FNA - Citadel Financial Wealth Group

FNA - Citadel Financial Wealth Group
A PERSONALIZED STRATEGY FOR FINANCIAL SECURITY.

If you're like many people, you're in the dark about your finances. You pay your bills each month and do your best to prepare for the future. But the truth is, there's only so much money to go around and preparing for the future can be overwhelming.

To get a better understanding of your financial situation and best be able to help, I would like you to fill out this financial needs assessment form. It should take no more than five minutes, and feel free to estimate / skip any questions you're not sure about or feel uncomfortable answering.

Thank you and looking forward to our meeting!

Select any other services your like to apply for- Please select all that applies:

High Interst Bank Account RRSP/Tax Free Savings Account RSP Loan Mortgage Review Segregated Funds Life Annuity ETF Investing

Some basic housekeeping
Name

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Date Of Birth

Month Day Year
Date
Current Age
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
How many dependents do you have?

Type a question

Name

Date Of Birth

Age

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Do you have a spouse/partner?

Yes No
Name

First Name Last Name
Date Of Birth

Month Day Year
Date
Current Age

Your total assets

Please enter the $ amount in the boxes below.

Your total assets

Current Value

Debt Amount ( What You Owe)

Year Bought

Home / property

Cash & savings

RRSP

TFSA

Pension Balance

Car

Other investments

Your total liabilities

Balance Owing

Mortgage

Credit card debt

Student loans

Car loans

Other debt

Other Debt

Let's talk household income

Please enter the $ amount in the boxes below.

Current

Monthly employment income

Property / asset income

Other income stream(s)

Total income

If you or your partner couldn't contribute to the family, how much annual income would you need to maintain your standard of living?
For how many years would you need this income replaced

Your insurance portfolio

Please enter the information below.
How much individual critical illness insurance do you own? ( Dollar Amount)
How much individual disability insurance do you own?
How much life insurance do you own?
Have you been declined for life, disability, critical illness, or long term care insurance before?

Yes No
If yes, why?
Do you have mortgage insurance?

Yes No
Do you have any other insurance?

Yes No
If yes, please list the type of insurance and amount below.

What are your aspirations?

Please complete each question below.
What are your financial goals?
Are you a saver or a spender
Why are you exploring insurance
Are you looking for help with financial planning as well?

Yes No
What age would you like to retire
How much would you like to retire on per month (in today's value)

In the event of death, would you like to make provision for a lump sum for a specific reason eg enough funds for your spouse to buy a house etc.

Amount

Reason (eg buy house)

Item 1

Item 2

Item 3

Item 4

Item 5

Item 6

Item 7

item 8

In the event of death, would you like leave an income for your spouse and or children or somebody else

Income per month (today's value)

Years that income must last

Person 1

Person 2

Person 3

Person 4

Person 5

Other

Do you have a will ?

Yes No
Who is your executor of your will ? ( List name and relation to you)

Please upload any documents you have on hand that will help us with ensuring we have the right information for your file.

Document List:

- Existing Insurance Coverage

- Mortgage Statements

- Investment Statements

- Savings Statements
Please Upload Documents Here

Browse Files

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Any other questions or comments?
By signing below you consent the information entered is correct and to the best of your knowledge, you consent for Citadel Financial Wealth Group Inc to use this information to build your custom plan.

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FNA - Citadel Financial Wealth Group

Some basic housekeeping

Your total assets

Let's talk household income

Health check

Your insurance portfolio

What are your aspirations?