Personal Information - Client - Page 1. Employment. Education. Military Service. Children & Dependents

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1 Personal Information - Client - Page Date Mr. Mrs. Ms. First Name M.I. Last Name Birth Date Age S.S. Number Street Address City/Town Home Phone Cell Phone State/Zip Fax Address Employment Occupation Employer Address Fax Employer Work Phone Address Education School Degree Affiliations (clubs, sports, activities) High School College Graduate School Dates of Active Duty Military Service Branch Children & Dependents Name Birth Date Relationship 4 Sercurities offered through Raymond James Financial Services, Inc. Member FINRA/SIPC

2 Personal Information - Spouse - Page Date Mr. Mrs. Ms. First Name M.I. Last Name Birth Date Age S.S. Number Street Address City/Town Home Phone Cell Phone State/Zip Fax Address Employment Occupation Employer Address Fax Employer Work Phone Address Education School Degree Affiliations (clubs, sports, activities) High School College Graduate School Dates of Active Duty Military Service Branch Children & Dependents Name Birth Date Relationship 4

3 Professional Contacts - Page Tax Preparer Name Address Phone Attorney Name Address Phone Insurance Agent Name Address Phone Investment Advisor Name Address Phone Notes Member FINRA/SIPC

4 Personal Concerns - Page 4 How do you think our firm can be of help? Please check which answer best describes your level of interest or concern in each of the categories below. Retirement Planning (Targeting specific dates/or income needed for retirement) Very Concerned Somewhat Concerned Not Concerned Portfolio Management (Managing investment assets) Estate Planning (Making sure your financial affairs are in order) Tax Planning (Minimizing income, estate or gift taxes) Long-Term Care Needs (Providing strategies to help provide income if you cannot care for yourself) Charitable Giving (Giving back to organizations that are important to you) Other (Please describe)

5 Financial Goals & Objectives - Page 5 Goal By When? Amount Needed Short Term (Within years) Medium Term (-7 years) Long Term (Over 7 years) Notes

6 Financial Information - Page 6 Assets - Current Market Value Liabilites - Current Balance Cash & CD's $ Credit Cards $ Primary Residence $ Mortgage Year of Maturity = Second Home $ Interest Rate = Rentals $ Pay-off Amount = Automobiles $ Other Home Loans (Equity Line) Year of Maturity = Other Vehicles $ Interest Rate = Business Interest $ Pay-off Amount = Retirement Accounts $ Vehicle Loans Year of Maturity = Investments $ Interest Rate = Life Insurance Cash Value $ Pay-off Amount = Fine Art, Jewelry, Collectibles $ School Loans Year of Maturity = Other Personal Property $ Interest Rate = Other Assets $ Pay-off Amount = Business Loans Year of Maturity = Interest Rate = Pay-off Amount = Other Liabilites $ Total Assets $ Total Liabilities $ Net Worth (Total Assets Minus Total Liabilities) $

7 Monthly Income - Page 7 Client Spouse Total Salary $ $ $ Bonuses, Commissions $ $ $ Pension Income $ $ $ Annuity Income $ $ $ Rental Property Income $ $ $ Interest, Dividends $ $ $ Alimony $ $ $ Child Support $ $ $ Income from trust $ $ $ Social Security $ $ $ Any other income $ $ $ Total Income $ $ $ Notes

8 Monthly Expenses - Page 8 Mortgage/ Rent/ Condo Fees $ Auto: Gas/ Maintenance/ Repairs $ Groceries: Food/ Household supplies $ Retirement plan contributions: IRA/ 40k/ 40b/ etc $ Other savings/ Investments $ Medical/ Dental/ Vision expenses (not paid by insurance) $ Personal Care: Hair/ Gym Fees/ Cosmetics/ etc $ Taxes: Federal/ State/ Local $ Clothing $ Dining/ Entertainment/ Hobbies/ Recreation/ Vacations $ Tithes/ Gifts/ Donations $ Insurance Premiums (Monthly) Auto $ Disability $ Home/ Property $ Life/ Accident $ Medical/ Dental/ Medicare $ Other $ Loan Payments (Monthly) Auto $ Credit Cards $ Home Equity $ Student Loans $ Utilities (Monthly) Cable/ TV $ Electric $ Telephone $ Water $ Heating $ Garbage $ Other Expenses $ Other Expenses $ Total Expenses $ Member FINRA/SIPC

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