Client Intake Form

1
Full Legal Name* This field is required.
Prefix
First Name
Middle Name
Last Name
Suffix
2
Residential Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
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
3
Do you have a different mailing address?* This field is required.
YESNO
4
Mailing Address* This field is required.If Different Than Your Residential Address
Street Address
Street Address Line 2
City
State / Province
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
Date of Birth* This field is required.
Date
Month
Day
Year
6
Social Security Number* This field is required.
7
Preferred Phone Number* This field is required.
Area Code
Phone Number
8
Preferred Email* This field is required.
example@example.com
9
Employment Status* This field is required.Pick One
Employed
Homemaker
Retired
Unemployed
10
Employer Information* This field is required.
Occupation and Job Title (Former Occupation and Job Title, if Retired)
Employer's Name (Former Employer's Name, if Retired)
Employer's Street Address (Former Employer's, if Retired)
Employers' City, State and Zip Code (Former Employer's, if Retired)
11
Does your employer offer a retirement plan?401k, 403b, Pension, Simple IRA, etc.
YESNO
12
Do you participate in your employer's retirement plan?If yes, please provide your last quarterly statement when prompted later in this form.
YESNO
13
Why do you not participate in your employer's retirement plan?
14
Relationship Status* This field is required.
Please Select
Please Select
Married
Single
Widow/Widower
Divorced
Please Select
15
Full Legal Name* This field is required.
Prefix
First Name
Middle Name
Last Name
Suffix
16
Date of Birth* This field is required.
Date
Month
Day
Year
17
Social Security Number* This field is required.
18
Preferred Phone Number* This field is required.
Area Code
Phone Number
19
Preferred Email* This field is required.
example@example.com
20
Employment Status* This field is required.Pick One
Employed
Homemaker
Retired
Unemployed
21
Employer Information* This field is required.
Occupation and Job Title (Former Occupation and Job Title if Retired)
Employer's Name (Former Employer's Name if Retired)
Employer's Street Address (Former Employer, if Retired)
Employer's City, State and Zip Code (Former Employer, if Retired)
22
Does your employer offer a retirement plan?401k, 403b, Pension, Simple IRA, etc.
YESNO
23
Do you participate in your employer's retirement plan?If yes, please provide your last quarterly statement when prompted later in this form.
YESNO
24
Why do you not participate in your employer's retirement plan?
25
Do you have children?* This field is required.
YESNO
26
Name     Date of Birth     Social Security #
Name     Date of Birth     Social Security #
Name     Date of Birth     Social Security #
Name     Date of Birth     Social Security #
Name     Date of Birth     Social Security #
27
Do you have children with special needs?
YESNO
28
Do you have children from a previous marriage/relationship?
YESNO
29
Will your children utilize the TN Promise program? (Only for residents of Tennessee.)
YESNO
30
Do you have a college savings account?529, Coverdell, Trust, etc.
YESNO
31
Please upload your College Savings Account Statement here.
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32
What college would you like for us to use when calculating education costs?
33
Name    Date of Birth Social Security #    %
Name    Date of Birth Social Security #    %
Name    Date of Birth Social Security #    %
Name    Date of Birth Social Security #    %
Name    Date of Birth Social Security #    %
34
Annual Gross Household Income* This field is required.
Less than $25,000
Between $25,000 and $49,999
Between $50,000 and $99,999
Between $100,000 and $249,999
Between $250,000 and $499,999
Between $500,000 and $749,999
Between $750,000 and $999,999
Over $1,000,000
35
Household Net Worth* This field is required.All Assets Minus All Debts
Less than $25,000
Between $25,000 and $49,999
Between $50,000 and $99,999
Between $100,000 and $249,999
Between $250,000 and $499,999
Between $500,000 and $749,999
Between $750,000 and $999,999
Over $1,000,000
36
Household Liquid Net Worth* This field is required.All assets that can be sold and converted to CASH in 7 days or less
Less than $25,000
Between $25,000 and $49,999
Between $50,000 and $99,999
Between $100,000 and $249,999
Between $250,000 and $499,999
Between $500,000 and $749,999
Between $750,000 and $999,999
Over $1,000,000
37
Do you own your home?* This field is required.
YESNO
38
How much is your home estimated value?* This field is required.
39
How much do you owe on your home?* This field is required.
40
What is the estimated balance in your checking and savings accounts?* This field is required.
41
Investment Objective for this Account* This field is required.Our 15+ years of experience has shown that the vast majority of our clients fall into 3 Major Investment Groups. Each group can and will offer various investment strategies and solutions within themselves. Every account is 100% custom for each client - nothing is cookie-cutter at Apex Financial Planning! For example, Client A may have a Growth Account with all individual stocks and Client B may have mutual funds.
Capital Preservation - Designed for investors who are NOT comfortable with stock market fluctuations AT ALL but are seeking higher returns than what Bank Savings Accounts and CD's are currently offering. These investors prefer safety over potentially higher returns offered with other investments. This type of accounts can offer guaranteed income as well.
Balanced Portfolio - Designed for investors who are comfortable with stock market fluctuations and want to see their accounts grow, however, they also wish to have a certain amount of stability and/or want to receive income from the account. These investors understand that investments are not guaranteed but would like a portfolio consisting of fixed income investments (Bonds, Bond Funds, Risk Managed Funds, etc.) and equity investments (mutual funds, ETFs, stocks, etc.).
Growth - Designed for investors with a primary goal of growing their account balance with returns from the stock market and are comfortable with the associated investment risk. These investors understand the stock market offers the highest long-term performance of all investments. Income is possible from this type of account but is not a main focus.
Other - Please select this option if you are unsure or if you feel that your Account Objective does not align with the choices above.
42
Which of the following statements would best describe your reaction if the value of your portfolio were to suddenly decline by 15%?Select one
I would be very concerned because I can't accept fluctuations in the value of my portfolio.
If the amount of income I receive was unaffected, it would not bother me.
Although I invest for the long-term growth, even a temporary decline would concern me.
Because I invest for the long-term growth, I would accept temporary fluctuations due to market influences.
43
Which of the following best describes your investment goals?Select one
Preserving principal while earning a small amount of interest and/or current income.
Generating the highest amount of current income.
Growing assets over the long term while generating a moderate amount of current income.
Growing assets substantially over the long term with no need for current income.
44
Is this account being funded with a 401k rollover?* This field is required.
YESNO
45
Please upload your 401k statement.
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46
Have the current 401k fees review by the advisor yet?* This field is required.
YESNO
47
Do you understand that your 401k fees may be lower than managed IRA fees?* This field is required.401k providers typically charge a smaller fee based on the size of the entire 401k plan.
YESNO
48
Why are you wishing to rollover your 401k?* This field is required.Please select all that apply.
Local Advisor Managing Funds
Larger Investment Selection
More Control Over Investments
Removing Funds From Previous Employer
Consolidating Accounts
Other
49
Do you plan on taking income withdrawals from this account anytime within the next 3 years?* This field is required.
YESNO
50
If yes, what is the estimated withdrawal amount?* This field is required.You can simply write RMD or an actual amount.
51
How long do you plan on keeping your account open?* This field is required.
1 to 3 Years
3 to 5 Years
5 to10 Years
10+ Years (I do not have a set date for closing this account.)
I am opening multiple accounts with various lengths of time that they will be open.
52
Please upload all investment account statements here.529, IRA, Roth IRA, Retirement Accounts from Previous Employers, Non-Retirement Investment Accounts, etc.
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Max. file size: 10.6MB
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53
Have you ever invested in Mutual Funds?* This field is required.
YESNO
54
If yes, how many years have you invested in Mutual Funds? * This field is required.
55
What is the current estimated balance of your Mutual Funds?* This field is required.
56
Have you ever invested in Individual Stocks / ETFs?* This field is required.
YESNO
57
If yes, how many years have you invested in Individual Stocks / ETFs?* This field is required.
58
What is the current estimated balance of your Individual Stocks / ETFs?* This field is required.
59
Have you ever invested in Individual Bonds?* This field is required.
YESNO
60
If yes, how many years have you invested in Individual Bonds?* This field is required.
61
What is the current estimated balance of your Individual Bonds?* This field is required.
62
Have you ever invested in Annuities?* This field is required.Indexed, Fixed, Variable, etc.
YESNO
63
If yes, how many years have you invested in Annuities?* This field is required.
64
What is the current estimated balance of your Annuities?* This field is required.
65
Have you ever invested using Margin?* This field is required.Using borrowed money from a Broker to invest in your account.
YESNO
66
If yes, how many years have you invested using Margin?* This field is required.
67
Have you ever invested in Options?* This field is required.
YESNO
68
If yes, how many years have you invested in Options?* This field is required.
69
Have you ever invested in Partnerships?* This field is required.
YESNO
70
If yes, how many years have you invested in Partnerships?* This field is required.
71
Have you ever invested in any other type of financial product that was not listed?* This field is required.
YESNO
72
If yes, what was the investment, current estimated balance and how many years did you invest?* This field is required.
73
Apex Financial Planning requires a minimum of one face to face financial planning review meeting per year. Do you agree to this requirement?(This meeting is in addition to systematic phone calls and emails throughout the year.)
YESNO
74
Is being debt-free important to you?
YESNO
75
How close are you to achieving your financial goals on a scale from 1 to 10?1 = not very close and 10 = very close
76
How often do you review your financial statements?
Never
Daily
Quarterly
Annually
77
How do you spend your free time?
78
What has been your BEST financial decision?
79
What has been your WORST financial decision?
80
What keeps you awake at night?(Outliving your money, stock market drops, etc.)
81
What would you like to accomplish by working with Apex Financial Planning?
