Confidential Profile

1
Full Name
First Name
Last Name
2
Spouse’s/Partner’s Name
First Name
Nickname
Last Name
3
Children’s Names & Birth Dates
Name + DOB
Name + DOB
Name + DOB
4
Address
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Phone Number
Area Code
Phone Number
6
E-mail
7
Employer
8
Your Job Title
9
Address
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
10
Spouse/Partner Job Title
11
Spouse/Partner Employer
12
Address
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
13
Future Career Plans
14
Career/Academic/Employment Background
15
Other Interests/Activities
16
Your Income: Salary
17
Your Income: Bonus
18
Your Income: Rental
19
Your Income: Investment
20
Your Income: Social Security
21
Your Income: Pension
22
Your Income: Other
23
Your Total Annual Income
24
Spouse/Partner: Salary
25
Spouse/Partner: Bonus
26
Spouse/Partner: Rental
27
Spouse/Partner: Investment
28
Spouse/Partner: Social Security
29
Spouse/Partner: Pension
30
Spouse/Partner Income: Other
31
Spouse/Partner's Total Annual Income
32
Total Combined Annual Family Income
33
Expenses: Fixed
34
Expenses: Variable
35
Expenses: Home Mortgage
36
Expenses: Second Mortgage
37
Expenses: Credit Card
38
Expenses: Personal Loans
39
Expenses: Life Insurance
40
Total Annual Expenses
41
Non-Retirement Investments: Account 1
42
Non-Retirement Investments: Account 2
43
Non-Retirement Investments: Account 3
44
Non-Retirement Investments: Savings
45
Non-Retirement Investments: Checking
46
Non-Retirement Investments: Other
47
Retirement Investments: IRA
48
Retirement Investments: Roth IRA
49
Retirement Investments: 401(k)/403(b)
50
Retirement Investments: Defined Benefit
51
Retirement Investments: Profit Sharing
52
Real Estate (check all that apply)
Residence
2nd Home
Rental Property
Land
53
Residence Value
54
2nd Home
55
Rental Property
56
Land
57
Do you have a business?
Yes
No
58
Business Value
59
Entity Type
60
Other Assets
61
Short-Term Liabilities: Credit Cards; Notes
Interest Rate
62
Short-Term Liabilities: Personal Loan
Interest Rate
63
Long-Term Liabilities: Home Mortgage
Interest Rate
64
Long-Term Liabilities: Second Mortgage
Interest Rate
65
Long-Term Liabilities: Business
Interest Rate
66
Long-Term Liabilities: Additional Property
Interest Rate
67
Other Liabilities
68
You:
69
Your Spouse/ Partner:
70
What do you value most in life?
71
What do you ultimately want to achieve in your life?
72
Are you more concerned about growing your assets or protecting what you already have?
73
What needs to happen over the next few years in order for you to feel our relationship has been successful?
74
Are you anticipating any major lifestyle changes? (i.e. marriage, divorce, retirement, move, etc.)
Yes
No
Unsure
75
What changes are you expecting and when?
76
Are you comfortable with your current cash flow?
Yes
No
Unsure
77
Planned/Actual Age at Retirement
You
Partner/ Spouse
78
What minimum after-tax income will you need at retirement (in today’s dollars)?
You
Partner/ Spouse
79
If you plan on working during retirement, estimate your anticipated income.
You
Partner/ Spouse
80
I expect an inheritance of how much and in how many years.
You
Partner/ Spouse
81
Are you contributing to an IRA?
Yes
No
82
Is your spouse/ partner contributing to an IRA?
Yes
No
83
Does your employer offer a retirement program?
Yes
No
84
What type of retirement program:
401k
403b
457
85
Do you participate in your employer's retirement program?
Yes
No
86
Do you have adequate disability coverage?
Yes
No
Unsure
87
Does your partner/ spouse have adequate disability coverage?
Yes
No
Unsure
88
Do you have adequate personal liability/umbrella coverage?
Yes
No
Unsure
89
Does your partner/ spouse have adequate personal liability/umbrella coverage?
