Preliminary Personal
Financial
Planning Profile


The following information is strictly
confidential and will not be disclosed
to anyone without your consent.
Personal Information
 (*=required field)
First Name: * 
Last Name: *
Birth Date: *
Spouse's Name:
Birth Date:
Address: *

City:

 *
State: *
  Zip Code: *
Home Phone: *
Work Phone:
Email Address: *
Please check one:   Married

Single
Divorced
Other
Your Occupation:
Spouse's Occupation:
Number of Children:
Children's Ages:
Number of other  Dependents
Living with You: 
Ages:
Is anyone disabled?:   Yes  No
If yes, please explain:
Asset Information
Please estimate the value of the following: <$25k $25k-
$50k		 $50k-
$100k		 $100k-
$150k		 $150k-
$200k		 $200k-
$250k		 $250k-
$300k		 $300k-
$350k		 $350k-
$400k		 $450k-
$500k		 >$500k
Your home
Other Real Estate
Checking, Savings/CD's,
Money Market funds
Stocks & Bonds and
 Mutual Funds
Retirement Accounts
(IRA's, 401(k)'s, SEP's, Keoghs)
Company Savings &
Profit Sharing Plans
Other Assets

Liability Information

Please estimate the balances of the following:

 <$25k $25k-
$50k		 $50k-
$100k		 $100k-
$150k		 $150k-
$200k		 $200k-
$250k		 $250k-
$500k		 >$500k
Installment Loans, Credit Card Balances
Mortgage(s) on your home
Mortgage(s) on other Real Estate
Other Liabilities
Income & Expenditure Information
Please estimate the balances of the following: <$25k $25k-
$50k		 $50k-
$100k		 $100k-
$250k		 $150k-
$200k		 $200k-
$250k		 $250k-
$300k		 $300k-
$350k		 $350k-
$400k		 $450k-
$500k		 >$500k
Annual Household Income
Annual Living Expenditures
Annual Savings
Is Income fairly uniform & predictable?

  Yes  No

Income Tax Information

  • Are all federal, state, & local taxes up-to-date and filed on time?

   Yes  No

  • Are any of your income tax filings on extension?

   Yes  No

  • Do you and your spouse 
    (if appl.) each have a will?

   Yes  No
  • Do your will(s) have trust arrangements?
   Yes  No
  • Do you and your spouse
    (if appl.) have a living trust?
   Yes  No
  • Do you and your spouse 
    (if appl.) have health proxies?
   Yes  No
  • Do you and your spouse 
    (if appl.) have a durable power?
   Yes  No
Insurance Information
Which policies do you have? (check all that apply)
Life Insurance  
Disability Insurance  
Homeowners  
How many automobiles
 do you own?		  
Total death benefit
of life insurance

  You:
 

  Spouse:
 

Your Financial Planning Goals
and Investment Objectives
How important are the following Financial Planning Objectives?  Please rank in the order of importance.
(1= most important, 4=least)		 1 2 3 4        

  • Retire comfortably

        

  • Provide for children's education

       
  • Save on income taxes
        
  • Provide for survivors in the event of my death
        
  • Structure my estate to minimize estate taxes
        
Other (please explain)

If retirement is one of your goals, at what age would you like to retire?

Your spouse (if applicable)?
How important are the following Investment Objectives?  Please rank in the order of importance.
(1= most important, 4=least)		 1 2 3 4        

  • Increase current income

       
  • Spread risk among investments (i.e., diversify)

       
  • Have cash available for emergency or investment opportunities

       
  • Accumulate funds that will keep pace with or do better than inflation
        
  • Use borrowed funds to increase returns (i.e., leverage)
        
  • Minimize the time that I have to spend managing my investments
        

What is your Attitude Towards Risk?
Check the one that best
describes your attitude:
  • Strongly dislike risk, prefer very safe investments (i.e., insured savings, government securities, etc.)
  • Prefer little risk. I want to know how much my investment will pay (i.e., high-rated bonds)
  • Willing to assume some risk (i.e., stocks, mutual funds, etc.)
  • Prefer greater risk (i.e., speculative stocks and other investments where the return is uncertain, but may be substantial)

Miscellaneous Information

Have you ever been unhappy with the recommendations of a stockbroker, insurance agent and/or any other financial advisor or consultant?

  Yes  No

If yes, please explain:

Do you expect any inheritances, legal settlements or gifts that may affect your financial plan?

   Yes  No

If yes, please explain:

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