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Financial Info
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Investment Information
Institution
Type/Class
Estimated Value
Owner
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2.
3.
4.
5.
6.
7.
8.
Insurance
Life Insurance
Institution
Insured
Death Benefit
Cash Value
Beneficiary
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2.
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7.
8.
Disability Insurance
Institution
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Long Term Care
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Objectives
Mark any you currently have
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Checking
Savings
Money Market
CD's
Savings Bonds
Fixed Annuities
401(k)
Roth 401(k)
IRA
Roth IRA
403b/TSA
Profit Sharing Plan
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Municipal Bonds
Corporate Bonds
Stocks
Variable Annuities
Indexed Annuities
Mutual Funds
Businesses
Home
Real Estate
Tax Shelters
Other
Savings
Yes
No
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
No
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
No
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
No
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
Risk Tolerance Questionnaire (required)
If you own a home, do you have more than 30% equity?
*
Please Select
Yes
No
Unknown
Which of the following describes your current employment situation?
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Please Select
Full-Time
Part-Time
Self-Employed
Retired
Unemployed
If married, which of the following describes your partner's current employment situation?
*
Please Select
Full-Time
Part-Time
Self-Employed
Retired
Unemployed
From an original investment of $15,000, your portfolio now worth $25,000 suddenly declines $3,750, or 15%. Which best describes your first response?
*
I would look for a way to invest more
I would take no action
I would be somewhat concerned
I would avoid any investment that could suddenly lose 15% of it's value
Label of your question Your portfolio, from the previous question, is now worth $21,250, suddenly declines $2,125, or 10%. Which best describes your first response?
*
I would look for a way to invest more
I would take no action
I would be somewhat concerned
I never would have made this investment
How would you describe your level of investment knowledge?
*
None
Limited
Good
Extensive
How much investment experience do yoiu have?
*
None
Limited (1 to 3 years)
Good (3 to 5 years)
Extensive (5+ years)
Do you have current investment needs from this investment?
*
Please Select
Yes
No
When will you begin to use the money from your goal?
*
Less than 2 years
2 to 5 years
5 to 10 years
More than 10 years
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