Client Starter Kit
Upon Submission your Starter Kit will be sent to your MathiesFP Coach!
Who is your advisor coach?
*
Jeff Mathies
Steve Foltz
Caleb Moore
Jeff Young
Lindsey Turner
Choose your marital status
*
Single
Married
Divorced
Widowed
Choose your tax filling status
*
Single
Head of household
Filling Jointly
Name
*
First Name
Last Name
Spouse Name
First Name
Last Name
Birthday
*
-
Month
-
Day
Year
Date
Spouse Birthday
-
Month
-
Day
Year
Date
Veterian
Yes
No
Yes (spouse)
No (spouse)
If applicable, what branch?
Wedding anniversary
-
Month
-
Day
Year
Date
Phone Number
*
Please enter a valid phone number.
Spouse Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Spouse email
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Profession
*
Spouse Profession
Work Email (Optional)
example@example.com
Spouse work Email (Optional)
example@example.com
Work Phone Number (Optional)
Please enter a valid phone number.
Spouse work Phone Number (Optional)
Please enter a valid phone number.
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Other information
Do you have a will?
*
Yes
No
Have you named your beneficiaries?
*
Yes
No
Do you have health insurance?
*
Yes
No
Do you have a health savings account?
*
Yes
No
Do you own disability insurance?
*
Yes
No
Do you own long term care insurance?
*
Yes
No
Do you have a general durable power of attorney?
*
Yes
No
Do you have a healthcare power of attorney?
*
Yes
No
Do you own final expense (burial) insurance?
*
Yes
No
Do you have a trust(s)
*
Yes
No
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Information of People who Live inside your American Dream
These are the people that live inside your American Dream, but are not beneficiaries. For example: cousins, best friend, business partner, god-children etc. can be anyone as long as they are not also beneficiaries.
Name
First Name
Last Name
Relationship
(ex. cousin, business partner, best friend, god-children, etc.)
Birthday
-
Month
-
Day
Year
Date
Add Another Person
Yes
No
Name
First Name
Last Name
Relationship
(ex. cousin, business partner, best friend, god-children, etc.)
Birthday
-
Month
-
Day
Year
Date
Add Another Person
Yes
No
Name
First Name
Last Name
Relationship
(ex. cousin, business partner, best friend, god-children, etc.)
Birthday
-
Month
-
Day
Year
Date
Add Another Person
Yes
No
Name
First Name
Last Name
Relationship
(ex. cousin, business partner, best friend, god-children, etc.)
Birthday
-
Month
-
Day
Year
Date
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Beneficiaries
(Son, Daughter, Mom, Dad, etc.)
Have you named beneficiaries?
*
Yes
No
How many beneficiaries have you named?
1
2
3
4
5
6
Beneficiary 1
First Name
Last Name
Relationship
(son, daughter, mom, dad, etc.)
Birthday
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Beneficiary #2
First Name
Last Name
Relationship
(son, daughter, mom, dad, etc.)
Birthday
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Beneficiary #3
First Name
Last Name
Relationship
(son, daughter, mom, dad, etc.)
Birthday
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Beneficiary #4
First Name
Last Name
Relationship
(son, daughter, mom, dad, etc.)
Birthday
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Beneficiary #5
First Name
Last Name
Relationship
(son, daughter, mom, dad, etc.)
Birthday
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Beneficiary #6
First Name
Last Name
Relationship
(son, daughter, mom, dad, etc.)
Birthday
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Financial Goals
List 1-4 goals you'd like to achieve with your finances and the date you'd like to achieve it by.
Financial Goals
*
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Employment income
Employer Client 1
Current Gross Monthly Salary
Projected annual salary increase %
Projected retirement
-
Month
-
Day
Year
Date
Employer Client 2 (spouse)
Current Gross Monthly Salary
Projected annual salary increase %
Projected retirement
-
Month
-
Day
Year
Date
Social Security Benefits (if known)
Client 1
First Name
Last Name
Strategy
Leave blank if you don't know
Start age
Gross monthly benefit
Projected COLA %
Full Retirement Age
Full Retirement Age Amount
Client 2 (spouse)
First Name
Last Name
Strategy
Leave blank if you don't know
Start age
Gross monthly benefit
Projected COLA %
Full Retirement Age
Full Retirement Age Amount
Pension Benefits
Do you have pension benefits?
*
Yes
No
Client 1
Company
Years of service
Description
Start age
Gross monthly benefit
Projected COLA %
Percentage to survivor
Client 2 (spouse)
Company
Years of Service
Description
Start age
Gross monthly benefit
Projected COLA %
Percentage to survivor
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Spendable Assets
This includes all bank accounts (savings / checking), retirement accounts (IRA, 401K, etc.), CDs, Stocks etc.
Do you have Spendable assets?
*
Yes
No
Who Owns It?
Client 1
Spouse
Both
Company or Custodian
Such as Boeing or Fidelity
Tax classification (IRA, 401k, TSP, Non Qualified, etc.)
If you don't know, leave blank.
Investment vehicle
(Mutual Fund, CD, Annuity, Life Insurance, Cash)
Value
Monthly contribution
Do you have more Spendable assets?
Yes
No
Who Owns It, Owner or Spouse Name
Client 1
Spouse
Both
Company or Custodian
Such as Boeing or Fidelity
Tax classification (IRA, 401k, TSP, Non Qualified, etc.)
If you don't know, leave blank.
Investment vehicle
(Mutual Fund, CD, Annuity, Life Insurance, Cash)
Value
Monthly contribution
Do you have more Spendable assets?
Yes
No
Who Owns It, Owner or Spouse Name
Client 1
Spouse
Both
Company or Custodian
Such as Boeing or Fidelity
Tax classification (IRA, 401k, TSP, Non Qualified, etc.)
If you don't know, leave blank.
Investment vehicle
(Mutual Fund, CD, Annuity, Life Insurance, Cash)
Value
Monthly contribution
Do you have more Spendable assets?
Yes
No
Who Owns It, Owner or Spouse Name
Client 1
Spouse
Both
Company or Custodian
Such as Boeing or Fidelity
Tax classification (IRA, 401k, TSP, Non Qualified, etc.)
If you don't know, leave blank.
Investment vehicle
(Mutual Fund, CD, Annuity, Life Insurance, Cash)
Value
Monthly contribution
Do you have more Spendable assets?
Yes
No
Who Owns It, Owner or Spouse Name
Client 1
Spouse
Both
Company or Custodian
Such as Boeing or Fidelity
Tax classification (IRA, 401k, TSP, Non Qualified, etc.)
If you don't know, leave blank.
Investment vehicle
(Mutual Fund, CD, Annuity, Life Insurance, Cash)
Value
Monthly contribution
Do you have more Spendable assets?
Yes
No
Who Owns It, Owner or Spouse Name
Client 1
Spouse
Both
Company or Custodian
Such as Boeing or Fidelity
Tax classification (IRA, 401k, TSP, Non Qualified, etc.)
If you don't know, leave blank.
Investment vehicle
(Mutual Fund, CD, Annuity, Life Insurance, Cash)
Value
Monthly contribution
Do you have more Spendable assets?
Yes
No
Who Owns It, Owner or Spouse Name
Client 1
Spouse
Both
Company or Custodian
Such as Boeing or Fidelity
Tax classification (IRA, 401k, TSP, Non Qualified, etc.)
If you don't know, leave blank.
Investment vehicle
(Mutual Fund, CD, Annuity, Life Insurance, Cash)
Value
Monthly contribution
Do you have more Spendable assets?
Yes
No
Who Owns It, Owner or Spouse Name
Client 1
Spouse
Both
Company or Custodian
Such as Boeing or Fidelity
Tax classification (IRA, 401k, TSP, Non Qualified, etc.)
If you don't know, leave blank.
Investment vehicle
(Mutual Fund, CD, Annuity, Life Insurance, Cash)
Value
Monthly contribution
Do you have more Spendable assets?
Yes
No
Who Owns It, Owner or Spouse Name
Client 1
Spouse
Both
Company or Custodian
Such as Boeing or Fidelity
Tax classification (IRA, 401k, TSP, Non Qualified, etc.)
If you don't know, leave blank.
Investment vehicle
(Mutual Fund, CD, Annuity, Life Insurance, Cash)
Value
Monthly contribution
Protected Assets
Non-spendable assets. For Example: your home, collector cars, art work
Do you have Protected assets?
*
Yes
No
Owner
First Name
Last Name
Company
Description
Value
Do you have more Protected assets?
Yes
No
Owner
First Name
Last Name
Company
Description
Value
Do you have more Protected assets?
Yes
No
Owner
First Name
Last Name
Company
Description
Value
Single Premium Annuities
Do you have Single Premium Annuities?
Yes
No
Owner
First Name
Last Name
Company
Tax Classification
Payout
Single
Joint
Mode
Monthly
Annual
Account Value
Benefit Amount
Benefit start date
-
Month
-
Day
Year
Date
Benefit end date
-
Month
-
Day
Year
Date
Do you have more Single Premium Annuities?
Yes
No
Owner
First Name
Last Name
Company
Tax Classification
Payout
Single
Joint
Mode
Monthly
Annual
Account Value
Benefit Amount
Benefit start date
-
Month
-
Day
Year
Date
Benefit end date
-
Month
-
Day
Year
Date
Income Benefit Annuities
Do you have Income Benefit Annuities?
Yes
No
Owner
First Name
Last Name
Company
Tax Classification
Payout
Single
Joint
Mode
Monthly
Annual
Account Value
Benefit Amount
Benefit start date
-
Month
-
Day
Year
Date
Benefit end date
-
Month
-
Day
Year
Date
Do you have more Income Benefit Annuities?
Yes
No
Owner
First Name
Last Name
Company
Tax Classification
Payout
Single
Joint
Mode
Monthly
Annual
Account Value
Benefit Amount
Benefit start date
-
Month
-
Day
Year
Date
Benefit end date
-
Month
-
Day
Year
Date
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Risk assessment questions
Emergency Fund Desired Amount
What dollar amount you would like to keep in liquid accounts, such as checking, savings, or money market accounts, etc.? These funds can be protected in the plan, for use in the future if needed.
