New Client Survey – Financial Planning Associates, Inc.

New Client Survey

By answering the questions presented in this brief preliminary client data survey you will help us use our time efficiently during your initial get-acquainted meeting. (Note: Exact values are not required at this time. If you are unsure of an answer please provide your best estimate.) (Also Note: We do not and will not use your information for any purpose other than to further our relationship with you.)

Thank you.

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Client first name. *

Note: Information concerning your co-client/spouse, if applicable will be requested below.

Client last name. *

Client date of birth *

Client age. *

Client email. *

Confirm Email

Client mobile phone. *

Client current job title, or Retired. *

Client current employer, or Retired. *

Do you have a co-client (spouse)? *

Yes, I have a co-client
No, I do not have a co-client

Referred by: *

How did you hear about us?

What is your most important financial objective? *

What are your additional financial objectives. *

What is your greatest financial concern/problem? *

What are your other concerns/problems. *

Tell us about your children and/or other dependents. *

Name / estimated value of your most valuable asset? *

What additional assets do you own? *

Name / estimated value of your largest liability? *

What additional liabilities do you own/owe? *

What is your approximate household net worth? *

What is your approximate annual household income? *

Estimate your average federal income tax rate. *

How many years before you expect to take distributions from your investment holdings? *

Where will you live during your retirement?

What will you do during your retirement?

What will you own during your retirement?

What do you want to retire from?

What do you want to retire to?

What will be important to you during your retirement?

What have you observed about other people's retirement?

What additional information should we know?

What is the street address of your primary residence? *

In what city is your primary residence located? *

In what state is your primary residence located? *

What is the postal code for your primary residence? *

What is your current federal income tax filing status? *

Choose your federal income tax filing status.

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