Birth Date (mm/dd/yyyy) / Marital Status / MarriedDivorcedSeparatedSingleWidowed
Wedding Anniversary / Previous Marriage (Y/N)
Address
City / State / Zip Code
Home Number / Cell Number / Work Number
Preferred Number (Home/Work/Cell) / HomeWorkCell
E-mail Address
Employer / Title
Years at Current Employer / Previous Employer
Spouse Information
First Name / Middle Name / Last Name / SexBirth Date (mm/dd/yyyy) / Previous Marriage Y/N)
Home Number / Cell Number / Work Number
Preferred Number (Home/Work/Cell) / HomeWorkCell
E-mail Address
Employer / Title
Years at Current Employer / Previous Employer
Children
First Name / Middle Name / Last Name / Birth Date / Gender / Previous Marriage (Y/N)Sterling Financial 1
Provide the requested information about your current income and employment status.
Client / SpouseCurrent Bases Gross Income
Commission Pay
Bonus Pay
Total Earned Income
How much annual income do you receive from your investments?
What annual income do you receive from other sources?
What is your employment status? Full-Time Full-Time
Part-Time Part-Time
Self Employed Self Employed
Retired Retired
Homemaker Homemaker
Unemployed Unemployed
Student Student
If you are employed, does your employer
provide a Pension plan? Yes No Yes No
What % does your employer provide contribute to your pension?Expected Monthly Income from pension?
Are you covered by Social Security? Yes No Yes No
Do you receive monthly payments from SS? Yes No Yes No
Amount of Social Security received monthlyCurrent Federal Income Tax Rate / %
Excluding retirement, how much of your income do
you set aside monthly? (savings, investments, etc.)
Sterling Financial 1
Provide the requested information about your current assets and financial liabilities. Provide all current statements.
Current Asset Balances
Client’s Retirement Assets / Investment AssetsSpouse’s Retirement Assets / Business Assets
Cash Savings Assets / Personal Assets
Liability (Debt) Balances (please attach additional pages if necessary)
Please include all liability statements.
Liability 1 Liability 2 Liability 3 Liability 4
DescriptionLoan Type
Primary Residence Primary Residence Primary Residence Primary Residence
Other Mortgage Other Mortgage Other Mortgage Other Mortgage
Rental Property Rental Property Rental Property Rental Property
Business Business Business Business
Margin Margin Margin Margin
Consumer Consumer Consumer Consumer
Automobile Automobile Automobile Automobile
Other Other Other Other
Original BalanceLoan Date
Length of Loan
Current Balance
Monthly Payment
Interest Rate
Tax
Deductible? Yes No Yes No Yes No Yes No
How important is it to reduce or eliminate debt?
(Check one)
Very Important Somewhat Important Neutral
Somewhat Unimportant Unimportant
Your risk tolerance is an indication of your potential level of comfort with different investment products.
Check the response that best reflects your answer to each of the following questions.
1. Which of the following investments would you feel most comfortable owning? (choose only one)
a. Certificates of Deposit c. Blue-chip stocks
b. U.S. Government securities d. Stocks of new, growth companies
2. Which of the following investments would you least like to own? (Choose only one)
a. Stocks of new, growth companies c. U.S. Government securities
b. Blue-chip stocks d. Certificates of Deposit
3. How optimistic are you about the long-term prospects for the economy?
a. Very pessimistic c. Somewhat optimistic
b. Unsure d. Very optimistic
4. Which of the following best describes your attitude about investments outside the
US?
a. I believe that investing in foreign markets involves risk
b. I believe that overseas markets provide attractive investment opportunities
5. From an original investment of $15,000, your portfolio now worth $25,000 suddenly declines $3,750 or 15%, which of the following statements would best describe your reaction?
a. I would avoid any investment that could suddenly lose 15%
b. I would be somewhat concerned
c. I would take no action
d. I would look for a way to invest more
6. Your portfolio, from the previous question, now worth $21,500 suddenly declines another $2,150 or 10%, which best describes your response?
