FINANCIAL PLANNING ORGANIZER 8401 Golden Valley Road, Suite 225 Golden Valley, MN 55427 Main: 763.762.3400 Fax: 763.762.3409 www.sterlingretirement.com Registered Representative of and securities and investment advisory services offered through Cetera Advisor Networks LLC, member FINRA/SIPC. Some advisory services are offered through AdvisorNet Financial. Cetera Advisor Network, AdvisorNet Financial, and Sterling Retirement Resources are not affiliated. This information will be used to prepare an individual report assessing your current financial needs. Your responses will not be sold or shared with any unaffiliated parties.
Congratulations on your desire and commitment towards planning for a successful financial future. Before we can begin our analysis, we ask you to complete the following questionnaire and return it to our office, along with the following documents listed below. All documents will be returned and all information will be held in the strictest confidence. Please furnish us with the following information: Bank account statements (checking, savings, money markets) Investment statements (Brokerage statement(s), Mutual Fund statement(s), Certificate of Deposit statements, IRAs, 401K, 403B, Pension, Stock Option statement) Most recent statement(s) for Annuity policy(s) AND copy of policy(s) Last year s tax return and W-2(s) Last year s property tax returns for ANY/ALL real estate Will(s), Trust(s), Power(s) of Attorney, Living Will(s), or Health Care Directive(s) Date Last Reviewed Most recent statement(s) for life insurance policy/policies AND copy of policy/policies Disability policy/policies. If group disability, Summary Plan Description is needed Long Term Care policy/policies Company benefits (most companies publish a benefits booklet/statement) Pension statement(s) Two consecutive months payroll stubs (to include explanation of deductions) Social Security Benefit statement(s) Copy of Mortgage(s) statement(s) AND Mortgage Note(s) Homeowner and automobile insurance policy(s) Loan and Liability statement(s) Other: -2-
Confidential Personal Profile Full Legal Name Please include middle initial Social Security Number Driver s License Issuing State Exp Exp Date of Birth Home Address Line 1 OR Same Address as Client Home Address Line 2 City State Zip Code Zip Code Home Phone Cell Phone Work Phone Personal Email Professional Email Preferred Email? Personal Professional email Personal Professional email I/we would like meeting notes to be delivered via: Email Mail Both Marital Status Single Divorced Married Widowed Employment Status Employed Homemaker Retired Not Currently Employed Employed Homemaker Retired Not Currently Employed Employer Name Work Address City, State, Zip Code Current Position/Title -3-
Family Information Children and Grandchildren Name: SS#: Birth Date: Spouse Name: State of Residency: (Your Children: Name DOB Name DOB Grandchildren) Children: Name DOB Name DOB Name: SS#: Birth Date: Spouse Name: State of Residency: (Your Children: Name DOB Name DOB Grandchildren) Children: Name DOB Name DOB Name: SS#: Birth Date: Spouse Name: State of Residency: (Your Children: Name DOB Name DOB Grandchildren) Children: Name DOB Name DOB Name: SS#: Birth Date: Spouse Name: State of Residency: (Your Children: Name DOB Name DOB Grandchildren) Children: Name DOB Name DOB Client 1 s Parents: Parents Name(s) and Age(s) Health Concerns: State of Residency: Is their estate in order? Yes No Comment: Client 2 s Parents: Name(s) and Age(s) Health Concerns: State of Residency: Is their estate in order? Yes No Comment: -4-
Family Background 1. Hobbies/Interests/Organizations/Clubs: Client 1: Client 2: 2. Health Concerns: Client 1: Client 2: 3. Financial Commitments (Previous Marriage, Outstanding Loans, etc.): Client 1: Client 2: 4. Is there a possibility that other people, such as a parent, might become financially dependent upon you? Yes No If yes, please explain: 5. Are there any special considerations that relate to your children and their future (e.g. Disabilities, Second Marriages, or Financially Unskilled Children)? Yes No If yes, please explain: Other Important Information: Financial Counselors Name Phone Number Satisfied? Financial Planner Yes No Stockbroker Yes No Attorney Yes No Accountant Yes No Life Insurance Agent Yes No Home/Auto Agent Yes No Who would you consult first on an important financial decision? -5-
