Cornerstone Financial Planning, LLC
Cornerstone Financial Planning, LLC
FINANCIAL PLANNING QUESTIONNAIRE FOR DIVORCE PLANNING
A. GENERAL INFORMATION
Today’s Date: _______________
How were you referred to us? __________________________
| |YOU |YOUR SPOUSE |
|Legal Name | | |
|Preferred Name | | |
|Date of Birth | | |
|Employer | | |
|Occupation | | |
|Work Phone | | |
|Work Email | | |
Your Current Address
Street: _______________________________________________________
City: _____________________ State: __________ Zip Code: ________
Home Phone: __________________ Home Email: _____________________
Date of marriage _____
Date of legal separation _____
B. CHILDREN
| |CHILD 1 |CHILD 2 |CHILD 3 |CHILD 4 |
|Name | | | | |
|Date of Birth | | | | |
|Health | | | | |
|Living with you? | | | | |
|Marital Status | | | | |
|College Planned | | | | |
|Grandchildren | | | | |
C. GENERAL PLANNING OBJECTIVES
Given your current situation, what are your objectives in working with a financial professional:
_________________________________________________________________
__________________________________________________________________
__________________________________________________________________
D. INCOME
Projected Income:
This Year Next Year How often are you paid?
You: ___________ __________ Weekly Biweekly Bimonthly Monthly
Your Spouse:___________ __________ Weekly Biweekly Bimonthly Monthly
Do you have plans to attend school or retrain to enter the work force:
____________________________________________________________________
____________________________________________________________________
Do you expect to receive an inheritance in the future? (when and how much)
____________________________________________________________________
E. HEALTH
Health Status:
What is your current health status? Please list any chronic medical conditions or other helpful information:
You: _______________________________________________
Your Spouse: _______________________________________________
F. ESTATE PLANNING
You Your Spouse
Year of execution (if created):
Wills __________ __________
Durable Power of Attorney __________ __________
Living Will __________ __________
Health Care Proxy __________ __________
Revocable Trusts __________ __________
G. INSURANCE
| |If Life Insurance, | | | |
|Type of Insurance (Life, |indicate if term or whole | | | |
|Disability, Long-Term Care) |life | |Who is the insured? |Group or private policy? |
| | |Amount | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
H. SMALL BUSINESS
Do you have an ownership interest in a small business? Please provide the following details:
Type of business: C Corp: ___ S Corp: ___ Partnership ___ Proprietorship ___
Nature of business: _______________________________________
Percent of ownership: ____%
What is the value of your interest? $________
Do you have a buy-sell agreement in place? _______
Do you use business credit cards for personal expenses? Circle any that apply:
Auto payment Landscaping Household supplies Utilities
Auto Insurance Travel Entertainment Meals
Auto Gas/Maint Country Club Telephone Cell Phone
Disability Insurance Life Insurance Health Insurance Internet
Other ___________________
I. TAXES
Are you aware of any income tax refunds you are owed?
Are you aware of any outstanding income tax liabilities?
J. EXPENSES
Extraordinary/Deferred expenses:
Describe any forthcoming obligations which have not been paid for yet:
____________________________________________________________________
____________________________________________________________________
Are you currently providing support to anyone other than minor or college age children?
____________________________________________________________________
____________________________________________________________________
PLEASE CONTINUE THE QUESTIONNAIRE ON THE NEXT PAGE
K. ASSETS AND LIABILITIES
|TYPE OF ACCOUNT |Ownership (Name) | Current Value |
|LIQUID ASSETS: | | |
|Checking Account | | |
|Savings Account | | |
|Money Market Account | | |
|Savings Bonds | | |
|Other | | |
|Total Liquid Assets: | | |
| | | |
|INVESTED ASSETS: | | |
|Direct Ownership | | |
|Brokerage Account | | |
|Mutual Fund Account | | |
|Other | | |
|Total Invested Assets: | | |
| | | |
|TAX-DEFERRED ASSETS: | | |
|IRA | | |
|IRA | | |
|Roth IRA | | |
|Roth IRA | | |
|Company Retirement Plan | | |
|Company Retirement Plan | | |
|Annuity | | |
|Annuity | | |
|Other | | |
|Other | | |
|Total Tax-Deferred Assets: | | |
| | | |
|PERSONAL ASSETS: | | |
|Personal Residence | | |
| Year purchased: Cost basis: |
|Second Home | | |
| Year purchased: Cost basis: |
|Personal Prop. & Furniture | | |
|Artwork/Collectibles | | |
|Auto | | |
|Auto | | |
|Boat | | |
|Other | | |
|Total Personal Assets: | | |
|TOTAL ASSETS: | | |
ASSETS AND LIABILITIES CONTINUED:
|LIABILITIES: |Ownership (Name) | Current Value |
|Mortgage | | |
|Home Equity Line | | |
|Credit Card | | |
|Credit Card | | |
|Student Loan | | |
|Auto Loan | | |
|Other | | |
|Other | | |
|Total Liabilities: | | |
| | | |
|NET WORTH: | | |
L. MISCELLANEOUS ASSETS
Do you have a safe deposit box: Yes No
Contents of value:________________________________
Do you have a safe: Yes No
Contents of value:________________________________
Do you have a rewards program Yes No
Value: __________________________________
Do you own company stock options? Yes No Company Name: _________________
Please provide a current Option Summary Statement
Thank you for completing this questionnaire.
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