a. I would look for a way to invest more
b. I would take no action
c. I would be somewhat concerned
d. I would probably sell
e. I would have never made this investment
7. You have just received a windfall of $50,000. How would you invest it?
a. I would invest in something that offered preservation of my money
b. I would invest in something that offered the potential for high income with a
moderate amount of risk
c. I would invest in something that offered the potential for high total return
(income plus capital appreciation with a moderately high amount of risk)
d. I would invest in something that offered substantial capital appreciation even
though it has a high amount of risk
8. Which of the following best describes your investment objectives?
a. Preserving principal and getting a moderate amount of income
b. Generating a high amount of income
c. Generating some income and increasing my assets over an extended time
frame
d. Increasing my assets substantially over an extended time frame
9. What do you expect your standard of living to be 10 years from now as compared to
your standard of living today?
a. Lower than it is today
b. The same as it is today
c. Somewhat higher than it is today
d. Substantially greater than it is today
10. Ten years from today, you expect the value of your investments to be:
a. The same as it is today
b. Somewhat more then it is today
c. Greater than it is today
d. Substantially greater than it is today
11. What is your age?
a. 56 and over c. 36-45
b. 46-55 d. 18-35
12. What is your primary financial goal?
a. Wealth preservation
b. Retirement Planning
c. Wealth accumulation
13. When will you begin to use the money from your goal?
a. 0-2 years
b. 2 to 5 years
c. 5-10 years
d. More than 10 years
14. Have you invested in equities?
a. No
b. Yes
15. Have you invested in fixed income?
a. No
b. Yes
16. Have you invested in Mutual Funds?
a. No
b. Yes
17. Have you invested in Options, Futures, or Derivatives?
a. No
b. Yes
18. How would you describe your level of investment knowledge?
a. None
b. Limited (1 to 3 years)
c. Good (3 to 5 years)
b. Extensive (> 5 years)
19. Do you have current income needs from this investment?
a. No
b. Yes
Answer the following questions about your preparation for and attitudes about financial protection for unexpected life events.
Client Spouse
What is the current death benefit of your life insurance?What is the cash value of your life insurance?
When did you last reviewed your will?
(check one) No Will No Will
< 3 Years < 3 Years
3-7 Years 3-7 Years
> 7 Years > 7 Years
How important is it for you to provide financial resources for your spouse, dependents, or others if you die? (check one)
Very Important Somewhat Important Neutral
Somewhat Unimportant Unimportant
Are you financially prepared for the high costs that may be associated
with long life in retirement, such as long-term care? Yes No
How important is it to you to provide long-term care funding for you, your spouse, or your dependents?
(check one)
Very Important Somewhat Important Neutral
Somewhat Unimportant Unimportant
Do you currently own a Long-Term Care policy? Yes No Yes No
Do you have a parent who may become your financial dependent? Yes No
Client Spouse
How long could you live on your current
assets in the event you become disabled or
suffered a prolonged illness? (check one) 4 Weeks 4 Weeks
1 - 6 Months 1 - 6 Months
6 - 12 Months 6 - 12 Months
> 1 Year > 1 Year
Client Spouse
Do you have a plan, at work or individually,
which provides continuing income if you are
unable to work due to accident or illness? Yes No Yes No
How important is it to you to replace your earned income in the event you become disabled or suffer a prolonged illness? (Check one)
Very Important Somewhat Important Neutral
Somewhat Unimportant Unimportant
Do you have a family & estate attorney? Yes No
Name / PhoneDo you have a CPA? Yes No
Name / PhoneDo you have any trusts formed? Yes No
If yes, type of trustPlease provide copies of all executed Trusts
Please list the top 5 areas of concern by rating them from 1 to 5 (with 1 being the most important)
Retirement / 12345Not Important / Taxes / 12345Not Important / Long-Term Care / 12345Not ImportantEducation / 12345Not Important / Estate Planning / 12345Not Important / Business Planning / 12345Not Important
Savings / 12345Not Important / Life Insurance / 12345Not Important / Other (Explain Below) / 12345Not Important
Debt / 12345Not Important / Disability Insurance / 12345Not Important
Are there any unique circumstances regarding you
or your family that we should be aware of? Yes No
Please explain:
Provide the requested information about your current preparations for retirement.
Client Spouse
At What age do you plan to retire?Do you plan to continue working in some capacity once retired? / Yes No / Yes No
If so, what percentage of your current income do you
expect to earn in semi-retirement? % %
How important is it for you to have a comfortable retirement? (Check one)
Very Important Somewhat Important Neutral
Somewhat Unimportant Unimportant
Approximately what percentage of your combinedincome do you feel you will need at retirement? / %
How much impact do you feel inflation will have on your retirement? (check one)
(Historic inflation rates have averaged 3.7% over the past 70 years)
Major Some Minimal Not Sure
Would you like Social Security benefits used in your retirement calculation? Yes No
Client Spouse
Do you contribute to a voluntary or
supplemental retirement plan (including
401(k), 403(b), IRA, Keogh)? Yes No Yes No
What percentage of your annual income is contributed to the plan? / % / %Employer Match / % / %
Do you save additional monies above your retirement
savings to put towards retirement? If so how much? % or $ annually
Answer each of the following questions regarding your education funding plans and expected life events.
Education Planning
How important is it to you to fund the educational needs of your children, grandchildren, or others?
Very Important Somewhat Important Neutral
Somewhat Unimportant Unimportant
What percentage of these needs do you want to fund?Do you feel you are adequately funding these educational needs?
Yes No Don’t Know
Life Events
Do you anticipate any of the following life events in the next twelve months?
Change of employment Yes No Dependent entering college Yes No
Start a new business Yes No Retirement Yes No
Marriage Yes No Home Purchase Yes No
Birth of a child or
grandchild Yes No Inheritance Yes No
1. Current tax return
2. Current Bank and Savings Account Statements
3. Current 401(k), other retirement plans, brokerage and mutual fund statements
4. Most recent mortgage, credit card, auto and all additional loan statements
5. Group disability insurance policy
6. Group life insurance policy
7. All private life, disability and long-term care insurance policies
8. Monthly Household Expense Statement (Separate Excel Form)
9. Most Recent Social Security Statement
10. Most Recent employer paystub
Please rate the importance of each item by placing an “x” the appropriate box. Low Medium High
Retirement/Investment
Your Retirement goalsDirecting a portion of your personal savings or investment portfolio to tax advantaged vehicles
Having all of your portfolios consolidated and analyzed to make sure your overall plan in on track
Matching your risk tolerance to that of your investment portfolio
Reviewing your investment performance against that of an index
Reviewing your investment performance against your plan
Reviewing alternative retirement methods
Minimizing the taxes on your investment accounts
Reviewing techniques to save income tax and estate taxes on deferred money
Asset protection in the result of serious illness
Protecting assets in the event that your require long term care in the future
Receiving adequate income in the event of disability during your working years
Planning for income for your spouse in the event of your premature death
Generating a guaranteed retirement income stream
Planning for income for your children in the event of your premature death
Estate Low Medium High
Distributing assets equally to your childrenProtecting your assets transferred to your children from creditors, divorce, and bankruptcy
Reviewing your insurance portfolio
Reviewing different methods of meeting your estate tax liabilities
Minimizing estate taxes
Charitable planning to your estate’s planning
Contributing annually to charity
Gifting to your children if it doesn’t interfere with your financial independence
Planning for your grandchildren’s education
Reviewing your current will structure to eliminate unnecessary taxes
Protecting your residence and/or vacation home from estate taxes
Having your estate in trust for your spouse in order to protect your children’s inheritance
Business Low Medium High
Maintaining control of your business throughout your lifetimeEliminating the need to liquidate your business to pay estate taxes
Passing your business in a manner where it is sold to key employees
Creating a business planning concept to help you sell your business to key employees in an efficient manner
Providing incentives to your keys employees with non-stock compensation alternatives
Having your key employees own stock in your company
Protecting your business for the death of a key employee
Protecting your company from serious illness and disability of your employees
Key employees to the continued success of your company
Passing your business in a manner that maintains family ownership and control
Maintaining family harmony after your estate has been settled
Having your spouse take an active/ownership role in the business after you pass
Creating a business planning concept that shows you how to gift/bequest your business to your children/heirs
Equalizing the inheritance for your children not active in the business
Leaving the business only to active children/heirs versus all children/heirs
Having your children/heirs active in the business with regards to the future success of your business
Passing your business in a manner where it is sold to a third party
Reviewing your business’ property and casualty coverages every two years
Reviewing alternative sources for your existing line of credit
Reviewing the efficiency of your long term debt structure
Buying out a partner’s interest in the event of his or her death
Client Defined Objectives