How many years can you let your assets grow before having to take out withdrawals?
*
1-2 years
3-5 years
6-10 years
10+ years
13+ years
Which statement best describes how you feel about saving and risk?
*
I do not want to see my principal amount decrease
I cannot afford a significant loss to principal regardless of interest earned or rate or return received.
If my interest or rate of return stays ahead of inflation, I don’t want exposure to risk.
If I can make a moderate interest or rate of return on my investments, I can withstand some market fluctuation.
I want to invest for higher returns, and I am willing to take on some risk.
What would you consider a reasonable interest rate or rate of return on your investments?
*
3% - 4%
4% - 6%
7% - 9%
9% - 11%
Greater than 11%
Which one of the possible outcomes on a one-year investment below, indicates the amount of risk you would be comfortable taking?
*
Best Case $102,000 (Increase of 2,000) - Worst Case $100,000 (Decrease of $0)
Best Case $104,000 (Increase of 4,000) - Worst Case $96,000 (Decrease of $4,000)
Best Case $108,000 (Increase of $8,000) - Worst Case $92,000 (Decrease of $8,000)
Best Case $112,000 (Increase of $12,000) - Worst Case $88,000 (Decrease of $12,000)
Best Case $116,000 (Increase of $16,000) - Worst Case $84,000 (Decrease of $16,000)
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Expenses
Current Monthly Expenses After Tax
*
Projected Inflation Rate
Monthly Budget Worksheet
(Make sure to break all ANNUAL payments such as property taxes and insurance into monthly payments for this form)
Mortgage Principal & Interest
(Do not include taxes)
Real Estate Taxes
Homeowners Insurance
Home Equity Loan
Association Dues
Rent
Renters Insurance
Renters Insurance
Utilities – Gas – Electric
Water – Sewer
Cable – Phone – Internet
Maintenance & Improvement
House Cleaning
Daily Living
Food
Dinning Out
Clothing
Personal Care
Healthcare & Insurance
Health Insurance
Prescription
Life Insurance
Long Term Care insurance
Disability Insurance
Veterinarian
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Transportation
Auto Loans
Auto Loans Payoff Date
-
Month
-
Day
Year
Auto Insurance
Fuel
Repairs
Debt & Obligation
Credit Cards
Credit Cards Payoff Date
-
Month
-
Day
Year
Tuition - Student Loans
Tuition - Student Loans Payoff Date
-
Month
-
Day
Year
Alimony
Child Support
Child Support Expected End Date
-
Month
-
Day
Year
Entertainment
Parties & Events
Sport- Hobbies- lessons
Membership Dues
Vacations & Travel
Miscellaneous
Charitable Donations
Gifts
Other
Liabilities
Include any liabilities not listed in the budget above here.
Do you have Liabilities?
*
Yes
No
Owner
First Name
Last Name
Company
Descriptions
Value
Do you have more Liabilities?
Yes
No
Owner
First Name
Last Name
Company
Descriptions
Value
Cash Flow
This would be things like rent payments from rental properties, or royalties from another business, child support received, alimony received - any cash coming in that is not earned income.
Do you have Existing Cash Flow?
*
Yes
No
Owner
First Name
Last Name
Description
Mode
Monthly
Annual
Type
Outflow
Inflow
Taxation
Taxable
Non- Taxable
Amount
% Change
Do you have more Existing Cash Flow?
Yes
No
Owner
First Name
Last Name
Description
Mode
Monthly
Annual
Type
Outflow
Inflow
Taxation
Taxable
Non- Taxable
Amount
% Change
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Red Line Solves
If you are projected to be "in the red", meaning your money will run out before you'd like it to, use a scale of 1-6 where 1 would be the most desirable step and 6 the least desirable step in order to correct this.
Retire at a later date.
Work a second or part time job after retirement.
If not yet retired, increase contributions to retirement savings.
Reverse mortgage.
Look for other income alternatives.
Health Information
Smoker
Yes
No
Smoker (Spouse)
Yes
No
Health Concerns
Health Concerns (Spouse)
Existing Life Insurance Information
Do you have Existing Life Insurance?
*
Yes
No
Owner
First Name
Last Name
Company
Type
Term
Permanent
Death Benefit
Monthly Premium
Cash Value
Policy End Date
-
Month
-
Day
Year
Date
Do you have more Existing Life Insurance?
Yes
No
Owner
First Name
Last Name
Company
Type
Term
Permanent
Death Benefit
Monthly Premium
Cash Value
Policy End Date
-
Month
-
Day
Year
Date
Existing Long-Term Care Coverage Information
Do you have Long-Term Care Coverage
*
Yes
No
Owner
First Name
Last Name
Company
Type
Cash
Reimbursement
Start Date
-
Month
-
Day
Year
Date
Daily Benefit
Years
Inflation Type
Simple
Compound
Inflation %
Monthly premium
Additional Information
Please list any additional information you would like to share with your coach.
Additional Information
Please verify that you are human
*
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