Painting A Portrait-Discovery Questions/The VIP Discovery ...



Dear Mr. and Mrs. Client,

I look forward to meeting with you to discuss your approaching transition to retirement.

During your earning years, you’ve focused on accumulation and growth of your money. I’m sure your goal has been to accumulate as much as possible by earning it and investing it in preparation for retirement. When nearing or at retirement, your need to preserve what you have accumulated will now typically outweigh your need to grow your money at a target rate.

After retirement, you typically no longer have money earned from your job or business to pay for your living expenses. You need safety and liquidity to ensure available funds for day-to-day costs of living, along with some growth of your savings to help ensure that your funds last as long as you need them.

Creating a retirement distribution plan is an in-depth process that can be complex. Our goal is to work with you to create a retirement income plan focused less on accumulating wealth and more on making it last throughout your retirement. This plan takes into consideration all income streams (i.e., Social Security, wages, pensions, investment income, annuity income, etc.), assets you’ve accumulated over time, inflation risk, investment risk and tax exposure, along with your specific circumstances, goals and needs.

To help us create a realistic retirement income plan designed around your required and desired income needs, it is important that you complete this packet of information and bring the items listed below to our scheduled meeting.

Sincerely yours,

John B. Czajkowski, CFP®, MS

332 Cantle Lane

Encinitas, CA 92024

858-759-3550

CHECKLIST FOR OUR FIRST WORKING MEETING

Please bring the following items to our office for our first working meeting.

( Your most recent pay stub(s) from all employers

( Your most recent Social Security statement

( A copy of your company’s retirement benefits plan

( Bank statements/CDs

( A copy of your defined benefit pension plan

( Your insurance policies (life, health, disability, auto, home, etc.)

( Investment statements (mutual funds, brokerage accounts, annuities, etc.)

Confidential Fact Finder Questionnaire

CONTACT INFORMATION

|Advisor Name |____________________________________________ |Rep # ________________________ | |

|Client Name |____________________________________________ |Date of Birth ___________________ |SSN _________________ |

|Spouse Name |____________________________________________ |Date of Birth ___________________ |SSN _________________ |

|Address |____________________________________________ |Phone _______________________ | |

| |____________________________________________ |Alt Phone _____________________ | |

FINANCIAL: Savings and Investments

|List all Qualified Accounts |Registration |Balance |Owner |Available for |

|(IRA, Roth, 401k, etc.) | | | |plan use? |

|__________________________ |__________ |____________________ |____________________ |( Yes ( No |

|__________________________ |__________ |____________________ |____________________ |( Yes ( No |

|__________________________ |__________ |____________________ |____________________ |( Yes ( No |

|__________________________ |__________ |____________________ |____________________ |( Yes ( No |

|__________________________ |__________ |____________________ |____________________ |( Yes ( No |

|List all Non-Qualified Accounts |Registration |Balance |Owner |Available for |

|(CD’s, investments, savings, etc.) | | | |plan use? |

|__________________________ |__________ |____________________ |____________________ |( Yes ( No |

|__________________________ |__________ |____________________ |____________________ |( Yes ( No |

|__________________________ |__________ |____________________ |____________________ |( Yes ( No |

|__________________________ |__________ |____________________ |____________________ |( Yes ( No |

|__________________________ |__________ |____________________ |____________________ |( Yes ( No |

Are you contributing to any accounts regularly? ( Yes ( No If yes, how much $ _____________ per month?

Are there any matching contributions to these accounts? ( Yes ( No If yes, how much $ _____________ per month?

Do you own any life insurance or annuities policies? ( Yes ( No If yes, please describe _________________________________

Do you expect to receive any inheritances, stock options, selling a business or other additional assets? _________________________________

FINANCIAL – Direct Income Sources

|Source |Client/ |Monthly Amount |Annual Change |Begin at Age |End |Guaranteed Income |

|(Pension, SS, Rental Income) |Spouse | | | |at Age | |

| | | | | |(or lifetime) | |

|_____________________________ |( C ( S |$___________ |______% |______ |______ |( Yes ( No |

|_____________________________ |( C ( S |$___________ |_______% |______ |______ |( Yes ( No |

|_____________________________ |( C ( S |$___________ |_______% |______ |______ |( Yes ( No |

|_____________________________ |( C ( S |$___________ |_______% |______ |______ |( Yes ( No |

|_____________________________ |( C ( S |$___________ |_______% |______ |______ |( Yes ( No |

