confidential client service...

Confidential Client Service

Questionnaire

Joseph Williams

Investment Consultant

2121 West Spring Creek Parkway, Suite 216

Plano, TX 75023

Office (972) 881-9393

Cell (214) 356-9956

Fax (972) 805-9492

[email protected]

Form Updated 1/25/2016

retirevibe.com Securities Offered Through LPL Financial Member FINRA/SIPC

Goal: Understanding How We can Serve You

Why We Have This Process—Planning and Building a Solid Retirement In order to understand the best way to serve your specific needs, we must first learn more

about you. This is a starting point, we learn much more as we discuss this questionnaire in

a face to face meeting. When it comes to understanding your needs, we want to get it

right. Our process allows us to check and then recheck your current circumstances… we

believe in the old adage “measure twice - cut once”.

We are a Confidential Advocate As you go through the questionnaire, we encourage you to be as open as possible - and keep in mind that everything shared with

us is strictly confidential. Protection of your personal information is of the highest priority. We will not disclose information about

you to anyone without your permission.

First Meeting Document List We may discuss the following documents in our first meeting. In order to provide the highest level of ser-

vice, we ask that you please have these items handy if possible.

Review Process Checklist

Confidential Client Service Questionnaire

401 (k) Statements

Salary Information / Pay Stub

Pension / Profit Sharing / Stock Option Statements

Employee Benefits Booklet

Brokerage Statements

IRA Statements (SEP, Roth, Traditional)

Trust Accounts

Bank Statements

Annuity Statements

Insurance Policies

Social Security Statements

Last Two Years Tax Returns

Mortgage Statements along with Other Loan Statements

Current Advisors:

CPA or Accountant O) #:___________________________

Name: ___________________________________________

Satisfaction Rating / 1 = Very Satisfied: 1 / 2 / 3 / 4 / 5

Attorney O) #:___________________________________

Name: ____________________________________________


Insurance Agent O) #:_____________________________

Name: ____________________________________________


Financial Advisor Web Address: ____________________

Name: ____________________________________________


Other:_____________________________________________


Joseph Williams Investment Consultant

2121 West Spring Creek Parkway,

Suite 216

Plano, TX 75023

Office (972) 881 -9393

Fax (972)805-9492

[email protected]



Suite 216

Plano, TX 75023

Office (972) 881 -9393

Fax (972)805-9492

[email protected]

Referred By: Date Completed:

Clients Personal And Contact Information

Family Data Client 1 Client 2

Full Name

Home Street Address

Date of Birth

Home / Mobile Phone

Fax

Email

Work Phone

Preferred Contact (home, email, work…)

Social Security #

U.S. Citizen (Y/N)

Gender

Marital Status (single, married, divorced, widow) / Years

Employment Client 1 Client 2

Occupation / Job Title

Employer Name

Self-Employed (Y/N)

If Y: Type of Business & Legal Structure

If Y: # of Employees

Employer Address

Years with current employer / Start Date Additional Notes:




Suite 216

Plano, TX 75023

Office (972) 881 -9393

Fax (972)805-9492

[email protected]

Parents Client 1 Client 2

Mother's Name

Mother's Date of Birth / Age

Marital Status (single, mar-ried, divorced, widow)

Health

Location

Other Comments

Father's Name

Living (Y/N)

Father's Date of Birth / Age

Marital Status (single, mar-ried, divorced, widow)

Health

Location

Other Comments

Additional Notes: (Where did you grow up, what did you like most about living there, what lessons did you learn about money growing up?)




Suite 216

Plano, TX 75023

Office (972) 881 -9393

Fax (972)805-9492

[email protected]

Children / Dependents Client 1 Client 2

Child / Dependent

Full Name

Relationship

Date of Birth

Social Security #

Marital Status

Spouse / Partner Name

Spouse / Partner DOB

Children names & DOB

Client Y/N

Comments (College Plans; Marital Status; Where Live; Where Work…

Child / Dependent

Full Name

Relationship

Date of Birth

Social Security #

Marital Status




Client Y/N


Child / Dependent

Full Name

Relationship

Date of Birth

Social Security #

Marital Status




Client Y/N



Rather you are preparing for retirement or already retired, we would like to hear how you feel about it. In general, what are your

expectations, hopes, and concerns as you consider this life transition and the possibility of working with an advisor?



Suite 216

Plano, TX 75023

Office (972) 881 -9393

Fax (972)805-9492

[email protected]


Client One Client Two

You may be

retired—but your

not done working



Suite 216

Plano, TX 75023

Office (972) 881 -9393

Fax (972)805-9492

[email protected]

History Client 1 Client 2

What is your education background?

Have you served in the military?

Favorite Investment / Least favorite

How Satisfied are you with the perfor-mance of your investments?

Goals and Priorities Client 1 Client 2

Objectives List all that apply List all that apply

What are your most important long-term financial goals? (Examples: children's ed-ucation, retirement, preserving wealth etc.)

What short-term financial goals or needs do you have? (Example debt consolida-tion, tuition payment, emergency cash, income protection, financial organization, etc.)

Please list any major financial obliga-tions or planned expenditures. (Example: car, home, business, land, vacation, vacation property)

What do you enjoy doing when you have free time? (Example: travel, hobbies, children, read, sports, etc.)

