financial planning questionnaire - capitalinsightfg.com
TRANSCRIPT
FinancialPlanningQuestionnaire
JacobJ.ReidLifePlanningStrategist™
[email protected] | www.capitalinsightfg.com2021LasPositasCourt,Suite165,Livermore,CA94551
Phone:925-449-7830 |Fax:(925)449-0598CAInsuranceLicense#0H05483
SecuritiesofferedthroughSecuritiesAmerica,Inc.MemberFINRA&SIPC.AdvisoryservicesofferedthroughSecuritiesAmericaAdvisors,Inc.CapitalInsightFinancialGroupandSecuritiesAmericacompaniesare
separateentities.
PersonalInformation
Title FirstName LastName DateofBirth SocialSecurity# Gender
HomePhone# BusinessPhone# CellPhone# EmailAddress
Street City State Zip
Title FirstName LastName DateofBirth SocialSecurity# Gender
HomePhone# BusinessPhone# CellPhone# EmailAddress
Street City State Zip
1.
2.
Dependents
Title FirstName LastName DateofBirth SocialSecurity# Gender
Street City State Zip
1.
Notes
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Relation&Dependent
Title FirstName LastName DateofBirth SocialSecurity# Gender
Street City State Zip
Relation&Dependent2.
JacobJ.Reid|[email protected]:(925)449-7830CAInsuranceLicense#0H05483
ProfessionalAdvisors
FirstName LastName BusinessPhone# EmailAddress
Street City State Zip
1. FinancialAdvisor
2. CPA– TaxPreparer
FirstName LastName BusinessPhone# EmailAddress
Street City State Zip
FirstName LastName BusinessPhone# EmailAddress
Street City State Zip
3. Estate/TrustAttorney
4. PropertyCasualtyInsuranceAgent
FirstName LastName BusinessPhone# EmailAddress
Street City State Zip
Notes
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JacobJ.Reid|[email protected]:(925)449-7830CAInsuranceLicense#0H05483
GeneralInformationWhatareyourhobbies,areasofinterest,clubsandassociationsyouparticipatein?
Isthereanyonethatmaybecomefinanciallydependentonyouinthefuture?
Whenyouthinkaboutmoney,whatkeepsyouawakeatnight?
Isthereanyoneelsethatyoulooktoforfinancialadvice?
Attheendofthisprocess,whatwouldyoufeelisasuccessfuloutcome?
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Children’sEducationIsityourgoalforyourchildrentoattendcollege? Yes No
PublicIn-State PublicOut-of-State Private
Doyoucurrentlyhavefundsoraccountsspecificallysetasideforeducation? Yes No
Notes
JacobJ.Reid|[email protected]:(925)449-7830CAInsuranceLicense#0H05483
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Estate/Retirement/TrustBeneficiaries
Name
Name Relation
Name Relation Percentage
Percentage
Percentage
Relation
EstatePlanningDoyouhavealivingtrust? Yes No Ifyes,datesignedDoyouhavewills? Yes No
Doyouandyourspousehavedurablepowersofattorneyforhealth? Yes NoDoyouandyourspousehavedurablepowersofattorneyforfinancialmatters? Yes NoWhatisyourultimategoalforthedistributionofyourwealth?
Inheritancetochildren/grandchildren Charitablepurposesduringlifetime
CharitablepurposesafterdeathIsyourestatevaluationover5.5Million?
Haveyoutakenanystepstoavoidestatetaxes(lifeinsurancetrust,annualgifting,etc.)?
Notes
JacobJ.Reid|[email protected]:(925)449-7830CAInsuranceLicense#0H05483
RetirementPlanningMostDesiredRetirementAge
AcceptableRetirementAge
Desiredpre-taxmonthlyincome
Acceptablepre-taxmonthlyincome
Whichofthefollowingmightbeincludedinyourplans?Relocation:Sellhometopurchaseanother?
Purchasevacationhome?
Workpart-time?
Travel?
Other
Timeshare?
Full-time/newcareerpath?
Aretravelfundsincludedindesiredincome?
RetirementIncomeSources
Client1 Client2
$$
$$
AreyoueligibleforSocialSecurity? Yes No
Client1 Client2
Yes No
PensionIncomeDescription
WhosePension: Description $
Pre-TaxAmount
/monthWillthisamountinflate? Yes No SurvivorBenefit: %WhosePension: Description $ /monthWillthisamountinflate? Yes No SurvivorBenefit: %
Notes
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JacobJ.Reid|[email protected]:(925)449-7830CAInsuranceLicense#0H05483
Employer&IncomeInformation
FamilyMember EmployerName Title YearsEmployed
Occupation&BriefDescription
Street City State Zip
1.
MonthlyPre-TaxIncome AnnualPre-TaxIncome PensionorRetirementAccount
FamilyMember EmployerName Title YearsEmployed
Occupation&BriefDescription
Street City State Zip
2.
