PERSONAL INFORMATION INVENTORY
|personal information INVENTORY FORM (PIIF) |
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|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: |
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|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: |
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|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: $ |
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|OTHER ASSETS OR SOURCES OF INCOME |
|DESCRIPTION: |AMOUNT/MONTH $: |TOTAL VALUE: |
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|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: |
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|OTHER DIRECTIVES & NOTES: |
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