Financial Planning Questionnaire

Financial Planning Questionnaire
- Take 60 minutes or less to organize your financial data. It is ok to approximate your figures.

- After you submit this form, you will receive an email with a link to schedule your financial planning meeting.

Personal Information
Full Name*

First NameMiddle NameLast NameSuffix
Address

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth*

MonthDayYear
Email Address
example@example.com
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Company Name
Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Fax Number
Please enter a valid phone number.Format: (000) 000-0000.
What is your preferred method of communication?*

Work PhoneCell PhoneEmail
Do you have a Spouse?*

YesNo

Spouse's Personal Information
Spouse's Full Name*

First NameMiddle NameLast NameSuffix
Same address as Previous?

YesNo
Spouse's Address

Street Address

Street Address Line 2

CityState

Zip Code
Spouse's Date of Birth*

MonthDayYear
Spouse's Email Address
example@example.com
Spouse's Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Spouse's Company Name
Spouse's Work Phone
Please enter a valid phone number.Format: (000) 000-0000.
Spouse's Fax Number
Please enter a valid phone number.Format: (000) 000-0000.
What is their preferred method of communication?*

Work PhoneCell PhoneEmail

Children And/or Grandchildren Information
Children And/or Grandchildren Information

Annual Income Information

It is okay to approximate your figures

Income

Rows	Current Year – Yours	Current Year – Spouse	Future Change (+/–) Yours	Future Change (+/–) Spouse
Salary & Bonuses
Dividends & Interest

Pension

Rows	Current Year – Yours	Current Year – Spouse	Future Change (+/–) Yours	Future Change (+/–) Spouse
Military / Federal
State
Municipal
Other Pension

Retirement Accounts & Benefits

Rows	Current Year – Yours	Current Year – Spouse	Future Change (+/–) Yours	Future Change (+/–) Spouse
IRA / 401(k)
403(b)
457(b)
Social Security
Other

Income Totals
Your Total Current Income
Your Spouse's Current Income
Your Total Total Future Income Changes
Your Spouse's Total Future Income Changes

Retirement Questions
At what age do you want to be financially independent?
At what age would you “ideally” like to retire?
How much monthly income (after tax) is needed to live comfortably?
How much are you saving for retirement monthly?
Do you have a pension?

YesNo
What is the monthly amount?
Will you work after retirement?

YesNo
What is your estimated monthly salary?

Income Taxes
How much federal and state income tax did you pay last year?
What are your yearly contributions to your IRAs, 401(k), 403(b), 457(b), or TSA?
Combine all into one total
Do you anticipate significant changes in taxable income in the future?

YesNo
Please explain:

Investments
Do you have a money manager or financial planner?

YesNo
If so, are you pleased with the service provided?

YesNo
Is your investment advice coordinated with your tax and estate planning?

YesNo
Please describe your experience and any changes in your financial planning that you would like to see.
How comfortable are you when dealing with investments?

LimitedGoodExtensive

Confidential Net Worth

Assets

Personal Assets

Rows	Amount
Checking accounts
Money markets
Certificates of deposit
Stocks (attach brokerage statement)
Bonds (attach brokerage statement)
Mutual funds (attach brokerage statement)
Other

Upload Brokerage Statements - (if applicable)

Cancelof

Retirement Assets

Rows	Amount
IRA accounts – yours
IRA accounts – spouse
Roth IRA
Other
401(k)
457(b)
403(b)
DROP
Self-employment plan
Company retirement plan
State or local government retirement plan
Military or federal retirement plan

Real Estate Assets

Rows	Property Address	Market Value
Residence - 1
Residence - 2
Rental - 1
Rental - 2

Business or Practice Assets

Rows	Property Address	Market Value
Business/Practice - 1
Business/Practice - 2

Other Assets

Rows	Describe	Market Value
Other - 1
Other - 2

Total Assets

Confidential Net Worth

Liabilities

Mortgage Balance

Rows	Remaining Balance	Monthly Payment
First Mortgage
Second Mortgage
Other

Rental

Rows	Remaining Balance	Monthly Payment
First Mortgage
Second Mortgage
Other

Other Liabilities

Rows	Remaining Balance	Monthly Payment
Auto Loans
Auto Loans
Credit Cards
Credit Cards
Other
Other

Total Liabilities
Net Worth

Additional Information
Do you expect any future inheritance?

YesNo
Please Provide Details
What do you hope to gain from our services?
Do you have any other financial, tax or estate planning concerns to address?
Should be Empty:

Financial Planning Questionnaire

Personal Information

Spouse's Personal Information

Children And/or Grandchildren Information

Financial Concerns and Goals

Annual Income Information

Income Totals

Retirement Questions

Income Taxes

Estate Planning and Marriage Information

Life, Disability, and Long-Term Care Insurance

Investments

Dreams, Visions, Images

Confidential Net Worth

Confidential Net Worth

Additional Information