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Comprehensive Client Data
Welcome!

By completing this data form you will begin a process which will help you develop a "confident forever plan" to define and accomplish a future that meets your objectives.

In addition to responding to the questions herein it is important that you provide the documents listed below. Our preference is that you scan the documents and upload them to your secure web portal. However, you may also drop copies of the documents by our office. If dropping off please confirm that we will be in during the drop off time.

Here are the documents we need:
  1. Two most recent income tax returns including all pages, worksheets, W-2s, etc.
  2. Personal financial statement and spending plan, if available.
  3. Most recent bank statements, brokerage statements, investment reports, etc.
  4. All loan information - home mortgage, bank loans, student loans, etc.
  5. All insurance policies - health, life, disability income, long-term care, property (home, car, etc.), liability (personal, professional).
  6. All employee benefit information including benefit booklets, benefit elections, costs, etc.
  7. Two most recent pay stubs.
  8. Most recent Social security statements.
  9. Wills, trusts, divorce decrees, prenuptial agreements, employment contracts, etc.
  10. Any and all additional information relevant to your financial success.
Thank you for allowing us to assist in your success!
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The Basics

We realize that you provided your name before when you completed the Initial Client Survey. However, we must ask you to tell us one more time. It is important that you know who you are. :)

Getting to know you, getting to know all about you...

Providing the information requested here will help us to understand you better. Include client and co-client information, if applicable.
Note that the IRR (internal rate of return), sometimes referred to as the dollar-weighted or money-weighted return is not necessarily the same as the return reported by a mutual fund. It is your return, which may differ from the fund's return.
Include client and co-client information, if applicable.
Include client and co-client information, if applicable.
Include client and co-client information, if applicable.

Tell us about your family, including adult children, parents, and others.

Include client and co-client information in all cases.

About your retirement...

Financial independence is a goal for most people. Please tell us about your plans.

Cash Outflows: Housing Expenses (Primary Home)

It is important that you understand your cash outflows. In this section please identify your expenses related to housing. Mortgage payments and other expenses associated with assets and/or liabilities will be included elsewhere.
Indicate whether you own your home.
What is the amount of your monthly rent payment?
Enter the amount that you pay for electric service, including periodicity.
Indicate the cost, starting date and frequency of replacing your roof.
Indicate the cost, starting date and frequency of this expense.
Indicate the cost, starting date and frequency of this expense.
Indicate the cost, starting date and frequency of this expense.
Indicate the cost, starting date and frequency of this expense.
Indicate the cost, starting date and frequency of this expense.
Do you own a second home?

Cash Outflows: Transportation Expenses

Enter here your expenses associated with transportation costs.
Inter the net cost to replace client's automobile / the year that you will next replace it / how often you will replace your automobiles, and / when you will stop replacing your automobiles.
Enter how much you pay, and how often you buy gasoline
Enter the amount you pay annually for these expenses. Estimate where necessary.
Enter the amount you pay for automobile insurance, and the periodicity.
Enter expenses related to transportation of children. Ex: transporting children, purchasing vehicles for children, additional auto insurance costs, additional gasoline, etc.
Enter expenses related to transportation not identified elsewhere.

Cash Outflows: Healthcare

Enter expenses related to the costs for healthcare. Note: we will discuss your contributions to flexible spending accounts, health savings accounts, employer provided benefits during retirement, etc. during your review.
How much does the client currently pay for medical insurance?
Estimate the total amount out of pocket annually for medical co-pays, coinsurance, etc.
Enter the amount you presently pay and the frequency of payment for dental and vision insurance.
Estimate costs for healthcare insurance and miscellaneous upon retirement before age 65.
Estimate the client's Medicare premium in current dollars.
Estimate the client's Medicare supplement premium in current dollars.
Estimate additional healthcare costs during retirement
Estimate additional healthcare costs not yet accounted for.

Cash Outflows: Lifestyle Expenses

Enter expenses associated with your lifestyle, including personal items, vacations, gifts, groceries, etc. In order to accurately compute survivor income needs please specify expenses for client and co-client.
Enter the amount you pay for groceries and the period. If you have a co-client enter the amount for the client only.
Enter the amount the client does, or would spend at restaurants, and the period.
Enter the amount spent by the client for clothing, and the period.
Enter the cost of the client's mobile phone service, and the period.
Enter costs associated with personal grooming, and the frequency.
Inter the amount paid for gifts to family members, and the frequency
Inter the amount paid for gym and/or club memberships, and the period.
Enter expenses associated with caring for pets, and the frequency.
Enter the amount spent on hobbies, etc.
Enter the amount spent on vacations.
Enter the amount spent on vacations.
Additional costs during retirement. Duration.
Enter expenses here that are not shown elsewhere.

Cash Inflows

Please provide the sources and amounts of your incomes, including the frequencies.
Indicate the client's salary, including the amount and frequency.
Indicate the client's bonus amount and frequency.
Indicate other earned income, including amount, recipient, frequency or date.
Indicate other earned income, including amount, recipient, frequency or date.
Describe any defined benefit pension benefits that you are entitled to.
Describe any defined benefit pension benefits that you are entitled to.
Describe your current or anticipated Social Security Retirement Income benefit.
Disclose income from business ownership including stock options, rents, royalties, etc.

Tell us about your assets and liabilities.

Use current fair market values.
What is the estimated fair market value of your primary residence?
Describe your bank accounts, including the bank names, amounts, purpose and ownership.
Describe your taxable brokerage accounts.
Describe your IRA accounts, etc.
Describe your employer-sponsored retirement accounts.
Describe your lifestyle assets.
Describe your liabilities.

Very Important!

Please scan and upload the documents requested at the top of this data form. These documents provide and/or confirm data that is necessary to fully understand your situation. Thank you!