Estate Planning Fact Finder Contents Page Family Information 1 Financial and Estate Planning Objectives 1 Present Estate Plan 2 Post-Death Monthly Income Objectives 2 Retirement Plans 2 Annual Income 3 Assets 3 Liabilities 3 Life Insurance 4 Health Insurance 4 Prepared for: Prepared by: Date: VSA, LP The information, general principles and conclusions presented in this report are subject to local, state and federal laws and regulations, court cases and any revisions of same. While every care has been taken in the preparation of this report, neither VSA, L.P. nor The National Underwriter is engaged in providing legal, accounting, financial or other professional services. This report should not be used as a substitute for the professional advice of an attorney, accountant, or other qualified professional.
Estate Planning Fact Finder Page 1 Client Spouse Children Name Family Information Age Health Problems or Special Needs, if Any Residence Address Telephone ( ) Your Occupation Employer Business Address Telephone ( ) Spouse s Occupation Employer Business Address Telephone ( ) Attorney Telephone ( ) Accountant Telephone ( ) Other Professional Advisor Telephone ( ) 1. 2. 3. Financial and Estate Planning Objectives Be specific. Examples: Survivor income; minimize estate taxes; pass the business on to children) Is there anything else I should know about your family, your plans and objectives, obligations or anything that is of particular concern?
Estate Planning Fact Finder Page 2 Present Estate Plan Do you have a will? Yes No Dated Does your spouse have a will? Yes No Dated Provisions of your and your spouse s wils: Simple Will, all to surviving spouse Yes No A will with provisions for a trust Yes No Were you and your spouse married in another state? Yes No If yes, where? Do you or your spouse own a residence or business in another state? Are you, spouse or children the beneficiaries of any trust? (Describe) Describe any existing trusts or any special bequests (such as to a charity or others): Post-Death Monthly Income Objectives Monthly Income to Spouse/Family $ for years then $ for years Presently covered by Social Security: Self (Yes/No) Spouse (Yes/No) Other monthly income sources available? (Describe) Education Fund Per Child Emergency Fund Mortgage Payoff Fund Other Needs (Describe) $ $ $ Retirement Plans Retirement Monthly Income Objective $ Projected Monthly Living Benefits Death Value Qualified Plans: Client s Life $ $ Spouse s Life $ $ Nonqualified Salary Continuation Plans? (Describe benefits) Other Funds Available for Retirement? (Describe)
Estate Planning Fact Finder Page 3
Estate Planning Fact Finder Page 4 Annual Income Client Salary Bonus Other Tax Bracket % Spouse Salary Bonus Other * Jointly owned and community property assets and liabilities are generally split equally between the spouses Residence Other Real Estate Business Interest Marketable Securities Checking and Savings Life Insurance Owned on Your Life Cash Value of Life Insurance Policies Owned on Others Personal Property Retirement Funds Revocable Trusts Future Inheritance Other Assets Subtotal Mortgage on Residence Other Mortgages Consumer Loans Other Debts Subtotal Assets and Liabilities Assets* Should this Current Fair Market Value ($) Value in Quick/ Forced asset be disposed of at 1 st death? Self Spouse Sale (Yes/No) Liabilities TOTAL (Assets Liabilities)
Estate Planning Fact Finder Page 5 Life Insurance (On self and spouse, and policies owned by self and spouse on others) Company Insured Owner Beneficiary Total Face Amount Cash Value Type* Loan Outstanding Annualized Premium * Permanent, Universal, Term, Group, Credit Life, Mortgage Life, Second-to-die Benefit Period: Waiting Period: Monthly Benefit: Describe: Heath Insurance Disability Income Insurance Other Health Insurance Notes