82
Which statement best reflects your expectations of working with a financial advisor?Select all that apply
I want my advisor to help me develop and achieve my comprehensive financial goals and meet with me on a regular basis to monitor these goals.
I prefer that my advisor focus on managing my overall investment portfolio and to be available only when I have financial questions.
I would like for my advisor to invest a certain amount of money for me and only call me when a change needs to be made.
I am looking for a CFP professional to build a financial roadmap and offer advice so that I may go find my own financial planning / investment products on my own time.
83
Which goals are important to you?Select all that apply
Retirement Objective
Educational Goals
Accumulation Goals
Survivor Needs
Disability Income Needs
Long Term Care Needs
Estate Planning
Risk Tolerance
Asset Allocation
Income Tax Analysis
84
Imagine that you have received a large sum of money. What would you do with it?Pick your Top 3
I would invest in something that offered moderate current income and was very conservative.
I would invest in something that offered high current income with a moderate amount of risk.
I would invest in something that offered high total return (current income plus growth) with a moderately high amount of risk.
I would invest in something that offered substantial growth even though it has a high amount of risk.
I would pay off my debts before investing in anything.
I would give a large portion away to charity.
85
Do you expect your financial situation to dramatically change in the next two years?Promotion, pay increase, inheritance, etc.
YESNO
86
How will your financial situation change?
87
How do you feel regarding the long-term prospects for the economy?Select one
Very Optimistic
Very Pessimistic
Somewhat Optimistic
Somewhat Pessimistic
Unsure
88
Do you have a retirement goal already set?For example, having $1,000,000 in retirement assets at age 65 or having $50,000 in annual retirement income?
89
At what age would you like to retire or semi-retire?
90
When would you like to start your Social Security Income?
As soon as possible - 62 years old
My Full Retirement Age - between the age of 65 and 67 depending on date of birth
Wait until I receive the highest income - 70 years old
I do not want to plan on Social Security Income
91
Please upload your Social Security Statement here.You can find your statement by logging into SSA.GOV
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92
Which option best fits you when it comes to your retirement income?Select One
I want to receive interest only, leaving my principal untouched.
I would like to maximize my income by depleting my principal over time based on my life expectancy.
I would like to take out as little as possible so that I can leave as much money to my beneficiaries as possible.
93
Do you feel that you are saving enough to retire comfortably?
YESNO
94
Are you prepared to make budget changes, if more retirement contributions are needed to ensure that you do retire comfortably?
YESNO
95
Do you currently own a Life Insurance Policy?* This field is required.Term, Whole Life, Universal Life, Variable Universal Life, etc.
YESNO
96
Would you like to receive a life insurance quote? Prices have dropped over the years so we may be able to replace or improve your current coverage with the same or lower premiums.
YESNO
97
Why do you not own life insurance?
98
Please upload a copy of your Life Insurance policies.
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99
What type of Life Insurance do you own?
Term Life Insurance
Cash Value (Whole, Universal, Indexed or Variable Life Insurance
100
How many years have you owned a Cash Value Life Insurance Policy?
101
What is the current estimated balance of your Cash Value Life Insurance Policies?* This field is required.
102
What is the death benefit and number of years remaining (if term insurance) on the policy?
103
Do you own Disability Insurance?
YESNO
104
Would you like a Disability Insurance quote?Prices have dropped over the years so we may be able to replace or improve your current coverage with the same or lower premiums.
YESNO
105
What is your plan in the event you become disabled?
106
Please upload a copy of your Disability policy.
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107
What are your Disability Insurance Policy details?Benefit Amount, Benefit Period, Definition of Disability, Elimination Period, etc.
108
Do you own a Long-term Care policy?Nursing Home or In-Home Care
YESNO
109
Would you like a Long-term Care policy quote?Prices have dropped over the years so we may be able to replace or improve your current coverage with the same or lower premiums.
YESNO
110
Please upload a copy of your Long-term Care policy.
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111
What are the benefit details of your Long-term Care policy?Benefit Amount, Benefit Period, etc.
112
How will you cover the costs of a long-term care facility or in-home care?
113
Will you be caring for elderly parents in the future?Financially, physically, etc.
YESNO
114
How do you plan to cover the costs associated with caring for your parents?
115
Do you have an up to date Estate Plan?Will, Living Will, Medical Directive, Power of Attorney, etc.
YESNO
116
Please upload your Estate Planning Documents.
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117
What is your strategy in the absence of a proper Estate Plan?
118
Do you have a cause or charity that you would like to incorporate into your financial planning?Church, school, non-profit, etc.
119
Who is your Attorney?Please include attorney's name, firm name, and contact information
120
Who prepares your tax forms?Please include accountant's name, firm name and contact information
121
Please upload your last two years tax returns here.
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122
Who is your Insurance Agent?Please include agent's name, firm name, and contact information
123
Please upload your Property Insurance Policies.
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124
Is there anyone else that you consult before making a large decision? If yes, please list their name below.
Should be Empty: