Contact and Financial Information Worksheet

Transcription

1 Contact and Information Worksheet Name Use this worksheet to gather all of your important information in one place. By filling out the details regarding your key contacts as well as medical, financial, and legal information, you and your family members will always know where to find your vital information. Give a copy to your financial advisor and also let a family member and/or your emergency contact know where to find this document if needed. Address Home phone Business phone Cell phone Date of birth Social Security Number EMERGENCY CONTACT(S) Name/Relationship Name/Relationship NEIGHBORS Name Name EMPLOYER Firm Address and main telephone Emergency contact at work (name and telephone) (continued on page 2) NOT FDIC INSURED MAY LOSE VALUE NO BANK GUARANTEE 1

2 Estate planning (continued from page 1) HEALTH CARE INSURANCE Insurer Medicare/Medicaid Policy number Policy number DOCTORS Primary care physician Other doctors Specialty Specialty Specialty CLINIC OR HEALTH CENTER Type of treatment PHARMACY Name and address Location of/contact for medications list List of medications up-to date (including drug names, dosages, location of/contact for medications list, what for, and prescribing doctor) (continued on page 3) 2

3 (continued from page 2) LEGAL/FINANCIAL/ ESTATE CONTACTS Attorney: Accountant: Tax preparer: Investment professional: Tax advisor: Insurance agent: Estate trustee: Estate executor(s): Guardian(s) for children: Power of attorney: Has copy of last will and testament Has advance medical directives (e.g., living will) PREARRANGED FUNERAL/BURIAL Funeral home Contact OTHER (continued on page 4) 3

4 (continued from page 3) FINANCIAL PORTFOLIO SHORT-TERM RESERVES INSTITUTION ACCOUNT NUMBER Checking accounts: Savings accounts: Money market mutual funds: Certificates of deposit (CDs): U.S. Treasury bills: Credit cards: INVESTMENTS Brokerage: Mutual funds: Corporate stock - in 401(k) Corporate stock options (continued on page 5) 4

5 (continued from page 4) FINANCIAL PORTFOLIO (CONT.) RETIREMENT ACCOUNTS INSTITUTION ACCOUNT NUMBER Traditional IRA: Roth IRA: Keogh account: 401(k) plans: 403(b) plans: Profit-sharing plan: Pension plans: Annuities: 529 COLLEGE SAVINGS PLANS Additional (see separate page) MILITARY BENEFITS (continued on page 6) 5

6 (continued from page 5) FINANCIAL PORTFOLIO (CONT.) INSURANCE INSTITUTION ACCOUNT NUMBER Life: Disability: Long-term care: Auto: Homeowner's: Umbrella: Other: PERSONAL PROPERTY Mortgage: Safe deposit box: Business/Partnership: Car/Truck/Boat: Loans: (continued on page 7) 6

7 (continued from page 6) Notes Contact your financial advisor for more information, or visit mfs.com. MFS does not provide legal, tax, or accounting advice. Any statement contained in this communication (including any attachments) concerning U.S. tax matters was not intended or written to be used, and cannot be used, for the purpose of avoiding penalties under the Internal Revenue Code. This communication was written to support the promotion or marketing of the transaction(s) or matter(s) addressed. Clients of MFS should obtain their own independent tax and legal advice based on their particular circumstances. Choose What Fits. At MFS we are committed to providing financial advisors with a diverse range of products, tools, and services that enables them to choose what fits for your individual goals. MFS Fund Distributors, Inc., 500 Boylston Street, Boston, MA HP-FBINFOW-FLY-5/