FINANCIAL: Goals

Please complete one or both of the following:

|Amount of desired income per month (before taxes) |$_______________________ |

|Amount of lump sum to determine maximum monthly amount |$_______________________ |

|Is client retired? |( Yes ( No |If no, expected date of retirement? |_______________ |

|Is spouse retired? |( Yes ( No ( NA |If no, expected date of retirement? |_______________ |

|Does client anticipate working part-time in |( Yes ( No |$__________/month |Ideal length of time _____________ |

|retirement to maintain current lifestyle? | | | |

|Does spouse anticipate working part-time in |( Yes ( No ( NA |$__________/month |Ideal length of time _____________ |

|retirement to maintain current lifestyle? | | | |

|Are there any additional income needs or financial goals client is planning for during retirement that has not | |

|already been listed? (From page 5) |( Yes ( No |

|(List below) |Monthly Budget |Plan for Lump Sum |

|____________________________________________________ |$_______________ |$_______________ |

|____________________________________________________ |$_______________ |$_______________ |

|____________________________________________________ |$_______________ |$_______________ |

|Please describe in detail any legacy goals: (leave money to heirs, charity, none, etc.) |

|________________________________________________________________________________________________________________ |

|________________________________________________________________________________________________________________ |

| | |

|Children/Heir’s names: |Relationship |

|____________________________________________________ |________________________ |

|____________________________________________________ |________________________ |

|____________________________________________________ |________________________ |

FINANCIAL – Tax Information

|Client’s Filing Status |( Single |( Head of Household |( Married Filing Jointly |( Married Filing Separately |

|Does client itemize deductions? |( Yes ( No |

|If yes, estimated deduction amount? |$_____________________ |

|Current tax bracket: |______________________ |

getting ready for retirement

The first step in getting ready for retirement is to understand your current income sources and commitments. This is generally a close indicator or starting point in determining the income you may need during retirement. Please complete the “Simplified Income Replacement Estimator” below. If you feel that your income needs will be significantly different in retirement than they are today, please complete the “Expanded Income Replacement Estimator” found in Appendix A of this packet. The “Expanded Income Replacement Estimator” can help you more precisely estimate your retirement income needs. Please note that you do NOT need to complete both tools.

SIMPLIFIED INCOME REPLACEMENT ESTIMATOR

|Your Current Monthly Income Minus Taxes |

|Individual/Combined take-home pay (after tax) |$ |

|Bonuses (after tax) – Divided by 12 if paid annually |$ |

|Other regular income (after tax) |$ |

|Additional Taxes (Fed/State/Local refund or pay in) divided by 12 |(+) or (-) $ |

|Monthly Take Home Pay |$ |

The second step is to understand any additional income needs or financial goals that you have for retirement. Please complete the following questions and list any additional spending you anticipate.

Do you want to work part-time in retirement to maintain your current lifestyle? ( yes ( no

Are there additions beyond what you are spending now that we should plan for? ( yes ( no

(If “yes” please list them below.)

additional Priorities for your Retirement (+) or (-) Monthly BudgeT Plan for Lump-Sum

( _________________________________________________ $ _________________ $ _________________

Priority: High – Medium – Low

( _________________________________________________ $ _________________ $ _________________

Priority: High – Medium – Low

( _________________________________________________ $ _________________ $ _________________

Priority: High – Medium – Low

( _________________________________________________ $ _________________ $ _________________

Priority: High – Medium – Low

( _________________________________________________ $ _________________ $ _________________

Priority: High – Medium – Low

( _________________________________________________ $ _________________ $ _________________

Priority: High – Medium – Low

( _________________________________________________ $ _________________ $ _________________

Priority: High – Medium – Low

( _________________________________________________ $ _________________ $ _________________

Priority: High – Medium – Low

( _________________________________________________ $ _________________ $ _________________

Priority: High – Medium – Low

Your desire for a reliable income

As you move to the next phase of your life, focus tends to shift from the rate of return on investments to how those investments will produce income for you in the coming years. The following questionnaire is designed to measure four key factors regarding your desire for a reliable income – the value you place on a guaranteed income stream (your Guarantee Factor†), your sensitivity to volatility within your retirement portfolio (your Volatility Factor), your need to set aside money for future needs (your Cash Needs Factor) and your desire to leave a legacy for your heirs and or charity (your Legacy Factor).

† Guaranteed income strategies employ investments in annuities, which are long-term investments, designed for retirement purposes.

Guarantees are based on the claims paying ability of the issuer subject to their terms and conditions.

Take a few moments to complete this questionnaire, and then calculate your scores on the results pages that immediately follow. Your scores on each factor can be used to help develop strategies for your customized retirement income plan

Please answer this 34-question questionnaire

(1) The amount of investable assets we plan to commit to produce retirement income is:

A. ( more than 75% of our investable assets.

B. ( 50% to 75% of our investable assets.

C. ( 25% to 50% of our investable assets.

D. ( less than 25% of our investable assets.

(2) An individual's total desired retirement income is made up of basic necessities (food, housing, healthcare, utilities, etc.) and discretionary wants (travel, leisure, entertainment, etc.) When examining our total desired retirement income, the percentage of the total made up of basic necessities is:

A. ( 80% or more of our total living needs.

B. ( 60% to 80% of our total living needs.

C. ( 40% to 60% of our total living needs.

D. ( Less than 40% of our total living needs.

(3) Over the course of our retirement we expect our monthly income needs to:

A. ( Decrease significantly.

B. ( Stay the same.

C. ( Increase at the rate of inflation.

D. ( Increase significantly.

(4) The income we will receive from guaranteed sources (i.e. pensions, social security, etc.) equal:

A. ( Less than 25% of our desired income.

B. ( 25% to 50% of our desired income.

C. ( 50% to 75% of our desired income.

D. ( More than 75% of our desired income.

(5) Guaranteeing a lifetime income stream is more important than inflation-adjusting a lifetime

income stream:

A. ( Strongly agree

B. ( Somewhat agree

C. ( Disagree

D. ( Strongly disagree

Questionnaire continued

6) Leaving a significant portion of this investment to your heirs (non-spouse) is important:

A. ( Strongly disagree

B. ( Disagree

C. ( Somewhat agree

D. ( Strongly agree

(7) Health permitting, how do you feel about work during retirement?

A. ( I would only return to work if it were an economic necessity.

B. ( I might enjoy part-time work the first few years of my retirement.

C. ( I might enjoy part-time work throughout my retirement.

D. ( I plan on working significant amounts of time throughout my retirement.

(8) I am worried that I will outlive my income stream:

A. ( Strongly agree

B. ( Agree

C. ( Disagree

D. ( Strongly disagree

(9) If the balance of the assets we used to generate retirement income dropped to 75% of their original value because of market performance, I would still feel comfortable with my income plan if:

A. ( 75% of the initial income stream was guaranteed.

B. ( 50% of the initial income stream was guaranteed.

C. ( 25% of the initial income stream was guaranteed.

D. ( I would be comfortable without any guarantee and view this decline as being in the range

of normal market activity.

(10) How experienced are you in managing investments?

A. ( Not experienced

B. ( Less experienced

C. ( Somewhat experienced

D. ( Very experienced

(11) In my retirement accounts, I am more concerned with maintaining principal than I am with achieving additional growth over and above my annual income need:

A. ( Strongly agree

B. ( Somewhat Agree

C. ( Disagree

D. ( Strongly disagree

Questionnaire continued

(12) If you needed $10,000 due to an unexpected financial obligation, would you need to liquidate a portion of this account?

A. ( Yes. This is my only source of liquid assets.

B. ( Maybe. I do have other sources of liquid assets, but this is my primary source.

C. ( Probably Not. I have several other sources of liquid assets that I would likely utilize.

D. ( No. I have several other sources of liquid assets that I would use first.

(13) Which statement best describes your attitude toward price fluctuations in your investments?

A. ( I am willing to forgo the potential of large returns for the stability of knowing my portfolio

is protected against large decreases in value.

