| Name | ||||||
| Date of Birth | ||||||
| Desired Retirement Age | ||||||
| Spouse Name | ||||||
| Date of Birth | ||||||
| Desired Retirement Age | ||||||
| Number of Children | ||||||
| Ages | ||||||
| Wages/Salary | ||
| Social Security | ||
| Pension | ||
| Investment Income | ||
| Rental Income | ||
| Other Income | ||
| Total Income | ||
| Desired Retirement Income |
Investment Accounts - Non-Qualified Accounts, Qualified Accounts, Savings Account
List Account type IRA, Roth, 401K, 403b, 457, Savings, etc..
| Yes No | |||||
| Yes No | |||||
| Yes No | |||||
| Yes No | |||||
| Yes No | |||||
| Yes No | |||||
| Yes No | |||||
| Yes No |
Real Estate
Personal Residence Information:
| Mortgage Payment (P&I only) |
|||||
| Outstanding Mortgage | Term Remaining | Years Interest Rate | |||
Type of Mortgage (Check Type & Fill in Applicable Length) |
|||||
| Fixed Term | Number of Years | ARM | Number of Years | Interest Only | Number of Years |
Other Property Owned:
| Outstanding Mortgage: | Term Remaining | Years Interest Rate | |||
| Type of Mortgage (Check Type & Fill in Applicable Length) | |||||
| Fixed Term | Number of Years | ARM | Number of Years | Interest Only | Number of Years |
Insurance
Husband Life Insurance:
| General Health | |||||
| Smoker | Yes | No | |||
| Permanent or Term | |||||
| Premium | Death Benefit | Cash Value | |||
Spouse Life Insurance:
| General Health | |||||
| Smoker | Yes | No | |||
| Permanent or Term | |||||
| Premium | Death Benefit | Cash Value | |||
Debt Related
Please list any outstanding debts other than mortgages:
Current Concerns
| Estate Planning | Controlling Spending | Wills/Trust |
| Eliminate Debt | Asset Protection | Reducing Taxes |
| Providing for childrens or grandchildrens education | Maximizing savings | Creating your own Family Bank |