Personal Wealth Report

PRELIMINARY INFORMATION – WEALTH REPORT

Please complete the following questionnaire to your best ability. This will help us provide the most accurate and comprehensive wealth report for you and your family.

I. CLIENT DETAILS

Name:

Date of Birth:

Spouse:

Date of Birth:

Phone:

Email: *

II. INCOME (COMPLETE AS APPLICABLE)

Salary (Gross) :

Self-Employed (Net):

Pension:

Investment Income:

RMD’s:

Rental Income:

Other Income:

How many years do you want to work:

How much money do you need to live on each month?

* Please provide current Social Security Benefit Statement (if not yet taking Social Security).

III. MORTGAGE (COMPLETE AS APPLICABLE)

Current Balance:

Interest Rate:

Home Value:

Monthly Payment: *

* Not including taxes or insurance.

IV. ASSETS (COMPLETE AS APPLICABLE)

Cash:

IRA’s: *

401(k):

Company match? If so, how much?

Life Insurance: *

Annuities: *

* Please provide a current statement.

The Following sections below are optional, but the more information you can provide the better!

V. FUTURE EXPENSES IN THE NEXT 1-5 YEARS (NEW CAR, WEDDING, HOME, REMODELING, ETC.)

Individual:

Description Event

Description Event:

Anticipated Cost/Value

Expected Event Age

VI. ADDITIONAL COMMENTS

What are the most important financial goals that you would like to accomplish? Please prioritize.

1.)

2.)

3.)

4.)

If you were going to change anything in your financial situation, what would it be?

financial situation:

If we were meeting here three years from today, what has to have happened for you to feel happy with your progress?

feel happy:

We have been able to grow substantially through the power of referrals. If we fulfill your expectations, what method of
communication may we talk to you about obtaining referrals that is most comfortable for you?

comfortable for you:

Will there be any other advisors involved in the decision making process?

making process: