CLIENT PROFILE
FP NAME:
DATE:
New
Update
1. Background Information
Client/Owner
Joint Client/Owner (if N/A put line through area)
*First Name
*
First Name
Last Name
*First Name
*
First Name
Last Name
*SSN/TIN
*
*SSN/TIN
*
*DOB (Age)
*
*DOB (Age)
*
Street Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Street Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Complete previous address if changed within the last 12 months
Please Complete previous address if changed within the last 12 months
Street Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Street Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
*Citizenship:
*
US
Resident Alien
Non-Resident
*Citizenship:
*
US
Resident Alien
Non-Resident
If non-US, specify:
If non-US, specify:
Daytime Phone:
Format: (000) 000-0000.
Evening Phone:
Format: (000) 000-0000.
Daytime Phone:
Format: (000) 000-0000.
Evening Phone:
Format: (000) 000-0000.
Email:
example@example.com
Email:
example@example.com
*Status:
*
Employed
Self-Employed
Retired
Unemployed
*Status:
*
Employed
Self-Employed
Retired
Unemployed
*Occupation:
*
*Occupation:
*
Employer Name:
Employer Name:
Employer Address:
Employer Address:
No. of Years:
No. of Years:
Education:
HS
Assoc.
BA/BS
Masters/Ph.D.
Education:
HS
Assoc.
BA/BS
Masters/Ph.D.
*Marital Status:
*
Single
Married
Divorced
Widowed
Widowed
Domestic Partner
* # Of Dependents:
*
Age(s)
Name(s)
(exp. 09/21)
Increase Financial
7335 Highway 6 South Ste 250
Missouri City, Texas 77459
Page 1
Back
Next
2. Financial Information
*CURRENT HOLDINGS
Complete all that apply (a-i).
Client/Owner Income (all sources):
a) CDs:
Joint Client/Owner Income (all sources):
b) Stocks
*Est. Gross Annual Household market Income:
*
c) Bonds:
*Est. Monthly Expenses:
*
d) Annuities:
*Est. Net Monthly Income:
*
e) Mutual Funds:
(post tax income minus est. monthly expenses)
f) Investment Real Estate (Net Equity):
*Fed. Tax Bracket:
*
10%
15%
25%
28%
33%
35%
g) Retirement Accounts (401(k), 403(b), IRA):
39.6%
h) Other (529 plans, life policy cash values, alternative investments, etc.):
i) Cash (checking, savings, money market):
*INVESTMENT EXPERIENCE (IN YEARS)
Rows
None
<1
1-4
5+
a)*CDs
b)*Stocks
c)*Bonds
d)*Annuities
e)*Mutual Funds
=j) *Total Assets (above):
*Net Worth (modified: all assets minus debts; excludes primary residence and associated debt):
*
*Liquid Net Worth
*
Definitions
Investment Experience - Includes all qualified and non-qualified experience within an asset class. Experience does not require there to be any current holdings within the referenced asset class.
Current Holdings - All qualified/retirement holdings should be listed under "Retirements Accounts". Assets used to fund this recommendation/purchase should be included in this section.
Other - All financial investment assets, liquid and non-liquid, that are not included in the remaining listed categories. This can include interests, but should exclude the primary residence. Only those assets that fit the liquid Net Worth definition above should be marked as liquid.
Total Assets - Total Assets exclude your primary residence and associated debt.
Net Worth (modified) - Is the value of your assets minus your liabilities. Assets include all your current holdings/Total Assets above plus personal property. Do not include your primary residence among your assets. For liabilities, include any outstanding loans, credit card balances, taxes, etc. Do not include debt on your primary residence among your liabilities.
Liquid Net Worth - Is your Net Worth minus assets that cannot be converted quickly and easily into cash such as investment real estate, business equity, personal property, automobiles, expected inheritances, and assets marked for other purposes. It may however include investments or accounts that can be liquidated within 30 days such as checking, savings and money market accounts, IRA, 403b, 401k, annuities, all marketable securities, etc. Liquid asset value with current surrender and early withdrawal penalties (i.e., annuities, CDs) can be adjusted down to reflect any current redemption charges or penalties.
3. Insurance Coverage
3. Insurance Coverage Indicate issuer and policy coverage:
Rows
Client/Owner
Joint Client/Owner
Life Insurance
Disability Insurance
LT Care Insurance
Comments:
Comments:
Comments:
(exp. 09/21)
Increase Financial
7335 Highway 6 South Ste 250
Missouri City, Texas 77459
Page 2
Back
Next
4. Patriot Act Information
Owner Form of Identification (Please check one.)
Valid Driver's License
Passport
State Issued ID
Identification Number
State/Country
Issue Date
Exp. Date
Joint Owner Form of Identification (Please check one.)
Valid Driver's License
Passport
State Issued ID
Identification Number
State/Country
Issue Date
Exp. Date
5. Additional Client Notes and Important Considerations (Inheritance/windfall, planned retirement date, special care needs, wills, trusts, etc.)
6. Current Financial Goals (Rank all that apply in priority using 1, 2, 3, etc.)
(e.g., Diversification, Replacement Income, Protect Assets, Death Benefits, Living Benefits, etc.)
Should be Empty: