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Retirement Planning

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Prospect’s Name

Birth Date ×

Employer

Home Address

Cell

Fax #

Spouses’ Name

Birth Date ×

Employer

Phone - Home

Phone - Work

Email Address

Childrens

Children

Age

State of Residence

Current savings/investments you currently own and approximate value? Ie Stocks, Bonds, Mutual finds, CD’s Money Markets, Annuities, Real Estate, Whole Life Cash Values, 40lk/other Retirement Plans, Limited Partnerships, Checking/Savings, etc.

Income: Mr. $

Net Worth: $

Home Value $

Total Debt not including home mortgage debt: $

Tax Bracket-Federal

Income: Mrs. $

Liquid Assets-Negotiable Securities and Bank $

Home Debt $

Gross expenses per month $

Five Pillars of Income

Wages

Pensions

Investable Assets

RMDs

Social Security PIA- Husband $

Social Security PIA- Wife $

What are the two most important financial objective goals that you would like me to help you with? (Concerning this Money/401k,IRA, CD etc.)

1. Compared to others, how do you rate your willingness to take financial/investment risks?*

Extremely low risk taker

Low risk taker.

Average risk taker.

High risk taker.

Extremely high risk taker.

2. When faced with a major financial/investment decisions, are you more concerned about the possible losses or the possible gains?*

Always the possible losses

Usually the possible losses

Usually the possible gains

Always the possible gains

3. How do you usually feel about your major financial/investment decisions after you make them?*

Very pessimistic

Somewhat pessimistic

Somewhat optimistic

Very optimistic

4. What degree of risk have you taken with your financial/investment decisions in the past?*

Very small

Small

Medium

Large

Very Large

5. What degree of risk are you currently prepared to take with your financial/investment decisions?*

Very small

Small

Medium

Large

Very Large

6. How much confidence do you have in your ability to make good investment decisions without the help of a professional?*

None

A little

A reasonable amount

A great deal

7. Investments will go up and down in value, you should be prepared to weather a downturn from time to time. How much could the total value of these investments go down before you would begin to feel very uncomfortable?*

Any fall in value would make me feel uncomfortable

10%

20%

33%

50%

More than 50%

8. What average annual rate of return (yearly) would you realistically be happy with, to earn on this proposed investment portfolio over the next ten years?*

9. How long do you anticipate that you will let this/these investments work and compound for you before you will need to start withdrawing an income?*

Not for at least 20 years

In 10 to 20 years

In 5 to 10 years

Not now, but within 5 years

Immediately

If income in needed what is the dollar amount that you need monthly/Quarterly/Yearly?

10. How long do you anticipate that you will let this/these investments work and compound for you before you anticipate that you would need to liquidate a portion, or all of, the investment?*

Not for at least 20 years

In 10 to 20 years

In 5 to 10 years

Not now, but within 5 years

Only RMDs if qualified money

Immediately

Intention is to leave money as a financial legacy to my heirs

11. Do you feel like you are paying too much in income taxes each year? Do you feel that you maximized all of the ways to lower your income tax bill?*

Very much so

I guess so

Not really

12. Would you consider investing a smaller portion, 5-10%, of your investment portfolio into an investment that has a higher degree of risk/volatility, but also has the potential for an increased long term return?*

Most likely not

I would consider it

Yes

13. Concerning your investment monies, how important is an absolute guarantee of principal on a portion of this money?*

Not important at all

Somewhat important

Very important

14. On what portion/percentage of this money would an absolute guarantee of principal be important to you?

15. If you could own a financial product with the guarantee that there would be no loss of principal when the stock market goes down, but still have some upside growth potential when the stock market index, like the S&P 500 goes up, would you consider a financial product like this? *

Yes

16. How would you describe your current health condition? Hour family health history? How long do you think you will live?

Husband life expectancy years

Wife’s life expectancy years

17. Have you talked about your options with Social Security claiming?*

Yes

Let’s assume that we did business together and we are in the future three years down the road. Tell me the two most important things that I have done for you, in that time with your financials and money, that tells you that this indeed was the right decision working with me?

18. Do you currently own life insurance?*

Yes

Type

Face Value

Yearly Premium

Spouse:

Yes

Type

Face Value

Yearly Premium

19. Do you currently own Long Term Care Insurance?*

Yes

Carrier

Daily Pay

Length

Cost Annual

Is this important to you?

Spouse*

Yes

Carrier

Daily Pay

Length

Cost Annual

Is this important to you?

20. Do you currently have a will?

Yes

Spouse

Yes

21. Do you currently have any trusts?*

Yes

Spouse*

Yes

22. Do you have specific monies, designated and put aside, for your Children’s College Education?*

Yes

23. Currently who do you work with as your professional

Lawyer

Accountant/CPA

Investment Broker/Planner

Life Insurance

24. Which of the following statements would best describe your attitude about the next three months’ performance of this/these investments?

Who cares? One calendar quarter means nothing

A loss greater than 10% would concern me

I can tolerate only small short-term losses

I cannot tolerate any loss what so ever

25. Do you currently own or are buying your home?*

Yes

26. Through the years how good of an investment do you consider your home/real estate to have been?*

A great investment

A good investment

An average investment

A poor investment

27. How much monies are in your current cash reserves, that are liquid and safe, to use in case of emergencies. ie: savings accounts, CD’s and money markets.*

Less than three month worth of living expenses

Approximately three month worth of living expenses

More than six months worth of living expenses

28. Do you have any preference or are more comfortable using a certain type of security to construct this investment portfolio, ie single stocks/ bonds or managed investments such as mutual funds or annuities, RIETS to construct your investment portfolio?*

Yes

29. Do you currently own an IRA, 401k any other retirement plan or an annuity?

A. Who did you designate as your beneficiaries?

B. Contingent Beneficiaries?

C. Subsequent Beneficiaries?

30. What do you consider to have been your worst investment made?

30b. What do you consider to have been your best investment made?

31. How important is current monthly or quarterly income from your investments?

Very important

Somewhat important

Not important

32. How important is life-time guaranteed income for you now or down the road?

Very important

Somewhat important

Not important

33. What is happening now or in the near future that could impact your financial outlook?

34. How involved do you like to be in the investment/financial decisions?

35. Who do you rely on currently for the majority of your investment/financial Advice?

36. Is there anyone else, besides you, who needs to be involved in the decision making process if you decide to invest with me?

37. Is there any of these investments that you are married to, or have an emotional tie, that would make it very hard for you to reposition in another investment, even knowing that the proposed investment could be much better for you?

38. If I could do state the let’s assume objective and state the let’s assume objective for you with this money, can you see making a change with your investments and us being able to work together?

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