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Financial Plan Data Gathering Sheet
Jeffrey Settle, CFP®, District Financial Planning
Client One
First Name
Last Name
Client Two
First Name
Last Name
Gross Annual Income
Sources include salary, bonuses, rental income, consulting fees, etc.
Client 1
Client 2
Notes on Annual Income
Cash Assets
Account type could be savings, checking, money market, etc.
Checking/Savings Balances
Notes on Cash Assets
401(k)/403(b)/TSP
Client 1
contribution to 401(k)/403(b)/TSP
This contribution is:
percentage
dollar amount
match to 401(k)/403(b)/TSP
This match is:
percentage
dollar amount
balance of 401(k)/403(b)/TSP
Client 2
contribution to 401(k)/403(b)/TSP
This contribution is:
percentage
dollar amount
match to 401(k)/403(b)/TSP
This match is:
percentage
dollar amount
balance of 401(k)/403(b)/TSP
Notes on 401(k)/403(b)/TSP
Housing
Number of Houses
Please Select
1
2
3
4
5
Notes on Housing
Auto
Number of Autos
Please Select
1
2
3
4
5
Notes on Autos
Other Assets
Client 1
Client 2
Notes on Other Assets
Other Liabilities
Personal loans, credit cards, student loans, etc.
Number of Liabilities
Please Select
0
1
2
3
4
5
Notes on Other Liabilities
Life Insurance
Do you have Life Insurance?
Yes
No
How many Life Insurance Policies?
Yes
No
Life Insurance Policy 1
Life Insurance Policy 2
Life Insurance Policy 3
Life Insurance Policy 4
Life Insurance Policy 5
Life Insurance Policy 6
Life Insurance Policy 7
Life Insurance Policy 8
Notes on Life Insurance
Disability Insurance
Do you have Disability Insurance?
Yes
No
How many Disability Insurance Policies?
Please Select
1
2
3
4
5
6
7
8
Disability Policy 1
Disability Policy 2
Disability Policy 3
Disability Policy 4
Disability Policy 5
Disability Policy 6
Disability Policy 7
Disability Policy 8
Notes on Disability Insurance
Long Term Care Insurance
Do you have Long Term Care Insurance?
Yes
No
How many Long Term Care Insurance Policies?
Please Select
1
2
3
4
5
6
7
8
Long Term Care Policy 1
Long Term Care Policy 2
Long Term Care Policy 3
Long Term Care Policy 4
Long Term Care Policy 5
Long Term Care Policy 6
Long Term Care Policy 7
Long Term Care Policy 8
Notes on Long Term Care Insurance
Expenses
Please record your actual expenses, not your aspirational expenses
Alimony
Frequency
Annual
Monthly
Associations/Dues
Frequency
Annual
Monthly
Automobile Fuel
Frequency
Annual
Monthly
Automobile Insurance
Frequency
Annual
Monthly
Automobile Lease
Frequency
Annual
Monthly
Automobile Maintenance
Frequency
Annual
Monthly
Cable/Internet
Frequency
Annual
Monthly
Charity
Frequency
Annual
Monthly
Child Care
Frequency
Annual
Monthly
Child Support
Frequency
Annual
Monthly
Clothing/Dry Cleaning
Frequency
Annual
Monthly
Clothing/Purchases
Frequency
Annual
Monthly
Club/Gym/Other Membership
Frequency
Annual
Monthly
Entertainment
Frequency
Annual
Monthly
Food/Dining
Frequency
Annual
Monthly
Food/Groceries
Frequency
Annual
Monthly
Gifts
Frequency
Annual
Monthly
Hobbies
Frequency
Annual
Monthly
Home Furnishings
Frequency
Annual
Monthly
Home Improvement
Frequency
Annual
Monthly
Home Lawn/Maintenance/Trash
Frequency
Annual
Monthly
Home Security
Frequency
Annual
Monthly
Homeowner's Association
Frequency
Annual
Monthly
Homeowner's Insurance
Frequency
Annual
Monthly
Maid Service/Nanny
Frequency
Annual
Monthly
Medical/Doctors & Dentists
Frequency
Annual
Monthly
Medical/General
Frequency
Annual
Monthly
Medical/Health Insurance
Frequency
Annual
Monthly
Medical/Prescriptions
Frequency
Annual
Monthly
Personal Care
Frequency
Annual
Monthly
Pet Care
Frequency
Annual
Monthly
Professional Fees
Frequency
Annual
Monthly
Property Taxes
Frequency
Annual
Monthly
Rent
Frequency
Annual
Monthly
Subscriptions
Frequency
Annual
Monthly
Telephone
Frequency
Annual
Monthly
Travel
Frequency
Annual
Monthly
Utilities
Frequency
Annual
Monthly
Vacations
Frequency
Annual
Monthly
Other Expenses/Miscellaneous
Frequency
Annual
Monthly
Notes on Expenses
Estate Planning
Have you done any estate planning?
Yes
No
If so, what is in place?
Do you work with any other financial professionals? If so, who?
Is there a HR person I can contact regarding any questions I may have on your benefits?
Please attach the following for all clients:
Most Recent Paystubs
Upload a File
Cancel
of
401(k)/403(b)/ TSP Statements
Upload a File
Cancel
of
Pension Statements (if applicable)
Upload a File
Cancel
of
Auto/Home Insurance Policy Declarations Pages
Upload a File
Cancel
of
All Investment/Banking Account Statements
Upload a File
Cancel
of
Any additional Notes
Submit
Should be Empty: