PLANNING QUESTIONNAIRE
Confidential
File no.:Client name:
Client type:
Spouse name:
Questionnaire completed on:
Updated:
Financial planner:
SECTION 1: PERSONAL INFORMATION
Residence and job
Client / SpouseMr. / Ms. / Mr. / Ms.
Address:
Since (date):
Date of birth: / Date of birth:
S.I.N.: / S.I.N.:
Home phone: / Home phone:
Office phone: / Office phone:
Cell phone: / Cell phone:
Fax: / Fax:
Email: / Email:
employer self-employed retired / employer self-employed retired
Name: / Name:
Address: / Address:
Since(date): / Since(date):
Position: / Position:
Job type: 1 2 3 4 / Job type: 1 2 3 4
1. Permanent2. Temporary3. Independent4. No job
Civil status
Client / Spouse
Since (date) / Since (date)
single / single
married/civil union / married/civil union
de facto union[1] / de facto union1
widowed / widowed
legally separated / legally separated
divorced / divorced
Support payments
Client / Spouse
paidreceivednot applicable / paid received not applicable
Marriage or civil union contract (append a copy to the questionnaire)
partnership of acquestsseparation of property community of propertyothern/a
Cohabitation agreement (append a copy to the questionnaire)
yes nonot applicable
Surrender of family property rights
yes nonot applicable / yes nonot applicable
Children / Grandchildren
First name / Date of birth / Job / Annual income / Civil status / Last name / First name / Date of birth
1)
2)
3)
Comments:
Other informationClient / Spouse
smokernon-smoker never smoked / smoker non-smoker never smoked
State of health: 1 2 3 4 / State of health:1 2 3 4
1. Excellent2. Good3. Fair4. Poor
Details:
Professionaladvisors
Name / Firm and address / Phone / Fax / EmailLawyer
Notary
Accountant or tax expert
Account manager
Financial security advisor
Broker’s representative
Liability insurance broker or agent
Other:
For the spouse, if different:
Name / Firm and address / Phone / Fax / EmailLawyer
Notary
Accountant or tax expert
Account manager
Financial security advisor
Broker’s representative
Liability insurance broker or agent
Other:
SECTION 2:GOAL SUMMARY
Personal and family situation
Yes / No / CommentsGet married or enter civil union
Live in a de facto union
Get divorced
Adopt children
Have children
Separate
Other:
Financial situation
Yes / No / CommentsEvaluate net worth
Evaluate cost of living
Eliminate personal debts
Establish a savings strategy
Purchase a home
Review investment strategy
Help children or grandchildren pursue higher education
Other:
Tax situation
Yes / No / CommentsReduce income taxes
Optimize after-tax investment income
Evaluate compensation method
Evaluate business structure
Use income-splitting strategies
Other:
Retirement situation
Yes / No / CommentsRetire at age . Maintain a cost of living of , in today’s dollars.
Evaluate options for cashing out RRSPs, RRIF, annuities, etc.
Choose between a defined benefit pension plan and transfer to a LIRA
Set up an individual pension plan
Other:
Situation at death
Yes / No / CommentsDraft or update the will
Determine life insurance needs
Maintain current cost of living for heirs for ____years
Provide additional bequests for heirs
Provide other bequests, such as to a foundation
Minimize taxes payable on death
Business:ensure continuation of the business after death
Other:
Protection situation
Yes / No / CommentsDraft or update a mandate in case of incapacity
Draft or update a general power of attorney
Review personal disability protection
Review business-related disability protection
Review other personal sickness or accident protections
Review other business-related sickness or accident protections
Other:
SECTION 3:FINANCE
Determine net worth
Complete Appendix A and attach copies of all relevant documents: account statements, contracts, invoices, contracts, invoices, statements of contribution, notices of assessment, etc.
Determination of cost of living
Complete Appendix B if the client has up-to-date records of all budgetary information. Otherwise, the cost of living can be determined based on Appendix C, after-tax income and annual savings.
Are you expecting any unusual income or expenses in the next year (e.g., trips, renovations)?
yes / no / Comments:Are you interested in borrowing to invest?
yes / no / not applicable / Comments:Do you have obligations from a previous marriage or relationship?
yes / no / Comments:Do you wish to save toward the postsecondary education of your children or grandchildren?
yes / no / not applicable / Comments:If so, what is the projected annual cost of education?
If so, how many years of education do you wish to finance?
Do you make contributions to an RESP?
yes / no / not applicable / Comments:If so, please provide the most recent account statement.
Determination of required emergency fund
The emergency fund is based on the budget or cost of living:
annual cost of living: / / 3 months / =12 months
Determination of current cash holdings
TFSA / Unregistered
Bank accounts
Certificates of deposit ( 1 yr)
T-bills
Savings bonds
Total current cash holdings
SECTION 4:TAXATION
Determination of after-tax income
Complete Appendix C using tax returns (or summaries) for the last three years.