B. ( I don’t want my portfolio to fluctuate as much as the general financial markets, but I can

withstand some up and down variances in my portfolio over time.

C. ( I am willing to accept a modest amount of price fluctuation to attempt to achieve a return

modestly higher than that available without risk of price fluctuations.

D. ( I am willing to accept a high level of volatility for the potential to realize maximum returns.

(14) A reasonable time to commit to an equity mutual fund investment is:

A. ( 1 to 3 years

B. ( 3 to 5 years

C. ( 5 to 10 years

D. ( More than 10 years

(15) If I invested 100% of my retirement assets to produce a non-guaranteed income stream, I would abandon the plan if the value of my account declined:

A. ( 10%

B. ( 20%

C. ( More than 20%

D. ( I would not abandon the plan.

(16) I expect future market returns to be less than historic long term averages

A. ( Strongly agree

B. ( Somewhat Agree

C. ( Disagree

D. ( Strongly disagree

(17) I believe my retirement income will need to last beyond twenty-five years:

A. ( Strongly agree

B. ( Somewhat Agree

C. ( Disagree

D. ( Strongly disagree

Questionnaire continued

(18) At my expected retirement date, I plan to be free of credit card debt?

A. ( Strongly disagree

B. ( Disagree

C. ( Somewhat agree

D. ( Strongly agree

(19) Over the last five years, I have had the need for $5,000 or more for an unexpected expense:

A. ( Three or More Times

B. ( Twice

C. ( Once

D. ( Never

(20) If my child(ren) or grandchild(ren) needed $5,000 for an unexpected expense, I would help them with the full amount and I would not expect repayment?

A. ( Strongly agree

B. ( Agree

C. ( Disagree

D. ( Strongly disagree

If you answered “Agree” or “Strongly Agree”:

How many times would you be willing to help? _____________________________

(21) In retirement, I would like to purchase a new/used vehicle every 3-5 years?

A. ( Strongly agree

B. ( Agree

C. ( Disagree

D. ( Strongly disagree

If you answered “Agree” or “Strongly Agree”:

Would you purchase new or used? ______________________________________

How much would you likely spend? ______________________________________

Do you currently make car payments that are included in your budget? __________

(22) I would like to travel during retirement and my travel expenses would come out of my normal budget:

A. ( Strongly Disagree, I would like to travel extensively including at least one “dream” trip and the expenses for this would not be part of my normal budget.

B. ( Disagree, I would expect to travel but there would be additional expenses that would not be part of my normal budget.

C. ( Agree, I do expect to travel and the expenses would be covered out of my normal budget.

D. ( I do not plan to travel in retirement.

Questionnaire continued

(23) Select the statement that best describes your level of participation in activities or hobbies during retirement:

A. ( The activities or hobbies I will most likely participate in require a substantial on-going investment

(collectible cars, flying, vacation home).

B. ( The activities or hobbies I will most likely participate in will require a major purchase to begin

enjoying (Boating, RV’ing).

C. ( The activities or hobbies I will most likely participate in will require additional money to enjoy

(golf, country club membership).

D. ( The activities or hobbies I will most likely participate in will require little or no money to enjoy

(walking, reading, gym, interest clubs).

(24) At my expected retirement date I plan to be free of mortgage debt?

A. ( Strongly disagree

B. ( Disagree

C. ( Somewhat agree

D. ( Strongly agree

(25) I plan to own one residence for the duration of our retirement?

A. ( Disagree, I currently own or want to purchase a second residence.

B. ( Agree, but I plan to upsize or make major upgrades to my current residence to maintain market value.

C. ( Agree and my current residence is less than 10 years old with no major upgrades planned.

D. ( Agree and I plan to downsize my current residence.

(26) I plan to provide some funds to support the educational need of our child(ren) or grandchild(ren)?

A. ( Strongly agree, I plan to provide educational support and would like to have assets designated

specifically for this purpose.

B. ( Agree, I plan on providing educational support and I plan to do so on a “pay as they go” arrangement.

C. ( Agree, I would like to provide support, but only if my retirement income would not be reduced in order

to provide that support.

D. ( Disagree, I do not plan on providing any education support.

(27) What percentage of your current estate in today’s dollars do you want to leave to your family?

A. ( 100%+

B. ( 50 to 100%

C. ( 26 to 50%

D. ( 0 to 25%

(28) What percentage of your current estate in today’s dollars do you want to leave to charity?

A. ( 100%+

B. ( 50 to 100%

C. ( 26 to 50%

D. ( 0 to 25%

Questionnaire continued

(29) I would be willing to reduce my income in retirement in order to provide for my heirs?

A. ( I would be willing to reduce my income by more than 20% to provide for my heirs.

B. ( I would be willing to reduce my income by up to 20% to provide for my heirs.

C. ( I would be willing to reduce my income by 10% to provide for my heirs.

D. ( Not at all.

(30) I would be willing to reduce my income in retirement in order to leave money to charity?

A. ( I would be willing to reduce my income by more than 20% to leave money to charity.

B. ( I would be willing to reduce my income by up to 20% to leave money to charity.

C. ( I would be willing to reduce my income by 10% or less to leave some money to charity.

D. ( Not at all.

(31) I/we will continue paying premiums on permanent insurance policies.

A. ( Yes, we have permanent insurance equal to 10+ times our retirement income needs.

B. ( Yes, we have permanent insurance equal to 5-10 times our retirement income needs.

C. ( Yes, we have permanent insurance equal to 0-5 times our retirement income needs.

D. ( No, we do not have any permanent insurance coverage.

(32) I/we are comfortable that our estate planning documents are in order and our assets would pass to our desired recipients.

A. ( Strongly Agree

B. ( Agree

C. ( Disagree

D. ( Strongly disagree

(33) I/we plan to obtain a Medicare Supplement Policy.

A. ( Yes, I have coverage in place.

B. ( No, I have considered but don’t want to purchase coverage at this time.

C. ( No, but I would consider purchasing if I had more information.

D. ( Not immediately, but I do plan to purchase in the next 2-3 years or when we turn 65.

(34) I/we plan to obtain a Long-Term Care Policy.

A. ( Yes, I have coverage in place.

B. ( No, I have considered but don’t want to purchase coverage at this time.

C. ( No, but I would consider purchasing if I had more information.

D. ( Not immediately, but I do plan to purchase in the next 2-3 years.

your Reliability of income QUESTIONNAIRE results

Tally your score by counting the number of answers marked for choices A, B, C and D. Multiply the number of responses times their score factor in the table below and total each column. Then, take those totals to the following page and place an “X” on each corresponding scale for each factor to show where your score lies.

|Questions 1 through 9 |Questions 9 through 17 |

|Guarantee Factor |Volatility Factor |

| | |

|____ # of A responses x 11 = _______ |____ # of A responses x 11 = _______ |

| | |

|____ # of B responses x 7 = _______ |____ # of B responses x 7 = _______ |

| | |

|____ # of C responses x 3 = _______ |____ # of C responses x 3 = _______ |

| | |

|____ # of D responses x 0 = _______ |____ # of D responses x 0 = _______ |

| | |

|Total Score: _______ |Total Score: _______ |

|Questions 18 through 26 |Questions 26 through 34 |

|Cash Needs Factor |Legacy Factor |

| | |

|____ # of A responses x 11 = _______ |____ # of A responses x 11 = _______ |

| | |

|____ # of B responses x 7 = _______ |____ # of B responses x 7 = _______ |

| | |

|____ # of C responses x 3 = _______ |____ # of C responses x 3 = _______ |

| | |

|____ # of D responses x 0 = _______ |____ # of D responses x 0 = _______ |

| | |

|Total Score: _______ |Total Score: _______ |

your Reliability of income QUESTIONNAIRE results (continued)

Place an “X” on the scale below for each factor to show where your score lies on each spectrum.

Guarantee Factor

0 10 20 30 40 50 60 70 80 90 100

0 to 37 The value of a guaranteed income stream is MINIMAL

37 to 62 The value of a guaranteed income stream is MODERATE

62-87 The value of a guaranteed income stream is MODERATELY HIGH

87+ The value of a guaranteed income stream is HIGH

Volatility Factor

0 10 20 30 40 50 60 70 80 90 100

0 to 37 The sensitivity to volatility in the portfolio is MINIMAL

37 to 62 The sensitivity to volatility in the portfolio is MODERATE

62-87 The sensitivity to volatility in the portfolio is MODERATELY HIGH

87+ The sensitivity to volatility in the portfolio is HIGH

cash needs Factor

0 10 20 30 40 50 60 70 80 90 100

0 to 37 The need for a lump sum pool in the portfolio is MINIMAL

37 to 62 The need for a lump sum pool in the portfolio is MODERATE

62-87 The need for a lump sum pool in the portfolio is MODERATELY HIGH

87+ The need for a lump sum pool in the portfolio is HIGH

Legacy Factor

0 10 20 30 40 50 60 70 80 90 100

0 to 37 The need for a legacy pool in the portfolio is MINIMAL

37 to 62 The need for a legacy pool in the portfolio is MODERATE

62-87 The need for a legacy pool in the portfolio is MODERATELY HIGH

87+ The need for a legacy pool in the portfolio is HIGH

Copyright July 2010, Securities America Financial Corporation. All rights reserved.

Important STRATEGY INFORMATION

Investments in model strategies have additional management fees and expose the investor to the risks inherent within the model and the specific risks of the underlying funds directly proportionate to their fund allocation.

All investments involve the risk of potential investment losses. Investment returns, particularly over shorter time periods are highly dependent on trends in the various investment markets. The investor may receive less than the original invested amount and is advised to consider the investment objective and risks before investing.

Asset allocation does not guarantee a profit or protection from losses in a declining market.

There is no guarantee that any or all segments will obtain their desired results. If desired returns are not met in any investment segment this could cause the investor to run out of income before the end of that income segment. To continue drawing income the investor may have to remove funds from other investment segments before scheduled. This action could lead to additional fees and ultimately the failure of the plan to meet the original objectives. Investors may have to adjust their income amounts to compensate for any investment segment not meeting its goal in order for the actual cash value to last the duration of that income segment.

*Guaranteed monthly income is based on current values as well as the terms and conditions of the annuity contract or optional rider. These advantages may have additional fees and can only be fully realized if you follow the benefit’s rules and hold the annuity through surrender period. Guarantees and principal are based on the claims paying ability of the issuing company.

Annuities are long term investments designed for retirement purposes. Withdrawals of taxable amounts are subject to income tax, and, if taken prior to age 59½, a 10% federal tax penalty may apply. Early withdrawals may be subject to withdrawal charges. The purchase of a variable annuity is not required for, and is not a term of, the provision of any financial service or activity.

Single Premium Immediate Annuity contracts cannot be surrendered once annuitized.

Purchase of an annuity contract through a qualified plan does not provide any additional tax-deferral benefits beyond those already provided through the plan. If you are purchasing an annuity contract through a plan, you should consider purchasing it for its death benefit, annuity options, and other non-tax-related benefits.

Investments in real estate or REITs may not be suitable for all investors and is subject to significant risks. These risks may include limited operating history, reliance on the investment advisor, potential conflicts of interest, payment of substantial fees to the investment advisor and its affiliates, potential illiquidity and liquidation at less than the original amount invested.

Mutual Funds and Variable Annuities are investments involving risk and are offered by prospectus only. Before investing, investors should carefully consider the investment objectives, risks, charges and expenses of the investment and its underlying investment options. The prospectus contains this and other important information. Please contact your representative or the investment company to obtain the prospectus. Please read each prospectus carefully before investing or sending money.

Investments in mutual funds are not insured or guaranteed by the Federal Deposit Insurance Corporation (FDIC) or any other government agency. Although money market funds seek to preserve their value at $1.00 per share, it is possible to lose money by investing in money market funds.

Investments in fixed income products are subject to market risk, interest rate risk, credit risk and special tax liabilities.

Purchasing CDs involves a number of risks. It is suggested that prospective depositors reach a purchase decision only after careful consideration with their financial, legal, accounting, tax and other advisors regarding the suitability of the CDs in light of their particular circumstances.

