PERSONAL INFORMATION INVENTORY



|personal information INVENTORY FORM (PIIF) |

|[pic] |

|BASIC Information |

|Name (1): |Date of Birth: |SSN: |

|Phone: |Cell phone: |Pager: |

|E-mail (home): |E-mail (work): |

|Name (2): |Date of Birth: |SSN: |

|Phone: |Cell phone: |Pager: |

|E-mail (home): |E-mail (work): |

|Name(s) of children/dependent(s): |Date of Birth: |SSN: |Cell Phone: |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

| | | | |

|Name of legal guardian designate(s) of child(ren) in case of emergency: |

|Relationship: |Address: |

|City: |State: |Zip Code: |

|Phone: |E-mail: |

|Employment Information |

|Current employer (1): |

|Employer address: |How long? |

|Phone: |E-mail: |Fax: |

|City: |State: |ZIP Code: |

|Position: |Salary: |Annual income: |

|Current employer (2): |

|Employer address: |How long? |

|Phone: |E-mail: |Fax: |

|City: |State: |ZIP Code: |

|Position: |Salary: |Annual Income: |

|Previous employer (1): |

|Address: |How long? |

|Phone: |E-mail: |Fax: |

|City: |State: |ZIP Code: |

|Position: |Salary |Annual income: |

|Previous employer (2): |

|Address: |How long? |

|Phone: |E-mail: |Fax: |

|City: |State: |ZIP Code: |

|Position: |Salary: |Annual Income: |

|checking, Savings, EDUCATIONAL SAVINGS account Information |

|Name of Bank (Checking): |

|Account #: |Name(s) on Account: |Opened: |Closed: |

|Address: |Phone: |E-mail: |

|Name of Bank (Checking): |

|Account #: |Name(s) on Account: |Opened: |Closed: |

|Address: |Phone: |E-mail: |

|Name of Bank (Savings): |

|Account #: |Name(s) on Account: |Opened: |Closed: |

|Address: |Phone: |E-mail: |

|Name of Bank ($$ Market): | | |

|Account #: |Name(s) on Account: |Opened: |Closed: |

|Address: |Phone: |E-mail: |

|Name of Bank (Other): | | |

|Account #: |Name(s) on Account: |Opened: |Closed: |

|Address: |Phone: |E-mail: |

|Name of Bank (ATM): |Pin #: |

|Name of Bank (ATM): |Pin #: |

|Name of Bank (Bill paying): |Sign-in Code(s): |Password: |

|Name of Bank (Bill paying): |Sign-in Code(s): |Password: |

|College Savings Account (529’s, etc.): |

|Account #: |Name(s) on Account: |Opened: |Closed: |

|Address: |Phone: |

|Account #: |Name(s) on Account: |Opened: |Closed: |

|Address: |Phone: |

|Employment related INVESTMENT Information |

|Current employer for (1): | |

|Employer address: |Start Date: |

|Phone: |E-mail: |Fax: |

|City: |State: |ZIP Code: |

|Position: |Salary |Annual Income: $ |

|Retirement/Savings Plan(s): |Phone: |

|Name & Account #: |Type of Plan: |

|Phone # of Plan Administrator: |E-mail address: |

|Name & Account #: |Type of Plan: |

|Phone # of Plan Administrator: |E-mail address: |

|Name & Account #: |Type of Plan: |

|Phone # of Plan Administrator: |E-mail address: |

|Name & Account #: |Type of Plan: |

|Phone # of Plan Administrator: |E-mail address: |

|Previous employer for (1): | |

|Employer address: |Start Date: |

|Phone: |E-mail: |Fax: |

|City: |State: |ZIP Code: |

|Position: |Salary: |Annual Income: $ |

|Retirement/Savings Plan(s): |Phone #: |

|Name & Account #: |Type of Plan: |

|Phone # of Plan Administrator: |E-mail address: |

|Name & Account #: |Type of Plan: |

|Phone # of Plan Administrator: |E-mail address: |

|Name & Account #: |Type of Plan: |

|Phone # of Plan Administrator: |E-mail address: |

|Current employer for (2): | |

|Employer address: |Start Date: |

|Phone: |E-mail: |Fax: |

|City: |State: |ZIP Code: |

|Position: |Salary: |Annual Income: $ |

|Retirement/Savings Plan(s): |Phone #: |

|Name & Account #: |Type of Plan: |

|Phone # of Plan Administrator: |E-mail address: |

|Name & Account #: |Type of Plan: |

|Phone # of Plan Administrator: |E-mail address: |

|Name & Account #: |Type of Plan: |

|Phone # of Plan Administrator: |E-mail address: |

|Previous employer for (2): | |

|Employer address: |Start Date: |

|Phone: |E-mail: |Fax: |

|City: |State: |ZIP Code: |

|Position: |Salary: |Annual Income: $ |

|Retirement/Savings Plan(s): |Phone: |

|Name & Account #: |Type of Plan: |

|Phone # of Plan Administrator: |E-mail address: |

|Name & Account #: |Type of Plan: |

|Phone # of Plan Administrator: |E-mail address: |

|Name & Account #: |Type of Plan: |

|Phone # of Plan Administrator: |E-mail address: |

|relative(s) to be notified in case of emergency |

|Name of relative(S) to be notified in case of emergency: |

|Name: |Phone: |

|Relationship: |

|Name: |Phone: |

|Relationship: |

|Name: |Phone: |

|Relationship: |

|Credit Cards |

|Name of Card/Lender: |Account Number: |PIN/Password: |Name(s) on Card: |Opened: |Closed: |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

| | | | | | |

|Mortgage(S) |

|(BE SURE TO UPDATE IF LOAN IS SOLD) |

|ACCOUNT #: |NAME(S) ON MORTGAGE: |

|DATE OPENED: |ADDRESS OF LENDER: |PHONE: |

|ACCOUNT #: |NAME(S) ON MORTGAGE: |

|DATE OPENED: |ADDRESS: |PHONE: |

|ACCOUNT #: |NAME(S) ON MORTGAGE: |

|DATE OPENED: |ADDRESS: |PHONE: |

|MORTGAGE(S) |

|(RENTAL PROPERTY) |

|ACCOUNT #: |NAME(S) ON MORTGAGE: |

|DATE OPENED: |ADDRESS: |PHONE: |

|ACCOUNT #: |NAME(S) ON MORTGAGE: |

|DATE OPENED: |ADDRESS: |PHONE: |

|ACCOUNT #: |NAME(S) ON MORTGAGE: |

|DATE OPENED: |ADDRESS: |PHONE: |

|MORTGAGE COMPANY |

|(EQUITY LINES AND/OR 2ND OR 3RD MORTGAGES) |

|ACCOUNT #: |NAME(S) ON MORTGAGE: |

|DATE OPENED: |ADDRESS OF LENDER: |PHONE: |

|ACCOUNT #: |NAME(S) ON MORTGAGE: |

|DATE OPENED: |ADDRESS: |PHONE: |

|ACCOUNT #: |NAME(S) ON MORTGAGE: |

|DATE OPENED: |ADDRESS: |PHONE: |

|STUDENT LOANS |

|(LIST OR, ATTACH SCHOOL DEBT REPORT) |

|ORIGINAL LENDER: |PHONE: |

|ORIGINAL LOAN AMOUNT: $ |ACCOUNT #: |

|GUARANTOR: |PHONE: |SERVICER: |PHONE: |

|CONSOLIDATED: |YES: |

|CONSOLIDATION LENDER: |PHONE: |

|CONSOLIDATION AMOUNT: $ |ACCOUNT #: |

|CONSOLIDATION GUARANTOR: |PHONE: |CONSOLIDATION SERVICER: |PHONE: |

|ORIGINAL LENDER: |PHONE: |

|ORIGINAL LOAN AMOUNT: $ |ACCOUNT #: |

|GUARANTOR: |PHONE: |SERVICER: |PHONE: |

|CONSOLIDATED: |YES: |

|CONSOLIDATION LENDER: |PHONE: |

|CONSOLIDATION AMOUNT: $ |ACCOUNT #: |

|CONSOLIDATION GUARANTOR: |PHONE: |CONSOLIDATION SERVICER: |PHONE: |

|AUTO/VEHICLE LOANS |

|LENDER NAME: |PHONE: |

|ACCOUNT #: |DATE OPENED: |

|NAME(S) ON LOAN: |NAME(S) ON TITLE: |

|VIN #: |DATE SOLD/TO WHOM: |

|LENDER NAME: |PHONE: |

|ACCOUNT #: |DATE OPENED: |

|NAME(S) ON LOAN: |NAME(S) ON TITLE: |

|VIN #: |DATE SOLD/TO WHOM: |

|OTHER LOANS, DEBTS, OR OBLIGATIONS |

|(PERSONAL, INCLUDING RENTALS) |

|DESCRIPTION: |ACCOUNT #: |AMOUNT: $ |

