LIFE PLANNING GUIDE Investment Centers of America, Inc.
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1 Rep: Craig Prudhomme (N22) Phone # LIFE PLANNING GUIDE Date: Updated: PART I Personal Information & Results from Dialogue Date of Birth (Age) Occupation Address Family Members included in the Planning Process Age (Not necessarily dependents. Could be grown children, etc.) Son/Daughter M / S Grand Children Based on the DIALOGUE with the client, briefly list clients major planning objectives. Try to prioritize and state as simply and clearly as possible. (ICA) member FINRA, SIPC and a Registered Advisor is not affiliated with First National Bank of Moose Lake. Securities, advisory services, and insurance products offered through ICA and affiliated insurance agencies are *not insured by the FDIC or any other Federal Government agency *not a deposit or other obligation of, or guaranteed by any bank or their affiliates *subject to risks including the possible loss of principal amount invested. April 2014 #
2 Rep: Date: Craig Prudhomme (N22) Income Sources* Birthdate LIFE PLANNING GUIDE Client: PART II Cash Flow Time Segment #1 Time Segment #2 Time Segment #3 Time Segment #4 Income Source Salary (W2) Salary (W2) Social Security (Age) Social Security (Age) Pension (Defined Benefit) Pension (Defined Benefit) Other Income: TOTAL Income without Investments *Income sources other than investments Living Expenses Total Household Expenses Total Income Taxes Total Soc/SecWithholding Total Liability Payments TOTAL Basic Needs Level 1 TOTAL Insurance Level 2 TOTAL Lifestyle Level 3 TOTAL Charitable Gifts Level 4 TOTAL Expenses All 4 Levels Net Cash Flow (Income less Expenses) * Attaching a tax return is a must for more accurate projections. Please Include W2's and 1099's! 2
3 Rep: Craig Prudhomme (N22) Client: Date: Personal Assets (NonInvestment) PERSONAL RESIDENCE PERSONAL PROPERTY BUSINESS ASSETS OTHER ASSETS: LIFE PLANNING GUIDE PART III Net Worth Joint Updated: (if applicable) Total NonInvestment Assets Investment Assets CHECKING, SAVINGS, MM, & CDs (Taxed already only interest earned taxable) Joint Total Bank Accounts & CDs NONQUALIFIED ANNUITIES & US SAVINGS BONDS (Deferred Taxation) Joint Total NonQualified Annuities NONQUALIFIED INVESTMENTS MUTUAL FUNDS, STOCKS, BONDS (Tax Deferred Capital Gains) Joint Total NonQualifed Investments 3
4 RETIREMENT PLANS & IRAs (Totally Deferred) Contributions Total Retirement Plans & IRAs ROTH IRAs (Already Taxed) Contributions Total Investment Assets (Per Client) Total Roth IRAs Total Investment Assets Total NonInvestment Assets Total Family Assets LIABILITES Joint Payments Total Liabilities Net Worth (Per Client) Total Family Net Worth 4
5 LIFE PLANNING GUIDE Rep: Craig Prudhomme (N22) Client: Date: PART IV Insurance Updated: Company Type Insured Owner Beneficiary PRESENT LIFE INSURANCE Issue Date Face Amount Premium Cash Value * Please include your most recent annual statements Totals Company PRESENT DISABILITY INCOME INSURANCE Insured Owner Date Issued Coverage Premium Totals Company PRESENT LONG TERM CARE INSURANCE Insured Owner Date Issued COLA Monthly Benefit Maximum Life Time Benefit Premium # Years Totals 5
6 LIFE PLANNING GUIDE Detailed Expense Worksheet (Average Amounts) Level 1 Basic Needs Living Expense Level 2 Risk Insurance Needs Household Expenses: Insurance Fixed Premium: Food Life Insurance Client 1 Dining Out Life Insurance Client 2 Clothing/Cleaners Sub Total Life Insurance Premiums Medical Doctors Medical Prescription Disability Insurance Medical Flex Spending Long Term Care Insurance Computer, Cable TV & Telephones Sub Total DI & LTC Premiums Fees (Bank, Credit, Invest) Gas and Oil TOTAL INSURANCE LEVEL 2 Homeowners (Dues/Maint) Insurance Automobile Level 3 Lifestyle Expense Insurance Health Premiums Leisure/Hobbies: Insurance Homeowners Boating/Fishing Medicare Insurance "B" plus Supps Dues/Memberships Personal Care Golf Professional (CPA, Legal) Tennis Real Estate Taxes Hobbies Utilities Other Vehicle Maintenance Subtotal Hobbies Veterinary/Pet Care Rent Travel/Adventure: Credit Cards Rolling Monthly Avg Bal Second Home Gifts to Family and Friends Vacations Other Recreational Vehicle Other Other Other Subtotal Travel Other Other Personal Growth/Education: Miscellaneous Education/Lessons SubTotal Household Expenses Health & Fitness Develop New Skills Taxes Income: Business (Meetings,etc) Federal Income Tax Other State Income Tax Subtotal Personal Growth SubTotal Income Taxes: TOTAL LIFESTYLE LEVEL 3 Social Security & Medicare w/holding SubTotal Soc/Sec W/H Level 4 Charitable Gifts Church/Non Profits/Charities Liability Payments: Years Left Universities/Schools Mortgage P & I Other Deductible Donation/Gifts Home Equity Other Deductible Donation/Gifts Automobile Other Deductible Donation/Gifts Automobile TOTAL CHARITABLE GIFTS Personal Loans LEVEL 4 Credit Cards Lg Avg Bal Frwd SubTotal Liability Payments TOTAL BASIC NEEDS LEVEL 1 TOTAL ANNUAL EXPENSES 6
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