Financial Planning Questionnaire
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- Sophia Ward
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1 Richard W. Greene Managing Principal Jennifer M. Wolfsberg Managing Principal John E. Wolfsberg Principal / Director of Fixed Income [email protected] Olga P. Okaty Financial Advisor [email protected] Financial Planning Questionnaire The financial planning questionnaire assists us in understanding your financial circumstances and objectives. This information allows us to suggest a financial strategy that will be tailored to your needs. Centerpoint Advisors, LLC 175 Highland Avenue, Suite 302 Needham, MA Ph: Fax: Toll-Free: Securities offered through National Securities Corporation, Member FINRA/SIPC.
2 Personal Information Today s date s full name Age Date of Birth Retirement Age 's full name Age Date of Birth Retirement Age Contact Information Mailing Address Telephone Risk Investment Attitude Investment Experience Very Conservative Conservative Moderate Aggressive Very Aggressive None Very Little Moderate Significant Extensive Insurance You may need to review your insurance policies in order to get this information. Permanent life insurance Term life insurance Cash values (less loans) Long-term care insurance
3 Income Earned Income (Gross) Increase Rate (%) Qualified Plan Contributions (401k, 403b, etc.) Other Pre-Tax Deductions (Medical, Dental, etc.) Federal Income Tax Bracket (%) State Income Tax Bracket (%) FICA Taxes Other Deductions Net Income Pension Anticipated Amount (Gross) Beginning at Age Anticipated Increase Rate (%) Survivor Benefit (%) Social Security Please provide a current Social Security benefit statement. Anticipated Amount (Gross) Beginning at Age Anticipated Increase Rate (%) Survivor Benefit Amount
4 Assets Please list your cash savings, investments, property, and personal assets. Liquid Cash Assets Current Savings Account Money Market Account Investment Assets Please specify account type (taxable vs. tax-deferred). Current Personal Assets Current Primary Residence Automobile 1 Automobile 2 Jewelry Personal Property Art & Collectibles
5 Expenses Please estimate monthly figures for living expenses related to shelter, food, clothing, transportation, insurance, bills, etc. You may find the Expense Budget Worksheet below helpful in assisting you with these estimations. Personal Property Expenses Rent or Mortgage (Principal & Interest) Property Taxes Mortgage Insurance Homeowner's Insurance Premiums Automobile Loan Payments Automobile Insurance Premiums Auto Operating & Maintenance Credit Card Payments Personal Loan Payments Household Expenses Food and Household Incidentals Clothing and Personal Items Entertainment Vacations Books, Newspapers, Subscriptions Home Furnishings & Goods Cable, Internet, Home Phone Cell Phone Electric Heat, Oil, Gas Property Improvements & Upkeep Domestic Help, Cleaning Services Pet / Animal Supplies Miscellaneous Household Expenses Health Insurance & Medical Expenses Life Insurance Premiums Medical Insurance Premiums Dental Insurance Premiums Pet Insurance Premiums Other Insurance Premiums Medical Expenses Dental Expenses Veterinary Expenses Other Expenses
6 Expenses Continued Total Current Living Expenses Inflation (%) Total Living Expenses During Retirement (in today's dollars) Inflation(%) Incidental Income / Expenses Please list any other sources of incidental income (sale of property, etc.) or expenses (new auto purchase, home remodeling, travel, etc.) Income / Expense Description Amount Beginning Duration (today's $) Inflation in Year ( # years) Mortgage & Loan Details Please provide information on the terms of any outstanding debt Please provide current statements for all outstanding loans. Description Loan Origination / Refinancing Details Outstanding Term Property Date Amount Rate Loan Remaining Value Primary Residence Mortgage Home Equity Loan Home Equity Line of Credit Please note if you are making any extra payments in addition to the minimum due monthly.
7 Education Savings Please list all education savings and any ongoing annual additions. Account Type & Beneficiary Current Education Funding Please list all current and expected annual education expenses, including primary, secondary, and higher education expenses. Beneficiary & Type of Education Funded Beginning Duration Amount Inflation in Year ( # years)
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