Client / SpouseAnnual earnings: / $ / $
Form (salary, commissions, business income, dividends):
If earnings are variable, enter possible range:
Client / Spouse
Gross rental income: / $ / $
Deductible expenses: / $ / $
Net rental income before depreciation: / $ / $
Capital cost allowance: / $ / $
Net rental income: / $ / $
Client / Spouse
Effective (or average) tax rate / % / %
Marginal tax rate / % / %
Net capital losses from prior years
Taxable capital gains declared in last 3 years:
Year:Amount:
Have you sold any property since the beginning of the year? / yes / no
If so, complete the following chart.
Description / Year of acquisition / Quantity / Net proceeds of disposition / ACB / UCC / Gain or loss / Recapture of depreciation1)
2)
3)
Has the $800,000 capital gains deduction for the sale of CCPC shares been used? Eligible farming property?Eligible fishing property?
yes / no / What amount?What tax shelters do you use?
Does your situation allow for the use of income-splitting techniques?
Do you use all available deductions and tax credits? Do you declare all of your income?
Do you have foreign investment property with a total cost of over $100,000?
yes / no / Comments:If so, please ensure that for every year that you were in this situation, the appropriate declarations were made (federal income declaration and federal form T1135).
Have you filed an election with regard to a property owned on February 22, 1994?
yes / noIf so, complete the following table:
Description / Quantity / Amount of election ($)1)
2)
3)
4)
5)
Other:
SECTION 5:RETIREMENT
Client / Spouseyes / no / yes / no
Are you eligible for the Old Age Security pension (OAS)?
Are you eligible for the Québec Pension Plan or the Canada Pension Plan (append a statement of contributions)?
Do you belong to a registered pension plan (RPP), a supplemental pension plan, a stock option plan, etc.?
If so, please append a copy of the most recent statement of participation and all documentation concerning the plan (brochures, regulations, etc.) and complete note 15in the personal balance sheet.
Do you belong to a group RRSP or group DPSP offered by your employer?
If so, append a copy of the most recent statement of participation and complete note 14in the personal balance sheet.
Do you always contribute the annual maximum to your RRSP* or spousal RRSP?
When do you make your annual RRSP or spouse RRSP contribution?
End of year
Beginning of year
Systematic savings program
Additional information about the RRSP:
Allowable contribution – current year
Unused contributions
Unused deductions
Overcontributions
ObtainAppendix 7 and the most recent federal notice of assessment
Other information:
The data and assumptions required to produce financial projections for retirement are presented in Appendix G.
SECTION 6:LEGAL ASPECTS AND ESTATES[2]
Client / Spouseyes / no / N/A / yes / no / N/A
Do you have a will?
If so, append a copy and complete note 23of the personal balance sheet.
Is there a “last survivor” clause in your marriage or civil union contract?
If you have no will, complete note 23in the personal balance sheet and identify the legal heirs in the event of an intestate death.
Does your will still reflect your last wishes?
Is the will structured to reduce taxes payable on death?
Is the will structured to reduce income taxes for the heirs in the years following the death?
Do you want to leave a bequest to a charity?
Have you made funeral pre-arrangements?
Provide an estimate of your death-related expenses?
Do you have a mandate in case of incapacity?
Do you have a cohabitation agreement?
Do you have a general power of attorney?
Do you have a shareholders’ or partners’ agreement?
Comments:
SECTION 7:INVESTMENTS
Client% / Spouse
%
Determination of investor profile[3]
Cash securities
Fixed-income securities
Growth securities
100% / 100%
Current asset allocation[4]
Cash securities
Fixed-income securities
Growth securities
100% / 100%
yes / no / N/A / yes / no / N/A
Is the investment portfolio diversified?
yes / no / N/A / yes / no / N/A
Is the investment portfolio structured to reduce income taxes?
yes / no / N/A / yes / no / N/A
If the “growth” portion of the investment portfolio protected against a stock market crash?
yes / no / N/A / yes / no / N/A
Is the liquidity level of the RRIF high enough for the chosen payout schedule?
Comments:
SECTION 8:INSURANCE
Client / Spouseyes / no / N/A / yes / no / N/A
Do you have life insurance?
Do you have disability insurance*?
Do you have critical illness insurance*? Long-term care? Access to care?
Are your loans covered by life insurance with the lending institution?
Are your loans covered by disability or critical illness insurance with the lending institution?
Does a corporation hold insurance on your life?
Are your insurance contracts sufficient to meet your objectives (complete Appendix I)?
Are the types of insurance contracts you have well-suited to your situation?
