Financial Checklist

Financial Checklist
Name*

First NameLast Name
What is your age?*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

Employment Information
What is your employment status?*

EmployedUnemployedRetired

Employment Information
Employer Name*
What is your current position?*
What is your current salary (including bonuses)?*
Please enter this as a gross number (before taxes, etc. are taken out).
How long have you been with this employer?*

Your Current Unemployment Income
How much income do you receive each month from unemployment?*
Please enter this as a gross number (before taxes, etc. are taken out).
When do you expect these benefits to stop (month/year)?*

My Anticipated Retirement Information
How much do you expect to receive each month from Social Security at your Full Retirement Age (FRA)?*
Please enter a number. If you are unsure, please enter "unsure".
When do you expect to retire?*

Within the next 2 yearsWithin the next 5 yearsWithin the next 10 yearsMore than 10 years from now

My Retirement Information
How old were you when you retired?*
What year did you retire?*
What is your current monthly income from Social Security?*
Please enter this as a gross number (before taxes, etc. are taken out).
What is your monthly income from pensions?*
If you do not receive any pension income, please enter 0. Please enter this as a gross number (before taxes, etc. are taken out).

What is your marital status?*

SingleMarriedPartneredSeparatedDivorcedWidowed

My Spouse/Partner Information
Name*
Age*
Email*
example@example.com
Phone Number
Please enter a valid phone number.
Spouse/Partner Employment Information
What is your spouse/partner's employment status?*

EmployedUnemployedRetired

Spouse/Partner Employment Information
Employer Name*
What is your spouse/partner's current position?*
What is your spouse/partner's current salary?*
Please enter this as a gross number (before taxes, etc. are taken out).
How long has your spouse/partner been with this employer?*

Your Spouse/Partner's Current Unemployment Income
How much unemployment income does your spouse/partner receive each month?*
Please enter this as a gross number (before taxes, etc. are taken out).
When are those unemployment benefits expected to end (month/year)?*

Spouse/Partner Anticipated Retirement Information
How much does your spouse/partner expect to receive each month from Social Security at Full Retirement Age (FRA)?*
Please enter a number. If you are unsure, please enter "unsure). Enter this as a gross number (before taxes, etc. are taken out).
When does your spouse/employer expect to retire?*

Within the next 2 yearsWithin the next 5 yearsWithin the next 10 yearsMore than 10 years from now

Spousal/Partner Retirement Information
How old was your spouse when they retired?*
What year did your spouse/partner retire?*
What is your spouse/partner's income from Social Security?*
Please enter this as a gross number (before taxes, etc. are taken out).
What is your spouse/partner's total monthly income from other sources such as pensions or annuities?*
If they do not have pension or annuity income, please enter 0. Please enter this as a gross number (before taxes, etc. are taken out).

Do you have any children?*

YesNo

Child #1
Name

First NameLast Name
Age
Child #2
Name

First NameLast Name
Age
Child #3
Name

First NameLast Name
Age
Child #4
Name

First NameLast Name
Age

Investment Accounts
Do you or your spouse/partner have any investment, retirement, pension, or college savings accounts not held with Money Concepts?*

YesNo

Investment/Savings Information
How much money do you have available for investing?*
How much money do you have saved for emergencies?*

Life Insurance Plans

Please bring copies of your policy to your meeting for review.
Do you or your partner have life insurance?*

YesNo

Do you own a home?*

YesNo

What is your monthly rent payment?*
Are you anticipating purchasing a home within the next 5 years?*

YesNo

How much do you owe on your mortgage?*
What is your monthly payment?*
What is your home's appraised value?*
Do you own any other homes or property?*

YesNo

What type of property is it?*

Vacation Home/CondoRental PropertyBusiness PropertyLand Only
How much money is owed on this property (mortgage or loan)?*
What is the monthly payment?*
What is this property's appraised value?*
If this is rental property, how much income does it generate each month?*
Please enter a net amount.

Do you have any outstanding credit card debt?*

YesNo

What is the total balance on all your credit cards?*
How much do you pay towards this debt each month?*

Do you have any outstanding car loans?*

YesNo

What is the total dollar amount of car loans you have?*
What is your total monthly payment on all car loans?*

Do you have any other outstanding debts (e.g., student loans, 2nd mortgage, Home Equity Line of Credit (HELOC), family assistance obligations?*

YesNo

What type of debt is it?*

Student Loan2nd MortgagePersonal LoanFamily Assistance/ObligationsHome Equity Line of Credit (HELOC)Other
What is the total amount of this debt?*
How much do you pay towards this debt each month?*
Do you have any other outstanding debt?*

YesNo

What type of debt is it?*

Student Loan2nd MortgagePersonal LoanFamily Assistance/ObligationsHome Equity Line of Credit (HELOC)Other
What is the total amount of this debt?*
How much do you pay towards this debt each month?*
Do you have any other outstanding debt?*

YesNo

What type of debt is it?*

Student Loan2nd MortgagePersonal LoanFamily Assistance/ObligationsHome Equity Line of Credit (HELOC)Other
What is the total amount of this debt?*
How much do you pay towards this debt each month?*

Financial Checklist

Employment Information

Employment Information

Your Current Unemployment Income

My Anticipated Retirement Information

My Retirement Information

My Spouse/Partner Information

Spouse/Partner Employment Information

Spouse/Partner Employment Information

Your Spouse/Partner's Current Unemployment Income

Spouse/Partner Anticipated Retirement Information

Spousal/Partner Retirement Information

Child #1

Child #2

Child #3

Child #4

Investment Accounts

Investment/Savings Information

Life Insurance Plans

Will / Power of Attorney / Advance Directive for Health Care