FACT AND FEELING FINDER

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A simple, guided questionnaire designed to help us understand your goals, priorities, and financial picture — so we can build a plan that truly fits you.

Are you completing this for *If you are completing this for yourself only, choose “Client 1 only.” If you are completing this with your spouse or partner, choose “Client 1 + Client 2.”Client 1 onlyClient 1 + Client 2 (spouse/partner)

Client 1 Information

First Name *

Last Name *

Preferred Name

Date of Birth *

Email Address *

Phone Number

Gender

Address

What brings you in today

Relationship Status

Are you already retired *YesNo

At what age did you retire?

At what age will you retire?

Notes

Client 2 Information

Please provide the information below for your spouse or partner so we can include both of you in the planning process.

First Name *

Last Name *

Preferred Name

Date of Birth *

Email Address *

Phone Number

Gender

Client 2 Address

What brings Client 2 in today

Relationship Status

Is Client 2 already retired *YesNo

Client 2 Age retired

At what age will Client 2 retire?

Client 2 Notes

Risk Tolerance Questions

Choose one option per question. Each option carries points that contribute to the COMRA score.

1.My primary financial goal is:Not running out of moneyLeaving a legacyMaximizing my incomeGrowing my assets

2.When it comes to investments and financial decisions, I consider myself:Not very knowledgeableSomewhat knowledgeableKnowledgeableAn expert

Note: This question is 0 points in the original PDF.

3.On the road to retirement, I am:Retired, I made itLess than five years awayFive to 10 years awayMore than 10 years away

4.My attitude toward risk is:A small loss would concern meI am comfortable taking some risks, but I am conservativeI am growth oriented, and I understand my assets may go up or downI am aggressive, and I want to grow my assets. If my assets lose value, I might buy more

5.Including all sources, my current household income is: *Under $50,000$50,000 - $99,999$100,000 - $249,999$250,000 - $499,999$500,000 or more

6.During retirement, I will rely on income from my assets:HeavilyModeratelySomewhatNot at all

7.I consider my retirement income sources to be: *I don’t have retirement income sourcesUnstableSomewhat stableVery stable

8.Not including my primary residence, my net worth is: *Under $250,000$250,000 - $499,999$500,000 - $999,999$1,000,000 - $1,999,999$2,000,000 or more

9.Relative to inflation, I would like my investments to:Keep pace with inflation with minimal riskModerately outpace inflation with some riskSignificantly outpace inflation with moderate to high riskMaximize performance with substantial risk

Reference: www.usinflationcalculator.com/inflation/historical-inflation-rates

10.If I placed $250,000 in an asset for five years, I would be most comfortable with:Worst: $270,000 | Best: $300,000Worst: $250,000 | Best: $330,000Worst: $230,000 | Best: $375,000Worst: $200,000 | Best: $450,000

11.If my asset lost 20 percent of its value, I would:Immediately sellChange to a more conservative optionStay the courseAdd to it while its value is down

Your COMRA ScoreThis is your Color of Money Risk Analysis score based on your answers. Please copy this score and enter it in the Fact and Feeling Finder form.

Your COMRA Score: {calculation-4}

What are your financial priorities?

Please rank each item based on its importance to you, with 1 being the most important and higher numbers being less important. This helps us understand what matters most when building your financial plan.

Protecting principal and avoiding losses (Client 1) *

Protecting principal and avoiding losses (Client 2)

Maximizing my income (Client 1) *

Maximizing my income (Client 2)

Minimizing income taxes (Client 1)

Minimizing income taxes (Client 2)

Receiving a better return on my assets (Client 1) *

Receiving a better return on my assets (Client 2)

Leaving a legacy (Client 1)

Leaving a legacy (Client 2)

Tax-advantaged income in retirement (Client 1)

Tax-advantaged income in retirement (Client 2)

Long-term care costs (Client 1)

Long-term care costs (Client 2)

Saving for a particular goal (Client 1)

Saving for a particular goal (Client 2)

Additional Financial Priorities

If you have any other important goals or priorities not listed above, please enter them here and rank their importance.

Other Financial Priority

Other Priority Rank (Client 1)

Other Priority Rank (Client 2)

Your Financial Accounts and Assets

Please list your financial accounts below, including who owns the account, the type of asset, and the current value. This helps us understand your overall financial picture.

Owner *

Account / Asset Name *

Asset Type *

Tax Type

Estimated Current Value *

Your Liabilities and Debts

Please list any loans, mortgages, credit cards, or other debts below. Include the current balance and payoff information if available.

Loan / Debt Name *

Current Balance Owed *

Monthly Payment

Estimated Payoff Date

Your Financial Summary

Below is a summary of your total assets, total debts, and estimated net worth based on the information you provided.

Account Assets Total: {calculation-1}

Total Liabilities: {calculation-2}

Estimated Net Worth: {calculation-3}

Account Assets Total

Total Liabilities

Net Worth

Inheritance

Do you expect to receive an inheritanceYesNo

Expected Inheritance Amount

Inheritance Timeframe

Social Security Information

If you are currently receiving Social Security or expect to receive benefits in the future, please provide the information below. If you are unsure about any answers, you may leave them blank.