You must evaluate whether a bond ladder and the securities held within it are consistent with your investment objectives, risk tolerance, and financial circumstances. If you decide to include callable bonds in your ladder, these bonds may be called prior to maturity. If a bond is called, your interest payments cease and the principal is returned as of the call date. If you seek to reinvest the principal in a similar bond issue, you will likely have to accept a lower yield (and lower interest payments) consistent with prevailing interest rates.

Any fixed income security sold prior to maturity may be subject to a substantial and taxable gain or loss.

Structured products typically pay an interest or coupon rate above prevailing market rates and limit upside participation in the referenced asset if principal protection is offered or if the security pays an above-market interest rate. Risks may include loss of principal and the possibility that at expiration the investor will own the referenced asset at a depressed price. Other factors that may affect the investment value of the structured product include: interest rates, volatility of the underlying asset, liquidity and time remaining until maturity. Structured investments are generally backed by the issuing firm which may or may not maintain a secondary market.

Investments are not FDIC or NCUA insured, not Bank or Credit Union Guaranteed and May Lose Value.

APPENDIX A – EXPANDED INCOME REPLACEMENT ESTIMATOR

|Current Essential Expenses |Change during retirement: | | |Current Essential Expenses |Change during retirement: | |Mortgage |$_________ |$_______ + or - | |Gas (leisure) |$_________ |$_______ + or - | |Loan Payments or Second Mortgage |$_________ |$_______ + or - | |Meals-Restaurants |$_________ |$_______ + or - | |Property Taxes |$_________ |$_______ + or - | |Tithe / Charitable Giving |$_________ |$_______ + or - | |Homeowners Insurance |$_________ |$_______ + or - | |Gifts |$_________ |$_______ + or - | |Home Maintenance |$_________ |$_______ + or - | |Subscriptions |$_________ |$_______ + or - | |Auto Payments |$_________ |$_______ + or - | |Toiletries and Household Products |$_________ |$_______ + or - | |Auto Insurance |$_________ |$_______ + or - | |Shopping – fashion, clothing, decorating |$_________ |$_______ + or - | |Auto Maintenance |$_________ |$_______ + or - | |Hobbies – Special Interests |$_________ |$_______ + or - | |Health Insurance Premiums |$_________ |$_______ + or - | |Entertainment – Movies |$_________ |$_______ + or - | |Prescriptions |$_________ |$_______ + or - | |Extra Personal Care –massage or spa services |$_________ |$_______ + or - | |Utilities – Electricity, Gas, Water |$_________ |$_______ + or - | |Club Memberships –

AAA, AARP, etc. |$_________ |$_______ + or - | |Cable, Internet, Phone or Cell Phone |$_________ |$_______ + or - | |Household Goods – furniture, landscaping, etc. |$_________ |$_______ + or - | |Food / Groceries |$_________ |$_______ + or - | |Travel – US |$_________ |$_______ + or - | |Gas (to/from work) |$_________ |$_______ + or - | |Travel – Abroad |$_________ |$_______ + or - | |Credit Card Payments |$_________ |$_______ + or - | |Loan Payments |$_________ |$_______ + or - | |Investments, 401(k), Stocks, Bonds, Mutual Funds, Emergency Fund |

$_________ |

$_______ + or - | |Pets – grooming, boarding, vet care |$_________ |$_______ + or - | |Basic Clothing |$_________ |$_______ + or - | |Other: ______________ |$_________ |$_______ + or - | |Basic Personal Care – hair care, manicure, etc. |$_________ |$_______ + or - | |Other: ______________ |$_________ |$_______ + or - | |Other: ______________ |$_________ |$________ + or - | |Other: ______________ |$_________ |$_______ + or - | |Total |$_________ |$________ + or - | |Total |$_________ |$_______ + or - | |

Estimate of Total Monthly Income Needed During Retirement $ ______________________

-----------------------

Securities offered through Securities America, Inc., member FINRA/SIPC. Advisory Services offered through Securities America Advisors, Inc., an SEC Registered Investment Advisor. SAI #318861 5/11

Prepared Personally for

Jonathan Allen Doe and Jane Doe

Tuesday, July 05, 2016

confidential fact finder

client packet

$250,000

Example: Purchase vacation home

(

Example: Save for new roof – five years

+$150

(

Example: Mortgage paid off

- $875

(

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