Financial Planning Questionnaire
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- Barbara McCarthy
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1 Financial Planning Questionnaire Personal Information Client Date of Birth Spouse/Partner Date of Birth Home # Work # Work # Address Family Information: Children Date of Birth Employment Information: Client Spouse/Partner Company Length of service Full/Part time Salary Bonus 401k/403B Matching Formula Self employment income: Company name Full/Part Time Retirement Plan Employees Net Income Client Spouse/Partner
2 Insurance & Risk Risk Profile Investment Attitude: Very Conservative Conservative _ Moderate Aggressive Investment Experience: None Very Little Moderate Extensive Insurance Information You may need to review your insurance policies to get this information. Permanent Life Insurance: Company Face Amount Premium Cash Value Owner Beneficiary Term Life Insurance: Company Face Amount Premium Years Left Owner Beneficiary Disability: Company client/spouse Income Replacement Through work yes/no Long Term Care: Company Premium Client/Spouse Home Insurance: Company Coverage Deductible Premium Umbrella Insurance yes/no Premium Auto Coverage: Company Coverage Deductible Premium
3 Estate Planning Issues Do you have any of the following? Will DPOHC Living Trust Revocable Trust Living Will Power of Attorney How is your joint property titled? Joint Tenants by the Entirety Joint Tenants in Common Joint Tenants With Rights of Survivorship Other Pension & Social Security Define Benefit Pension(s) Include information on pension plans that provide an annual income based on your years of service or income level (ie: military pension, state pension etc. ) Client Pension 1 Client Pension 2 Spouse Pension 1 Spouse Pension 2 Anticipated annual $ Starting Age: Increase rate before Ret: Increase rate after Retire: Survivor Benefit : Planned Retirement Age Client Spouse Social Security Client Spouse Age to start Annual Increase rate Earned Income now Or Anticipated/current benefit Age 62 Age Age 70 Expenses Estimate annual figures for expenses related to shelter, food, clothing, transportation, insurance, loans, etc. Do not include taxes. Annual Living Expenses (today s dollars) Annual inflation rate for living expenses Now: Current Surviving Household During Retirement: Single Retiree Survivor: Before Retirement Surviving Household: During Retirement: Single Retiree Survivor:
4 Budget Worksheet Monthly Expense Items Now Retirement Survivor Rent or lease payment Food & Household incidentals Gas, Electric, Heat, Water Cell phone + Home Phone Internet + Cable/satellite Auto operating & maintenance Clothing & Personal Items Property improvements & upkeep Domestic help, babysitting Property taxes Entertainment & vacations Charitable contributions Child Care Alimony, child support Books, papers, subscriptions Home furnishings Gifts, birthdays Medical expenses Other expenses Mortgage Payment Auto loan Boat & RV payment Credit Card Payments Other loan payments Home Equity Life Insurance premiums Medical Insurance premiums Auto Insurance premiums Home Insurance premiums Other Insurance Retirement Plan Savings Other Savings
5 Assets List capital assets including banking accounts, investment accounts, retirement accounts, business assets. No. Asset name Current Value Annual additions Account description (ie. Stock, 401k,bank) 1 $ $ 2 $ $ 3 $ $ 4 $ $ 5 $ $ 6 $ $ 7 $ $ 8 $ $ 9 $ $ 10 $ $ 11 $ $ 12 $ $ 13 $ $ 14 $ $ 15 $ $ 16 $ $ 17 $ $ 18 $ $ 19 $ $ 20 $ $ Please include copies of your recent brokerage and bank statements. Other Asset Values Other Debts/Liablities House Mortgage Car(s) Car Loans Rental Property 1 Mortgage Rental 1 Rental Property 2 Mortgage Rental 2 Boats/RV Boats/RV Loans 2 nd Home Mortgage 2 nd Home Collectibles coins etc. Home Equity Loan
6 Education and Special Income/Expenses Special Income/Expense List any other sources of income or special expenses to be paid from your capital accounts. Description Annual Annual increase Starting # years Amount rate year Children s Education and Fund Expenses Child name D.O.B./Age Age to start Cost per year Number of Current College years college fund Inflation rate to use for college planner: Rate of return on college funds: College fund account types(529,ugma) Other funds like scholarships, grandparents etc. Do you contribute to a ROTH IRA? Client 1 Client 2 Who are your beneficiaries on your retirement accounts? Who are your beneficiaries on your brokerage accounts? What is the rate on your mortgage? Term Time Left Do you know if you pay PMI Insurance? What is the rate on your home equity? Is it fixed or variable? Tell me about your worst investment experience
7 What financial issue keeps you up at night? Other thoughts or concerns that you would like to address or talk about? Notes:
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