MonthlyPre-TaxIncome AnnualPre-TaxIncome PensionorRetirementAccount
CurrentAnnualHouseholdIncome(gross)/InsuranceCoveragesPleaseprovideacopyofmostrecentyear’staxreturnsandemployerpaystubs
$100,000to$150,000 $150,001to$200,000
Under$50,000 $50,001to$74,999 $75,000to$99,999
$200,001andover
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HealthInsurance:DisabilityInsurance:LifeInsurance:
Groupcoveragethroughemployer
Groupcoveragethroughemployer
Insured Company Owner Beneficiary Type DeathBenefit AnnualPremium
$$
$$
$$
LongTermCareInsuranceInsured Company DailyBenefit YearscoveredAnnual CashValue
$$
Privateprovider
Privateprovider
CashValue
JacobJ.Reid|[email protected]:(925)449-7830CAInsuranceLicense#0H05483
RealEstate&LifestyleAssets
Description Type:Residence/Rental PurchaseDate PurchaseAmount
Address MarketValue ValuationDate
PropertyTax Frequency
1.
Description Type:Residence/Rental PurchaseDate PurchaseAmount
Address MarketValue ValuationDate
PropertyTax Frequency
2.
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MortgageInformationInformationregardingyourhomeand/orotherrealestateholdings:
Originalcostofyourhome $
Estimateoftoday’smarketvalue $
Currentmortgagebalance
Interestrate
Monthlypayment
$
$
Originalloanamount
Fixed
Dateoffirstpayment
$
Variable #ofYears
SecondMortgage/CreditLine? Yes No
InterestRate Amount MonthlyPayment% $ $
NotesForrentalorotherrealestateholdings,pleaseprovidesimilarinformationonaseparatesheet.
%
Howisthepropertytitled?
Ispropertytaxandhomeinsurancewrappedintomortgage? Yes No
JacobJ.Reid|[email protected]:(925)449-7830CAInsuranceLicense#0H05483
Liabilities
LiabilityName: InterestRate PaymentType
1.
LinkedtoAsset
Amount
PaymentFrequency Amortization(Years) StartDate EndDatePrincipalAmount
LiabilityName: InterestRate PaymentType
2.
LinkedtoAsset
Amount
PaymentFrequency Amortization(Years) StartDate
LiabilityName: InterestRate PaymentAmount
3.
AmountOwed
PaymentFrequency
LiabilityName: InterestRate PaymentType
5.
Amount
PaymentFrequency Amortization(Years)
CreditCards
AutoLoan
EquityLine
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LiabilityName: InterestRate PaymentAmount
4.
AmountOwed
PaymentFrequency
CreditCards
Misc.
Notes
PrincipalAmount
PrincipalAmount
JacobJ.Reid|[email protected]:(925)449-7830CAInsuranceLicense#0H05483
InvestmentAccountsandBankAccounts
Description AccountType Owner
MarketValue$ DateofValue CostBasis(IfKnown)
1.
Description AccountType Owner
MarketValue$ DateofValue CostBasis(IfKnown)
2.
Description AccountType Owner
MarketValue$ DateofValue CostBasis(IfKnown)
3.
Description AccountType Owner
MarketValue$ DateofValue CostBasis(IfKnown)
4.
Description AccountType Owner
MarketValue$ DateofValue CostBasis(IfKnown)
5.
Description AccountType Owner
MarketValue$ DateofValue CostBasis(IfKnown)
6.
Notes
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7. AdditionalAssets(Property,Itemsofsignificantvalue)
Description
JacobJ.Reid|[email protected]:(925)449-7830CAInsuranceLicense#0H05483
CashFlowWorksheetGeneralLivingExpenses: Monthly
Food,Groceries
Clothing
Cleaners
HousePayment
HomeMaintenance
HouseholdPurchases
CarLoan
DomesticHelp
Donations/Tithe
Dues/Subscriptions
Gifts/Birthday/Christmas
Associations/Clubs
Utilities(PG&E,Cable,Water,Phone)
AutoMaintenance(Gas,Oil,Repairs)
Medical(Premiums&Co-payments)
$Personal
$Allowances
$Hobbies
$Pets
$Vacations
$Entertainment(EatingOut)
$CarInsurance(Annual)
$HouseInsurance(Annual)
$UmbrellaPolicy(Annual)
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
Notes
GeneralLivingExpenses: Monthly
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PropertyTax(Annual)
JacobJ.Reid|[email protected]:(925)449-7830CAInsuranceLicense#0H05483
FinancialInformationPleaseprovidecopiesofthedocumentslistedbelow(toensureaccuracyofplanresults)
FederalandStateIncomeTaxReturns(mostrecent)
CurrentPayStub
PersonalFinancialStatement(Ifavailable)
MostRecentBankandBrokerageAccountStatements
RetirementPlanStatement(401(k),403(b),etc.)
RetirementPlan– ListofInvestmentOptions
SocialSecurityStatements
TrustDocuments(asGrantororBeneficiary)
Will(s)
PensionFundInformation
LifeandLongTermCareInsurancePolicies
CashValueLifeInsuranceCurrentStatementofValues
DisabilityInsurancePolicies&CurrentStatement
GroupandIndividualAccident&HealthInsurancePolicies
Pro/PostNuptialAgreements
Other
Notes
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JacobJ.Reid|[email protected]:(925)449-7830CAInsuranceLicense#0H05483