FINANCIAL FACT MAP
Name
Gender
D.O.B.
Occupation
Income
Bonuses
Phone #
Email
example@example.com
Name (Spouse)
Gender
D.O.B.
Occupation
Income
Bonuses
Phone #
Email
example@example.com
What Are Your Desired Outcomes of Becoming Debt Free?
1.
2.
3.
4.
5.
Passive Income
Name
Monthly Amount ($)
Name
Monthly Amount ($)
Name
Monthly Amount ($)
Liabilities/Wealth Transfers
Rows
Mortgage Company
Balance
Interest Rate
Monthly Principal
Monthly Interest-
Actual Payment
Liabilities/Wealth Transfers
Rows
Vehicle
Balance
Interest Rate
Minimum Payment
Actual Payment
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Continued: Liabilities/Wealth Transfers
Rows
Other Liabilities
Balance
Interest Rate
Minimum Payment
Actual Payment
Current Life Insurance Type: Term or Cash Insurance
Rows
Owner
Type (Term/Cash)
Company
Death Benefit
Monthly Premium
Term Left/Cash Value
Liquid Assets
Type: Savings Account or CD
Rows
Owner
Type
Current Value
Monthly Contribution
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Type: Active 401k, Old 401k, IRA, Roth IRA or Other
Rows
Owner
Type of Account
Current Value
Monthly Contribution
Employer Contribution
Additional Questions
Are you anticipating any major lifestyle changes? (ex. marriage, divorce, retirement, moving etc)
Yes
No
Uncertain
Explanation
Are you happy with your current cash flow?
Yes
No
Uncertain
If Yes, Explain
Do you anticipate any significant changes in your cash flow?
Yes
No
Uncertain
If Yes, Explain
Do you anticipate any major expenditures in the near future?
Yes
No
Uncertain
If Yes, Explain
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