Client 1

currently receiving Social Security benefitsYesNo

Benefit Type

What is your monthly benefit?

When did you start receiving it?

What is your Primary Insurance Amount (Full Retirement Age benefit)?

What is your anticipated age when filing for benefits?

Assume average life expectancy?YesNo

Specify Age

Client 2

Currently receiving Social Security benefitsYesNo

Benefit Type

What is your monthly benefit?

When did you start receiving it?

What is your Primary Insurance Amount (Full Retirement Age benefit)?

What is your anticipated age when filing for benefits?

Assume average life expectancyYesNo

Specify Age

COLA & Special Situations

Estimated Annual Cost of Living Adjustment (%) *

Include Medicare Estimates in Planning? *YesNo

Do any of the following apply to you? (Select all that apply)Divorced (married 10+ years)WidowedDivorced and ex-spouse is deceased

Former Spouse Information

If you may be eligible for benefits based on a former spouse, please provide the information below.

Former Spouse Date of Birth

Estimated Monthly Benefit Amount (if known)

Notes (optional)

Deceased Spouse / Survivor Information

If you may be eligible for survivor benefits, please provide the information below.

Spouse / Ex-Spouse Date of Birth

Date of Death

Estimated Monthly Benefit Amount (if known)

Were they receiving benefits at the time of death?YesNo

Benefit Amount at Time of Death

Date They Filed for Benefits

Additional Notes (optional)

Important Notice

If you receive a pension from employment where you did not pay Social Security taxes, your benefits may be reduced under special rules. If this applies to you, please note it above or discuss it with your advisor. More information is available at www.ssa.gov.

Other Income Sources

Please list any additional sources of income you expect to receive now or in the future, such as pensions, rental income, business income, or part-time work. Include the owner, estimated annual amount, and the ages when this income starts and ends.

Income Source

Owner

Annual Income

Start Age

End Age

Retirement Income Needs

Estimated Monthly Living Expenses *

Is this income goal before or after taxes? *

Desired Annual Retirement Income *Total annual income you would like to receive in retirement.

Assumed Annual Cost of Living IncreaseEstimated annual increase to keep up with inflation (optional).

Will you need additional income beyond Social Security each month?YesNo

Do you currently have a retirement income plan? *YesNo

Based on your current plan, your expected retirement income is:

Does your plan include increases for inflation and healthcare costs?YesNo

Additional NotesUse this space to share any additional thoughts or concerns about your retirement income goals.

Insurance & Protection

This section helps us understand your current life insurance and long-term care coverage. If you are unsure about any answers, you may leave them blank. This immediately lowers anxiety.

Do you currently have life insurance? *YesNo

What are the primary reasons you purchased life insurance?

Have you had any major health concerns in the past?YesNo

Please briefly explain (optional)

Do you currently have long-term care coverage? *YesNo

Is long-term care a concern for you in the future?YesNo

Life & Long-Term Care Policy Details

Please list any life insurance or long-term care policies you currently own. Add as many policies as needed.

Policy Owner

Insured Person

Insurance Company / Policy Name

Policy Type

Death Benefit / LTC Benefit Amount

Current Cash Value

Estate Planning & Professional Relationships

This section helps us understand your current estate planning documents and how you typically seek financial guidance. If you are unsure about any answers, you may leave them blank. Calm. Non-legal. Low pressure.

Which of the following estate planning documents do you currently have? (Select all that apply)Estate PlanTrustWillDurable Power of AttorneyMedical Directive / Living WillNone of the above

Approximately how many years since your estate plan was last reviewed?Enter a number (for example: 2, 5, 10). Leave blank if unsure.

Are you interested in charitable giving strategies? *YesNo

When you have a financial question, who do you typically ask? (Select all that apply)FamilyFriendsCo-workersFinancial Professional

If you currently work with a financial professional, is this person a relative or close family friend? *YesNoI do not currently work with a financial professional

How often do you meet with your financial professional to review your goals?Once a yearEvery six monthsEvery three monthsLess oftenI do not currently meet with a financial professional

Do you see any reason that would prevent you from moving forward with a financial advisor at this time? *YesNo

Please briefly explain (optional)

Additional Notes (optional)

Acknowledgment *

I certify that the information I have provided in this form is true and accurate to the best of my knowledge. I understand that this information will be used for financial planning purposes.

Save as Draft

Please do not fill in this field.

French Capital Management

Disclosure: Advisory services offered through Foundations Investment Advisors, an SEC registered investment advisor. This site is published for residents of the United States only. Investment Advisor Representatives may only conduct business with residents of the states and jurisdictions in which they are properly registered. Therefore, a response to a request for information may be delayed until appropriate registration is obtained or exemption from registration is determined. Not all of the services referenced on this site are available in every state. For additional information, please contact Kim Creque at kimcreque@fiatwm.com. Fiat Wealth Management does not offer legal or tax advice.

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