What are your major concerns regarding the future? (Examples: outliving your savings, disability, the need for home health care or nursing home, income tax-es, estate taxes, premature death, needs of beneficiary, etc.)

Please note any health or other family circumstances that might impact your financial planning.

Please describe your ideal retirement lifestyle…




Suite 216

Plano, TX 75023

Office (972) 881 -9393

Fax (972)805-9492

[email protected]

Retirement Goals Client 1 Client 2

Are you considering a career change?

What is your gross Annual Income?

What is your tax bracket?

Do you expect any major changes to your income during the next three years?

At what age do you expect to retire?

What is your retirement income goal? (75% is typically recommend-ed to maintain your current stand-ard of living)

Social Security to begin at what age / Expected monthly income? Do you currently have an annual income target for retirement?

How much do you contribute each year to your retirement plan? How much does your employer con-tribute each year to your retirement plan?

Employer Pensions to begin at what age / Exacted monthly income? How many years do you anticipate being retired?

Please describe any special consid-erations regarding your retirement plans:

Retirement Assets Client 1 Client 2

Retirement Plan or 401 (k) Do you participate in an em-ployer stock option plan (ESOP)? Do you participate in an em-ployer stock grant plan? Do you participate in an employ-ee Stock purchase plan (ESPP)

Current Retirement plan maxi-mum matching percentage? Other considerations regarding current company retirement plan (Example: Vesting, rollover control, medical savings ac-counts, Roth options etc.)

Old employer plans

IRA's

Annuities (Fixed or Variable) Other




Suite 216

Plano, TX 75023

Office (972) 881 -9393

Fax (972)805-9492

[email protected]


Statement of Net Worth

Liquid Assets Client One Client Two Joint Total

Checking, Bank Savings, Money Mar-ket Funds

Certificate of Deposit

Taxable Bonds

Tax Free Bonds

US Savings Bonds or EE Bonds

Stocks

Mutual Funds

REIT or Non Correlated Assets

Structured CD's

Life Insurance Cash Value

Other

Generational Assets Client One Client Two Joint Total

529 / Tuition Savings Plans

UTMA / UGMA Custodial Accounts

Joint accounts with children/family

Other property owned with children

Trust accounts for children/family

Personal Property Client One Client Two Joint Total

Primary Residence Value

Vacation Property

Other Real Estate

Vehicles / RVs / Boats Leases / Memberships / Season tick-ets or other assets of value

Small business Value

Jewelry / Art / Antiques

Household and other property

Other Assets/Notes



Suite 216

Plano, TX 75023

Office (972) 881 -9393

Fax (972)805-9492

[email protected]

Debts / Liabilities Client One Client Two Joint Total

Primary Residence Mortgage

Second Mortgage, Equity Loan, or Line of Credit

Other Margin loans Current Annual Household Expens-es

Education loans

Auto Loans

Credit Card Balances

401k or Retirement Plan Loans

Any other loans or debts

Total debts / Liabilities

Household Net Worth Client One Client Two Joint Total

Total Own

Total Owe

Net Worth (Total As-

sets - Total Liabilities)

Investment Policy Client 1 Client 2

Are there investments you avoid because of principal?

How comfortable are you managing your fi-nances? How do you determine the success of an investment?

Confidence in your current financial plan 1 to 10 with one being very confident?

Please rank the following objectives 1 to 5 with one being very important. Client 1 Client 2

Cash / Liquidity

Income

Growth with Income

Growth

Aggressive Growth Client Projections Client 1 Client 2

Annual return pre-retirement/Retirement Annual inflation pre-retirement/Retirement

Tax rate pre-retirement/Retirement




Suite 216

Plano, TX 75023

Office (972) 881 -9393

Fax (972)805-9492

[email protected]


Wealth Protection Client One Client Two Do you have any Life Insurance? Benefit Amount Premiums Beneficiary Contingent Do you have Medical Insurance? Is medical insurance through your employer? Do you have homeowner Insurance? Do you have umbrella or liability Insurance? Who do you have auto insurance through? Do you have short term disability insurance? Do you have long term disability insurance? Do you have long term care insurance? What are the specifics you understand about the plan? (Example: premiums, daily bene-fit, inflation provision, future premium in-creases, etc.) Other thoughts or concerns regarding wealth protection

Estate Planning Client 1 Client 2 When Was your will last updated? Was your will written in your state of residence? Have you been previously married? Do you have a durable power of Attorney? Do you have a trust? If so, what type of trust do you have? Trustee of the trusts that you established? Do you have a health care proxy? Are you the beneficiary of any trust? Please describe inheritances you are anticipating? Please describe assets you are currently gifting? If you have goals for your estate (i.e., children, charities), please describe. Please describe any illiquid asset (s) (i.e., farm-land, real estate, small business) that you would like to pass on to the next generation and your current strategy for doing so? Do you have strategies in place for estate taxes? Please describe…

Other information

Other information

How often would you like to meet personally to review your financial goals? [semi-annually / An-nually]

Please send

information

about your

services to this

person:

Family Member Business Associate Friend Neighbor

Name:

Address:

City: State: Zip:

Phone:

E-Mail:

Referred by:


Please send

information

about your

services to this

person:

Family Member Business Associate Friend Neighbor

Name:

Address:

City: State: Zip:

Phone:

E-Mail:

Referred by:


confidential client service...

Documents