Financial & Investment Planning

Financial & Investment Planning
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Marital Status

SingleMarriedDivorcedWidowed
Number of Dependents
Ages of Dependents
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Current Employment Status

EmployedSelf-EmployedRetiredUnemployed
Occupation
Employer Name

First NameLast Name
Annual Income
Financial Goals
Primary Financial Goals

Retirement PlanningEducation FundingDebt ReductionHome PurchaseInvestment GrowthOther
Time Horizon for Each Goal: Short-term (0-2 years)
Time Horizon for Each Goal: Medium-term (3-5 years)
Time Horizon for Each Goal: Long-term (5+ years)
Income and Expenses
Monthly Income
Salary/Wages
Rental Income
Investment Income
Other
Monthly Expenses
Housing (mortgage/rent, utilities)
Transportation
Groceries
Insurance Premiums
Debt Payments
Savings/Investments
Other
Assets and Liabilities
Assets
Cash and Savings
Investments (stocks, bonds, mutual funds)
Retirement Accounts (401k, IRA)
Real Estate
Other
Liabilities
Mortgage
Credit Card Debt
Student Loans
Car Loans
Other
Investment Risk Tolerance

Very ConservativeConservativeModerateAggressiveVery Aggressive
Experience with Investing

NoneLimitedModerateExtensive
Insurance Coverage
Life Insurance Coverage Amount
Beneficiaries
Health Insurance Coverage Details
Disability Insurance Coverage Details
Property and Casualty Insurance Coverage Details
Additional Comments
I authorize the Financial Planning Firm to use the information provided in this questionnaire to develop a personalized financial plan. I understand that this plan will be based on the accuracy and completeness of the information I have provided.
Date

MonthDayYear
Date
Signature
Should be Empty:

Financial & Investment Planning

Financial Goals

Income and Expenses

Monthly Income

Monthly Expenses

Assets and Liabilities

Assets

Liabilities

Insurance Coverage