Yes
No
Unsure
90
Do you have enough life insurance?
Yes
No
Unsure
91
Does your partner/ spouse have enough life insurance?
Yes
No
Unsure
92
Do you have long-term care insurance for home health care?
Yes
No
Unsure
93
Does your partner/ spouse have long-term care insurance for home health care?
Yes
No
Unsure
94
Do you have long-term care insurance for assisted living?
Yes
No
Unsure
95
Does your partner/ spouse have long-term care insurance for assisted living?
Yes
No
Unsure
96
Is employer-provided health insurance available during retirement?
Yes
No
Unsure
97
Is your partner/ spouse's employer-provided health insurance available during retirement?
Yes
No
Unsure
98
When were your current wills/trusts signed?
You
Partner/ Spouse
99
Do you or your partner/ spouse have any established trusts?
Yes
No
Unsure
100
Are you or your partner/ spouse the beneficiary of any trusts?
Yes
No
Unsure
101
Have you or your partner/ spouse adequately planned for estate taxes?
Yes
No
Unsure
102
Have you or your partner/ spouse provided adequate estate liquidity for your heirs?
Yes
No
Unsure
103
Have you or your partner/ spouse planned your legacy?
Yes
No
Unsure
104
Please list your current concerns, financial or otherwise:
105
What Professional Advisors do you have?Check all that apply*
Financial Advisor
Accountant
Attorney
Home and Auto Insurance Agent
Bank Officer
Trust Officer
Real Estate Agent
Life Insurance Agent
106
Financial Advisor’s Name
First Name
Last Name
107
Financial Advisor’s Firm
108
Length of Relationship with Financial Advisor
109
Financial Advisor’s Phone Number
Area Code
Phone Number
110
Financial Advisor’s Email
example@example.com
111
Are you committed to working with this advisor?
Yes
No
112
Attorney’s Name
First Name
Last Name
113
Attorney’s Firm
114
Length of Relationship with Attorney
115
Attorney’s Phone Number
Area Code
Phone Number
116
Attorney’s Email
example@example.com
117
Are you committed to working with this advisor?
Yes
No
118
Accountant’s Name
First Name
Last Name
119
Accountant’s Firm
120
Length of Relationship with Accountant
121
Accountant’s Phone Number
Area Code
Phone Number
122
Accountant’s Email
example@example.com
123
Are you committed to working with this advisor?
Yes
No
124
Life Insurance Agent’s Name
First Name
Last Name
125
Life Insurance Agent’s Firm
126
Length of Relationship with Life Insurance Agent
127
Life Insurance Agent’s Phone Number
Area Code
Phone Number
128
Life Insurance Agent’s Email
example@example.com
129
Are you committed to working with this advisor?
Yes
No
130
Home & Auto Insurance Agent’s Name
First Name
Last Name
131
Home & Auto Insurance Agent’s Firm
132
Length of Relationship with Home & Auto Insurance
133
Home & Auto Insurance Agent’s Phone Number
Area Code
Phone Number
134
Home & Auto Insurance Agent’s Email
example@example.com
135
Are you committed to working with this advisor?
Yes
No
136
Bank Officer’s Name
First Name
Last Name
137
Bank Officer’s Firm
138
Length of Relationship with Bank Officer
139
Bank Officer’s Phone Number
Area Code
Phone Number
140
Bank Officer’s Email
example@example.com
141
Are you committed to working with this advisor?
Yes
No
142
Real Estate Agent’s Name
First Name
Last Name
143
Real Estate Agent’s Firm
144
Length of Relationship with Real Estate Agent
145
Real Estate Agent’s Phone Number
Area Code
Phone Number
146
Real Estate Agent’s Email
example@example.com
147
Are you committed to working with this advisor?
Yes
No
148
Trust Officer’s Name
First Name
Last Name
149
Trust Officer’s Firm
150
Length of Relationship with Trust Officer
151
Trust Officer’s Phone Number
Area Code
Phone Number
152
Trust Officer’s Email
example@example.com
153
Are you committed to working with this advisor?
Yes
No
Should be Empty: