1. Instructions

    1. Instructions

  2. Personal Information

    1. *Please provide your full name.

    2. Please provide your date of birth

    3. Please indicate your gender.

    4. What is your marital status?

    5. Please provide your primary contact phone number.

    6. *Please provide your primary contact email address.

    7. Please provide your full address and postal/zip code.

  3. Employment Details

    1. *What is your place of employment?

    2. *What is your current job title?

    3. *Please provide the address of your place of employment.

    4. *How many years have you been at the company?

  4. Spouse/Partner's Details

    1. Spouse/Partner's Details

    2. Please provide your spouse's full name.

    3. Please provide their date of birth.

    4. Please provide their current address.

    5. Please provide the name of your spouse's employer.

    6. What is their current job title?

    7. How many years have they been at the company?

  5. Aims

    1. *Please indicate your areas of financial concern.

    2. If there are any others, please let us know here.

    3. *Please describe your idea of financial security.

    4. *Do you have any large/major planned financial commitments or expenditures within the next two years?

    5. *Do you have any large/major planned financial commitments or expenditures further along the line?

    6. *Do you feel comfortable/confident when it comes to managing your finances?

    7. *How happy are you with your previous investments and how they performed?

    8. If there are any things you feel may impact your financial planning, please indicate them here.

  6. Income

    1. *Please provide your gross annual income.

    2. *At what frequency are you paid?

    3. *Is there a possibility of a career change in the near future?

    4. *Is there a possibility of major changes in income within the near future?

  7. Retirement

    1. *How much income do you expect to require in retirement?

    2. *What amount do you contribute each year to your retirement plan?

    3. *What amount does your employer put towards your retirement plan each year?

    4. *Once having retired, how much monthly income are you expecting to be given by Social Security?

    5. *Once having retired, how much monthly income are you expecting to be given by Employer Pension?

    6. *Are you a participant in an employer stock option plan (non-qualified or incentive)?

    7. *Are you a participant in an employer stock grant plan (restricted stock)?

    8. *Are you a participant in an employee stock purchase plan (ESPP)?

  8. Insurance

    1. Do you have life insurance?

    2. *Do you have short term disability insurance?

    3. *Do you have long term disability insurance?

    4. *Do you have long term care insurance?

    5. Do you have medical insurance?

    6. *Do you have homeowner or renter insurance?

    7. Do you have umbrella liability insurance?

    8. *Do you have ID Theft Protection coverage?

    9. *Do you have auto insurance?

  9. Estate

    1. *Have you previously been married?

    2. *Do you have a Will?

    3. *Do you have a Durable Power of Attorney?

    4. *Do you have a Health Care Proxy?

    5. *Do you have a Trust?

    6. *Did you file a Homestead Declaration when you purchased your home?

    7. *Are you the beneficiary of any Trust?

  10. Money

    1. Aasets

    2. *Checking and Savings

    3. *Money Market funds

    4. *CDs

    5. *Savings Bonds

    6. *Other

  11. Taxable Investments

    1. *Stocks, Bonds, Mutual Funds

    2. *Investment Real Estate

    3. *Other Taxable Accounts or Assets

  12. Retirement Investments

    1. *IRA: Traditional or Rollover

    2. *IRA: Roth, SEP or SIMPLE

    3. *Employer Plans: 401K, 403B, 457

    4. *Other Retirement Plans

    5. *Pension

  13. Education Investments

    1. *529 / Tuition Savings Plans

    2. *UTMA / UGMA Custodial Accounts

  14. Property and Belongings

    1. *Primary Residence

    2. *Vacation Property

    3. *Vehicles / Boats

    4. *Jewellery / Art / Antiques

    5. *Household and Other property

  15. Debts/Liabilites

    1. *Primary Residence Mortgage

    2. *2nd Mortgage, Equity Loan or Line of Credit (HELOC)

    3. *Education Loans

    4. *Auto Loans

    5. *Credit Card Balances

    6. *401K or Retirement Plan Loans

    7. *Any other loans or debts

Financial Planning Questionnaire


Financial Planning Questionnaire

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Getting started


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*Please provide your full name.

Please provide your date of birth

Please indicate your gender.

What is your marital status?

Please provide your primary contact phone number.

Please provide your full address and postal/zip code.

*What is your place of employment?

*What is your current job title?

*Please provide the address of your place of employment.

*How many years have you been at the company?

Spouse/Partner's Details

 If your spouse/partner is currently retired or not working, you can leave this section blank.  

Please provide your spouse's full name.

Please provide their date of birth.

Please provide their current address.

This is only necessary if different to your address.  

Please provide the name of your spouse's employer.

What is their current job title?

How many years have they been at the company?

Please ensure that your answer meets the following requirements:

*Please indicate your areas of financial concern.

Please check all that apply.

  • Cash Flow and Budgeting

  • Investment Review

  • College Planning

  • Tax Planning

  • Retirement Planning

  • Estate Planning

  • Insurance Review

  • Home Purchase

If there are any others, please let us know here.

 If not, feel free to leave this blank. 

*Please describe your idea of financial security.

 For example, in 5 years time, what would indicate to you that you're financially secure?  

*Do you have any large/major planned financial commitments or expenditures within the next two years?

 Please indicate them here.  

*Do you have any large/major planned financial commitments or expenditures further along the line?

 Please indicate them here.  

*Do you feel comfortable/confident when it comes to managing your finances?

*How happy are you with your previous investments and how they performed?

If there are any things you feel may impact your financial planning, please indicate them here.

 E.g: Family circumstances, health conditions, etc.  

*Please provide your gross annual income.

Please ensure that your answer meets the following requirements:

*At what frequency are you paid?

*Is there a possibility of a career change in the near future?

*Is there a possibility of major changes in income within the near future?

*How much income do you expect to require in retirement?

*What amount do you contribute each year to your retirement plan?

*What amount does your employer put towards your retirement plan each year?

*Once having retired, how much monthly income are you expecting to be given by Social Security?

*Once having retired, how much monthly income are you expecting to be given by Employer Pension?

*Are you a participant in an employer stock option plan (non-qualified or incentive)?

*Are you a participant in an employer stock grant plan (restricted stock)?

*Are you a participant in an employee stock purchase plan (ESPP)?

Do you have life insurance?

 If this is the case, please disclose the coverage amount.  

*Do you have short term disability insurance?

*Do you have long term disability insurance?

*Do you have long term care insurance?

Do you have medical insurance?

 If this is the case, please disclose the coverage amount.   

*Do you have homeowner or renter insurance?

Do you have umbrella liability insurance?

 If this is the case, please disclose the coverage amount.   

*Do you have ID Theft Protection coverage?

*Do you have auto insurance?

*Have you previously been married?

*Do you have a Will?

*Do you have a Durable Power of Attorney?

*Do you have a Health Care Proxy?

*Do you have a Trust?

*Did you file a Homestead Declaration when you purchased your home?

*Are you the beneficiary of any Trust?

Aasets

Below, please provide an approximate monetary value that best represents the amount of capital you have invested/currently possess within each of the following.  

*Checking and Savings

*Money Market funds

*CDs

Must be a valid number


*Savings Bonds

Must be a valid number


*Other

Must be a valid number


*Stocks, Bonds, Mutual Funds

Must be a valid number


*Investment Real Estate

Must be a valid number


*Other Taxable Accounts or Assets

Must be a valid number

*IRA: Traditional or Rollover

Must be a valid number


*IRA: Roth, SEP or SIMPLE

Must be a valid number


*Employer Plans: 401K, 403B, 457

Must be a valid number

*Other Retirement Plans

Must be a valid number


*Pension

Must be a valid number


*529 / Tuition Savings Plans

Must be a valid number


*UTMA / UGMA Custodial Accounts

Must be a valid number

*Primary Residence

Must be a valid number


*Vacation Property

Must be a valid number


*Vehicles / Boats

Must be a valid number


*Jewellery / Art / Antiques

Must be a valid number


*Household and Other property

Must be a valid number


*Primary Residence Mortgage

Must be a valid number

*2nd Mortgage, Equity Loan or Line of Credit (HELOC)

Must be a valid number


*Education Loans


Must be a valid number

*Auto Loans

Must be a valid number


*Credit Card Balances

Must be a valid number


*401K or Retirement Plan Loans

Must be a valid number


*Any other loans or debts

Must be a valid number