Financial Planning Questionnaire

Personal Information

Today’s date: ______

Client initials: ______

Name on cover page:______

Contact Information

Individual 1Individual 2

Full name: ______Full name: ______

Date of Birth: ______Date of Birth: ______

Age: ______Age: ______

Retirement Age: ______Retirement Age: ______

Social Security #: ____ - ___ - ____ (optional)Social Security #:____ - ___ - ____ (optional)

Address & Employment Information (optional)

Individual 1Individual 2

Email: ______Email: ______

Phone: ______Phone: ______

Address: ______Address: ______(if different)

City: ______State: ___ Zip: ______City: ______State: ___ Zip: ______
Employment

Individual 1Individual 2

Employer: ______Employer: ______

Job Title: ______Job Title: ______

Phone: ______Phone: ______

Email: ______Email: ______

Address: ______Address: ______

City: ______State: ___ Zip: ______City: ______State: ___ Zip: ______Employment Period: ______Employment Period: ______

Risk

Risk Profile

Investment Attitude: Very Conservative SomewhatConservative Moderate

SomewhatAggressive Very Aggressive

Investment Experience: None VeryLittle Moderate Significant Extensive

Estate

Check the box if you have any of the following: Individual 1Individual 2

Will

Revocable Living Trust

Martial Trust Provisions

Credit Shelter Trust Provisions

Qtip Trust Provisions

Irrevocable Life Insurance Trust

Durable General Power of Attorney

Living Will

Generation Skip Trust Provisions

Joint Revocable Trust

Testamentary Trust

Insurance

Insurance Information You may need to review your insurance policies in order to get this information.

Individual 1 Individual 2

Permanent life insurance: $______$______

Term life insurance: $______$______

Cash values (less loans):$______$______

Long-term care insurance: $______$______

Pension, Earned Income & Social Security

Defined Pension Information Include information on pensions that provide an annual income level

(i.e.: military pension, state pension, etc.)

Individual 1 Individual 2

Pension 1 Pension 2 Pension 1 Pension 2

Anticipated annual amount: $______$______$______$______

Starting age:______

Increase rate before retirement:______% ______% ______% ______%

Increase rate after retirement: ______% ______% ______% ______%

Survivor benefit (%): ______% ______% ______% ______%

Individual 1 Individual 2

Earned Income

Earned income now: $______

Social Security

Age to start benefit: ______

Annual increase rate: ______% ______%

Estimated or current annual benefit: $______$______

Expenses

Estimate annual figures for expenses related to shelter, food, clothing, transportation, insurance, loans, etc.

Do not .include taxes.

Annual Living Expenses (today’s dollars)Annual inflation rates for living expenses

Now:$______Before Retirement: ______%

Current Surviving Household: $______Surviving Household: ______%

During Retirement:$______During Retirement: ______%

Single Retiree Survivor:$______Single Retiree Survivor: ______%

Special Income/Expenses

Special Income/Expense List any other sources of income or special expenses to be paid from your capital accounts.

Description Annual amount Increase rate Starting year # of years Priority*

______$______% ______

______$______% ______

______$______% ______

______$______% ______

______$______% ______

______$______% ______

______$______% ______

______$______% ______

*Priority – Essential (E), Primary (P), Secondary (S), Optional (0)

Education Funding

Children’s Education and Fund Expenses

Child’s Name Age Age to start college Cost per year* # of years Current college fund

______$______$______

______$______$______

______$______$______

______$______$______

______$______$______

______$______$______

______$______$______

Inflation rate to use for college planner: ______%

Rate of return on college funds: ______%

College fund account types (529,UGMA,Ect): ______

*In today’s dollars

Assets

List capital assets including banking accounts, investment accounts, stocks, bonds, mutual funds, business interests

and other financial assets.

No. Asset name Current value* Annual Account description Owner

Additions (i.e. stock, 401k, bank account, etc)

1 ______$______$______

2 ______$______$______

3 ______$______$______

4 ______$______$______

5 ______$______$______

6 ______$______$______

7 ______$______$______

8 ______$______$______

9 ______$______$______

10 ______$______$______

11 ______$______$______

12 ______$______$______

13 ______$______$______

14 ______$______$______

15 ______$______$______

16 ______$______$______

17 ______$______$______

18 ______$______$______

19 ______$______$______

20 ______$______$______

21 ______$______$______

22 ______$______$______

23 ______$______$______

24 ______$______$______

25 ______$______$______

Additional Assets/Debts

Other Asset Values Owner Other Debts/Liabilities Owner

Residence value:$______Residence mortgage: $______

Personal property:$______Credit card balances: $______

Autos: $______Autos loans: $______

Boats, RVs, etc: $______Boats, RVs, etc. loans: $______Other assets: $______Other loans: $______

Rates

Rate of Return Estimate annual rates of return for investment assets.

Taxable Asset Tax Free Assets Tax Deferred Assets Annuity Assets

Before Retirement: ______% ______% ______% ______%

During Retirement: ______% ______% ______% ______%

Cost Basis: ______% ______% ______% ______%

Taxes

Estimate presentand post-retirement effective income tax rates.

Effective income tax rate before retirement:______%

Effective income tax rate after retirement: ______%

Increase Rates of Capital Additions per Year

Money added to savings, investments, and retirement accounts increases the amounts available for retirement. In many cases, the amount you are adding now will increase in the future as your income increases. If the expected amount of deposits will increase, enter the increase rate in this section. If the additions will be level then enter zeros. Negative rates are also acceptable.

Savings & investment accounts:______%

Retirement accounts for client:______%

Retirement accounts for spouse:______%

Notes

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

______

Risk Assessment Questionnaire

Your name ______

  1. I am more concerned about protecting my assets than about growth.
  2. I prefer the ease of mutual funds to the uncertainty of trying to pick winning stocks.
  3. Professional advisors and mutual funds may achieve higher growth than I can.
  4. I am comfortable with investments that promise slow, long-term appreciation and growth.
  1. I don’t brood over bad investment decisions I have made.
  2. I feel comfortable with aggressive growth investments.
  3. I do not like surprises.
  4. I am optimistic about my financial future.
  5. My immediate concern is for income rather than growth opportunities.
  6. I am a risk taker.
  7. I make investment decisions comfortably and quickly.
  8. I like predictability and routine in my daily life.
  9. I usually pick the tried and true, the slow, safe but sure investments.
  10. I need to focus my investment efforts on reserve funds and insurance rather than growth.
  11. I prefer predictable, steady returns on my investments, even if the return is low.

Budget Calculation Worksheet

Expense Worksheet / Estimated Monthly Expenses
Item: / Now: / Retirement: / Survivor Now: / Survivor Retirement:
Rent or lease payment
Food household incidentals
Utilities, telephone
Auto operating and maintenance
Clothing and personal items
Property improvement & upkeep
Domestic help, babysitting
Property taxes
Entertainment & vacations
Charitable contributions
Childcare
Alimony, child support
Books, papers, subscriptions
Home furnishings
Gifts, birthdays
Medical expenses
Other expenses
Mortgage payment
Auto loan payment
Boat & RV payments
Credit card payments
Other loan payments
Life insurance premiums
Medical insurance premiums
Auto insurance premiums
House insurance premiums
Other insurance premiums