New Client Fact Finder

Personal Info
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Address *

Street Address

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City State / Province

Postal / Zip Code Country
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Financial Info
Quickbooks or Bank Statement

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Employer
Occupation
Annual Income
Spouse Employer
Spouse Occupation
Spouse Annual Income
Estimated Assets
Estimated Debts
Estimated Net Worth
Property
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Real Estate

Property Name

Purchase Date

Estimated Value

Amount Owed

Interest Rate

Term

Retirement Investments
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Investment Information

Institution

Estimated Value

Owner

Beneficiary

Other Investments
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Investment Information

Institution

Type/Class

Estimated Value

Owner

Insurance

Life Insurance

Institution

Insured

Death Benefit

Cash Value

Beneficiary

Disability Insurance

Institution

Insured

Premium

Monthly Benefit

Benefit Period

Long Term Care

Institution

Insured

Premium

Monthly Benefit

Benefit Period

Objectives
Mark any you currently have *

Checking Savings Money Market CD's Savings Bonds Fixed Annuities 401(k) Roth 401(k) IRA Roth IRA 403b/TSA Profit Sharing Plan Deferred Comp Gov't Bonds Municipal Bonds Corporate Bonds Stocks Variable Annuities Indexed Annuities Mutual Funds Businesses Home Real Estate Tax Shelters Other

Savings

Yes

N/A

Want Reviewed

I believe I should have an emergency fund of
at least 50% of my income in safe, secure vehicles

I am satisfied with my present rate of savings

I generally reinvest my interest that I earn
in my savings account or money markets

I understand that compound interest may lead
to compound taxation

I understand how the FDIC protects my money

I understand and utilize tax-deferred savings vehicles

I understand and utilize tax-free savings vehicles
such as 529 plans and Roth IRAs

I maximize my 401(k) and/or retirement plan
contributions

I realize that most tax-deductible retirement plans
are fully taxable upon distribution

I would like help in reviewing my savings strategies

Debt

Yes

N/A

Want Reviewed

I believe that prepaying or paying off
my mortgage is prudent

I believe there are potential benefits to
restructuring my outstanding debt

I am able to completely pay off my credit
card each month

I understand how intra-family loans
may be a valuable option to consider

I have a home equity line of credit

I would like help in reviewing my current debt

Protection

Yes

N/A

Want Reviewed

My vehicle insurance has been properly protected.

I have a complete, up to date inventory of my
personal property

My residence and other posessions are insured for
their replacement cost

I carry excess liability coverage

I understand how excess liability coverage integrates
with the rest of my insurance protection

If I were sick or hurt, my income would be fully replaced,
net of taxes

My income protection continues if I leave my employer

I have adequate insurance coverage for long-term illnesses

I understand how asset-based long-teerm care works

I understand my government benefits for disability and death

I understand my government benefits for my retirement

My wills and trusts have been updated within the last
two years

All my assets are titled to reduce taxes and probate

I understand how life insurance integrates with my
long-term financial objectives

My life insurance program provides for maximum economic
life value protection

Growth

Yes

N/A

Want Reviewed

I would like to utilize strategies to minimize my
taxable income during retirement

I understand the difference between stocks,
bonds, and cash

I understand the differences between government,
corporate, and municipal bonds

I realize that municipal bonds provide income
that can be both federal and state income tax free*

I understand the difference between ordinary
income and long-term capital gains

I understand all the costs and taxes associated
with the use of mutual funds

...

*Income from Municipal Bonds may not be tax free in all situations and circumstances. Depending on the individual's circumstances, municipal bond income may be subject to tax under the current Internal Revenue Code if the Alternative Minimum Tax requirements have not been met.
In the next year I am considering or expect to...

Check all that apply
Personal

Change my marital status An addition to our family Relocate Take an extended vacation
Professional

Change careers Accept a job transfer Change employers Retire Start a business Sell a business
Financial

Purchase a home Make a major purchase Pay off debt Save more Change in salary Save for education Receive an inheritance
Over the next few years I look forward to...
What concerns me the most about the future is...

Business Owners Q's

If you are an owner or partner in a business, please complete the following

Low

Medium

High

N/A

Maintaining control of your business throughout your lifetime

Eliminating the need to liquidate your business to pay estate taxes

Passing your business to a key employee

Create a business plan to sell your business to key employees efficiently

Provide incentives to key employees with non-stock compensation alternatives

Having your key employees own stock in your company

Protecting your business from the death of a key employee

Protecting your key employees and their families from serious illness and disability

Protecting your company from serious illness and disability of your employees

Passing your business to maintain family ownership & control

Maintaining family harmony after your estate has been settled

Having your spouse take an active/ownership role in the business plan after you pass

Create a business plan to gift/sell/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 to a third party

Reviewing your business property & casualty coverage every 2 years

Reviewing alternative sources for your existing line of credit

Reviewing the efficiency of your existing long term debt structure

Buying out a partner's interest in the event of his/her death

Protecting assets of business from creditors/litigation

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Property

Retirement Investments

Other Investments

...

In the next year I am considering or expect to...

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