Confidential Financial Questionnaire Online Form

Confidential Financial Questionnaire
Personal Information

Please bring the following items with you to the meeting: Beneficiary information & Social Security Numbers, Statements/policies for accounts/investments that you would like to review.
Client 1 Name*

First NameLast Name
Birth Date*

MonthDayYear
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Employer
Occupation
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Income

Please enter information about your income sources below. If you have income from real estate or investment accounts, please do not enter that information here.
Income*

Investments/ Retirement Accounts

Please enter information below regarding your investment accounts. The more detail you can provide, the better.
Investments*
Some investment accounts leverage annuities. Annuities can seem complicated. If you have any accounts involving annuities, please bring a recent copy of your statement or upload here and we can review and discuss your plan with you. Do you have any annuity accounts?*

YesNoUnsure
File Upload

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Pension Accounts*

Real Estate

Enter the types of real estate you own below. Please use interest & principal only.
Real Estate*

Life Insurance

Please complete information and/or bring copies of statements. Having this information prior to the meeting is helpful in creating a true financial profile.
Insurance*
Do you have any additional types of insurance? Please mark those that apply below.*

Short Term DisabilityLong Term DisabilityLong Term CareNone

Liabilities & Expenses

Please complete information or bring copies of statements. *Do not include real estate loans.
Debts & Liabilities*
Estimated Monthly Expenses:
Dollar Amount $

SPECIAL CIRCUMSTANCES OR SURVIVOR NEEDS

We provide specialized planning for clients with loved ones who may require extra care. “Special needs planning” can mean different things to different families, and we want to ensure your financial plan accounts for these possibilities. Do you have a child, parent, or sibling who may need special care at some point? Unexpected expenses can have a significant impact on a family’s financial security, and planning ahead can make all the difference.
Please let us know in a manner that is comfortable for you, if you can foresee any time in the future that you may have any of these circumstances.
Please feel free to upload any additional documents that you think may be helpful.

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Confidential Financial Questionnaire