Financial Worksheet Personal InformationFirst Name *Last NamePreferred NameAge *Email Address *Phone Number *Gender *MaleFemaleAddress *City *State *ZIP Code *What brings you here today?Relationship & RetirementRelationship Status *Relationship StatusSingleMarriedDomestic PartnershipOtherAre you retired? *YesNoIf retired, at what age did you retire?If not retired, at what age do you plan to retire? *NotesFinancial PrioritiesFor each option below, please select a rating from 1 for most important to 8 least important.Protecting principal and avoiding losses *012345678Maximizing income *012345678Minimizing income taxes *012345678Receiving better returns on assets *012345678Leaving a legacy *012345678Tax-advantaged income in retirement *012345678Long-term care costs *012345678Saving for a particular goal *012345678Have you taken the Risk Tolerence Assessment? *YesNoIf yes, what is your score? *Assets and LiabilitiesAsset Type *CheckingSavingsCDInvestmentLife InsuranceOtherSpecify Other Asset Type *Tax Type *Tax TypeQualifiedNon-QualifiedRothValue of the Asset *Do you have any liabilities? *YesNoIf yes, please list the liabilities and their value *Total Net WorthCalculate and enter the amountSocial SecurityAre you currently receiving Social Security benefits? *YesNoIf Yes, what type of benefit are you receiving? *If Yes, what type of benefit are you receiving?ClientSpousalSurvivorDisabilityEx-SpousalFamilywhat is your monthly benefit?When did you start receiving it?What is your Primary Insurance Amount (FRA benefit)?At what age do you plan to file for Social Security?Have you accounted for Cost of Living Adjustment (COLA) and Medicare estimates? *YesNoIncome SourcesCurrent Income Source *Annual Income *Start Age *End Age *Retirement PlanningMonthly Expenses *Annual Retirement Income GoalPlease specify whether the Annual Retirement Income Goal is Gross or Net (after-tax).Annual Cost of Living AdjustmentDo you have a retirement income plan? *YesNoIf yes, does the plan cover inflation or healthcare costs? *YesNoNotesInsuranceDo you currently have life insurance? *YesNoPrimary reason for purchasing life insuranceLife Insurance Policy Details:Policy Name *Insurance TypeInsurance TypeLifeLTCDeath/LTC BenefitCash ValueDo you have long-term care protection? *YesNoIf no, is long-term care a concern for you? *YesNoEstate PlanningDo you have an estate plan? *YesNoDo you have a trust? *YesNoDo you have a will? *YesNoDo you have a Durable Power of Attorney? *YesNoDo you have a Medical Directive/Living Will?YesNoYears since your estate plan has been reviewed?Interested in charitable giving strategies? *YesNoNotes & ConfirmationAdditional Notes or CommentsDo you see any reason not to move forward with hiring a financial professional? *YesNoSubmitSave as Draft