Comments:
APPENDIX A
Personal balance sheet as at
Client ($) / Spouse ($) / Total ($)ASSETS
Cash and near-cash assets
Bank accounts (note 3)
Life insurance cash surrender value (note 4)
Non-registered investments (note 5)
Tax-free savings account (note 6)
Advances receivable (note 7)
Other:
Total cash and near-cash assets
Personal assets
Principal residence (note 8)
Secondary residence (note 9)
Automobiles (note 10)
Antiques, works of art, jewellery, collections (note 11)
Other:
Total personal assets
Income-producing assets
Equity ownership in a private corporation or partnership (note 12)
Rental property (note 13)
Other:
Total income-producing assets
Deffered taxation plans
RRSP or RRIF (note 14)
Registered Pension Plan (note 15)
LIRA or LIF (note 16)
RESP or RDSP (note 17)
Other assets:
Total deffered taxation plans
TOTAL ASSETS
LIABILITIES
Accounts payable (note 18)
Unpaid credit card balances
Credit purchases
Taxes payable
Other:
Total accounts payable
Personal loans (note 19)
Bank overdraft
Line of credit
Car
RRSP
Investments
Advances received from a private corporation
Other:
Total personal loans
Mortgage loans (note 20)
Principal residence
Secondary residence
Rental property
Other:
Total mortgage loans
TOTAL LIABILITIES
NET WORTH
Notes to the personal balance sheet
NOTE 1:Personal, professional and family situation
NOTE 2:Accounting conventions
Assets and liabilities are evaluated at their estimated current value.
NOTE 3:Bank accounts
Financial institution / Type of account / Balance ($)1)
2)
3)
Total
NOTE 4:Life insurance cash surrender value
Type of contract / Cash surrendervalue ($) / Comments1)
2)
3)
Total
NOTE 5:Non-registered investments
Liquid securities
Savings bonds
Issuer / Series / Interest rate / Maturity / Face value ($) / Accrued value ($)1)
2)
Total
Term depositsor guaranteed investment certificates maturing in less than 1 year
Financial institution / Date of deposit / Date of maturity / Interest rate / Accrued value ($)1)
2)
3)
Total
Bonds maturing in less than 1 year
Issuer / Date of acquisition / Cost of acquisition ($) / Interest rate / Maturity / Market value ($)1)
2)
3)
Total
Money market mutual funds
Description / Date of acquisition / MER / ACB ($) / Number of units / Market value ($) / Total ($)1)
2)
3)
Total:
Other liquid securities
Total:
Fixed-income securities
Term deposits or guaranteed investment certificates
Financial institution / Date of deposit / Date of maturity / Interest rate / Accrued value ($)1)
2)
3)
Total:
Bonds
Issuer / Date of acquisition / Cost of acquisition ($) / Interest rate / Maturity / Market value ($)1)
2)
3)
Total:
Stripped bonds
Issuer / Date of acquisition / Cost of acquisition ($) / Rate of return / Market value ($)1)
2)
Total
Note: Also indicate interest declared each year on income tax return.
Redeemable preferred shares
Description / Date of acquisition / ACB ($) / Rate of return / Maturity / Quantity / Market value ($) / Total ($)1)
2)
3)
Total:
Fixed income mutual funds
Description / Date of acquisition / ACB ($) / Rate of return / Maturity / Quantity / Market value ($)1)
2)
3)
Total:
Other fixed income securities
Total:
Growth securities
Common shares
Description / Date of acquisition / ACB ($) / Annual dividend / Quantity / Market value ($) / Total ($)1)
2)
3)
4)
Total
Perpetual preferred shares
Description / Date of acquisition / ACB ($) / Rate of return / Quantity / Market value ($) / Total ($)1)
2)
3)
4)
Total
Growth securitiesmutual funds
Description / Date of acquisition / MER / ACB ($) / Number of units / Market value ($) / Total ($)1)
2)
3)
4)
Total
Income trusts
Description / Date of acquisition / ACB ($) / Annual distributions ($) / Quantity / Market value ($) / Total ($)1)
2)
3)
Total
Note: The ACB should be adjusted downward each year to reflect capital distributions.
Other growth securities
Total:
NOTE 6: Tax-free savings account (TFSA)
Liquid securities
Savings bonds
Issuer / Series / Interest rate / Maturity / Face value ($) / Accrued value ($)1)
2)
Total
Term deposits or guaranteed investment certificates maturing in less than 1 year
Financial institution / Date of deposit / Date of maturity / Interest rate / Accrued value ($)1)
2)
3)
Total
Bonds maturing in less than 1 year
Issuer / Date of acquisition / Cost of acquisition ($) / Interest rate / Maturity / Market value ($)1)
2)
3)
Total
Money market mutual funds
Description / Date of acquisition / MER / ACB ($) / Number of units / Market value ($) / Total ($)1)
2)
3)
Total:
Other liquid securities
Total:
Fixed-income securities
Term deposits or guaranteed investment certificates
Financial institution / Date of deposit / Date of maturity / Interest rate / Accrued value ($)1)
2)
3)
Total:
Bonds
Issuer / Date of acquisition / Cost of acquisition ($) / Interest rate / Maturity / Market value ($)1)
2)
3)
Total:
Stripped bonds
Issuer / Date of acquisition / Cost of acquisition ($) / Rate of return / Market value ($)1)
2)
Total
Note: Also indicate interest declared each year on income tax return.