Financial Planning Objectives At Sterling, we are committed to providing our clients with broad-based financial planning. To be the most effective partner in helping you to achieve your goals, please select which goals and objectives are important to you. 1. Establish a savings plan, accumulate wealth 2. Become financially able to retire 3. Taking care of self and family during a period of long-term disability/long-term care 4. Design an investment strategy for: 5. Professional management of my investment portfolio 6. Reduce income taxes 7. Provide funds for college education for children/ grandchildren 8. Provide for my family's cash and income needs in the event of death 9. Prepare estate plan, protect estate for heirs, reduce taxation upon death 10. Provide for continuation/sale of business as a result of death or disability 11. Other: From the list above, please tell us which three are the most important to you now by indicating their number below: 1. 2. 3. Is there anything we haven t asked you that we should discuss? What is the most important thing you hope to get from this process? What do you like most/least about your present financial position? If you were going to make improvements in your financial plan, what steps would you take? If we were meeting three years from today, and you were to look back over those three years, what has to have happened during that period, both personally and professionally, for you to feel happy about your progress? -6- Client 1 Client 2
Target Retirement Age When would you like to retire? First enter your Target Retirement Age, then indicate how willing you are to delay retirement beyond that age if it helps you reach your Lifestyle Goals. Client 1 Client 2 Target Retirement Age OR Retired Now OR Retired Now Not at all Not at all How willing are you to retire Slightly Willing Slightly Willing later (if necessary) to attain Somewhat Willing Somewhat Willing your goals? Very Willing Very Willing Lifestyle Goals Before & During Retirement Lifestyle Goals are above and beyond what you need to pay for the basic expenses of day-to-day living. Dream a little (or a lot), and create all the goals you would like, even if you re not sure you can afford them. Only include separate goals not accounted for in the Retirement and Education Goal sections. Travel - Recurring Vacations Wedding - Celebration Cars - Transportation Gifts - Donations Leave Bequest Health Care for Yourself or Others New Home - Vacation Home - Renovations Start a Business Other Major Purchases Importance High 10 Description and Details Start Target Amount How Often Low At Year 1 Retirement 8 Example: Annual Travel Fund $12,000 Yearly 20 How Many Times -7-
Portfolio Suitability Questionnaire The following questionnaire will help us determine an investment strategy that best fits your needs. If completing with a spouse or partner, please use the first column for Client 1 response and the second column for Client 2 response. This questionnaire can be completed before or during your next meeting. Client 1 Client 2 Client 1 Client 2 1) When do you expect to START withdrawing money from your investment portfolio? A. Currently or within 2 years B. 2 to 4 years C. 5 to 8 years D. 8 to 12 years E. 12 or more years 3) If your investment portfolio worth $500,000 started losing value, at which point would you START to become uncomfortable? A. $490,000 B. $475,000 C. $450,000 D. $400,000 E. $350,000 F. $300,000 or lower 2) Once withdrawals start, how long will you need the withdrawals to last? A. Less than 2 years B. 2 to 5 years C. 6 to 10 years D. 11 to 15 years E. 15 or more years 4) If the same investment portfolio continued to lose value, at which point would you ask your advisor to reduce your risk level? A. $490,000 B. $475,000 C. $450,000 D. $400,000 E. $350,000 F. $300,000 or lower 5) If the choices below represented the best and worst possible outcomes for a $500,000 portfolio invested for five years, which portfolio would you choose? Worst Case Best Case A. $550,000 $670,000 B. $500,000 $720,000 C. $450,000 $800,000 D. $400,000 $950,000 6) Which of the following statements best describes your attitude towards investment (market) risk? A. I prefer taking a high level of risk in a portfolio that seeks significant growth. B. I prefer taking a significant level of risk in a portfolio that seeks growth. C. I prefer taking a moderate level of market risk in a portfolio that seeks growth and income. D. I prefer taking a low level of market risk in an attempt to limit market losses. E. I prefer taking no investment risk in an attempt to avoid losing any capital. -8-