| | | |

| | | |

| | | |

|OTHER ASSETS OR SOURCES OF INCOME |

|DESCRIPTION: |AMOUNT/MONTH $: |TOTAL VALUE: |

| | | |

| | | |

| | | |

| | | |

|INSURANCE(S) |

|TYPE: |INSURER: |INSURED: |ADDRESS: |PHONE: |

|LIFE (1): | | | | |

|ACCOUNT #: |CONTACT: |BENEFICIARY(IES): |

|LIFE (2): | | | | |

|ACCOUNT #: |CONTACT: |BENEFICIARY(IES): |

|DEATH/DISABILITY(1): | | | | |

|ACCOUNT #: |CONTACT: |BENEFICIARY(IES): |

|DEATH/DISABILITY(2): | | | | |

|ACCOUNT #: |CONTACT: |BENEFICIARY(IES): |

|LONG-TERM CARE(1): | | | | |

|ACCOUNT #: |CONTACT: |BENEFICIARY(IES): |

|LONG-TERM CARE(2): | | | | |

|ACCOUNT #: |CONTACT: |BENEFICIARY(IES): |

|HEALTH: | | |

|DENTAL: | | |

|MALPRACTICE: | | |

|AUTO: | | |

|MOTORCYCLE: | | |

|HOMEOWNER: | | |

|RENTER: | | |

|PROFESSIONAL ADVISORS |

|ATTORNEY (WILL/TRUST): |ADDRESS: |

|OFFICE PHONE: |CELL PHONE: |

|ATTORNEY (BUSINESS): |ADDRESS: |

|OFFICE PHONE: |CELL PHONE: |

|CERTIFIED FINANCIAL PLANNER/ |Address: |

|Investment Representative: | |

|Phone: |Cell phone: |

|Address: |E-mail: |

|Name of Executor/Executrix of Will: |

|Location of Will document: |

|Phone: |Cell phone: |

|Address: |E-mail: |

|Name of Trust Administrator: |

|Location of Trust document: |

|Phone: |Cell phone: |

|Address: |E-mail: |

|Bank housing Safety Deposit Box: |Box #: |

|Location of Safety Deposit Key: |

|Address of bank: |Phone: |

|Durable Power of Attorney representative: |Address: |

|Phone: |Cell phone: |

|E-mail: | |

|FUNERAL ARRANGEMENTS |

|Body Donation: |Where: |Phone: |

|Funeral Home: |Where: |Phone: |

|Cemetery: |Where: |Phone: |

|Cremation: |Where: |Phone: |

|OTHER IMPORTANT CONTACTS: |

| |

| |

| |

| |

|OTHER DIRECTIVES & NOTES: |

| |

| |

| |

| |

| |

| |

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download