Redeemable preferred shares
Description / Date of acquisition / ACB ($) / Rate of return / Maturity / Quantity / Market value ($) / Total ($)1)
2)
3)
Total:
Fixed income mutual funds
Description / Date of acquisition / ACB ($) / Rate of return / Maturity / Quantity / Market value ($)1)
2)
3)
Total:
Other fixed income securities
Total:
Growth securities
Common shares
Description / Date of acquisition / ACB ($) / Annual dividend / Quantity / Market value ($) / Total ($)1)
2)
3)
4)
Total
Perpetual preferred shares
Description / Date of acquisition / ACB ($) / Rate of return / Quantity / Market value ($) / Total ($)1)
2)
3)
4)
Total
Growth securities mutual funds
Description / Date of acquisition / MER / ACB ($) / Number of units / Market value ($) / Total ($)1)
2)
3)
4)
Total
Income trusts
Description / Date of acquisition / ACB ($) / Annual distributions ($) / Quantity / Market value ($) / Total ($)1)
2)
3)
Total
Note: The ACB should be adjusted downward each year to reflect capital distributions.
Other growth securities
Total:
Total TFSA:
NOTE 7: Advances receivable
NOTE 8:Principal residence
Address / Year of acquisition / Price paid ($) / Municipal evaluation ($) / Market value ($)Note: Include the price paid for major improvements or renovations. If the market value differs from the municipal evaluation, identify the evaluation method.
NOTE 9:Secondary residence
Address / Year of acquisition / Price paid ($) / Municipal evaluation ($) / Market value ($)Note: Include the price paid for major improvements or renovations. If the market value differs from the municipal evaluation, identify the evaluation method.
NOTE 10:Cars
Model / Year / Cost of acquisition ($) / Market value ($)1)
2)
Total
NOTE 11: Antiques, works of art, jewellery, collections
Description / ACB ($) / Market value ($)1)
2)
Total
Note: Specify how market value was established.
NOTE 12:Equity ownership in a private corporation or partnership
Description / % ownership / ACB ($) / Market value ($)1)
2)
Total
Note: Identify the evaluation method. The company’s financial statements can be.
NOTE 13:Rental property
Description / Address / Date of acquisition / ACB ($) / UCC ($) / Municipal evaluation ($) / Market value ($)1)
Land portion / n/a
2)
Land portion / n/a
Total
NOTE 14:Registered Retirement Savings Plan or Registered Retirement Income Fund
Liquid securities
Savings bonds
Issuer / Series / Interest rate / Maturity / Face value ($) / Accrued value ($)1)
2)
Total
Term deposits or guaranteed investment certificates maturing in less than 1 year
Financial institution / Date of deposit / Date of maturity / Interest rate / Accrued value ($)1)
2)
3)
Total
Bonds maturing in less than 1 year
Issuer / Date of acquisition / Cost of acquisition ($) / Interest rate / Maturity / Market value ($)1)
2)
3)
Total
Money market mutual funds
Description / Date of acquisition / MER / ACB ($) / Number of units / Market value ($) / Total ($)1)
2)
Total:
Other liquid securities
Total:
Fixed-income securities
Term deposits or guaranteed investment certificates
Financial institution / Date of deposit / Date of maturity / Interest rate / Accrued value ($)1)
2)
3)
Total:
Bonds
Issuer / Date of acquisition / Cost of acquisition ($) / Interest rate / Maturity / Market value ($)1)
2)
Total:
Stripped bonds
Issuer / Date of acquisition / Cost of acquisition ($) / Rate of return / Market value ($)1)
2)
Total
Note: Also indicate interest declared each year on income tax return.
Redeemable preferred shares
Description / Date of acquisition / ACB ($) / Rate of return / Maturity / Quantity / Market value ($) / Total ($)1)
2)
3)
Total:
Fixed income mutual funds
Description / Date of acquisition / ACB ($) / Rate of return / Maturity / Quantity / Market value ($)1)
2)
3)
Total:
Other fixed income securities
Total:
Growth securities
Common shares
Description / Date of acquisition / ACB ($) / Annual dividend / Quantity / Market value ($) / Total ($)1)
2)
3)
4)
Total
Perpetual preferred shares