INFORMATION FOR RETIREMENT PROFILE



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Fact Finder

Client: ___________________________

Advisor: ________________________

Date _____________

155 West Harvard St, Suite 401

Fort Collins, CO 80525

Phone: 970-223-1922

Fax: 970-223-2875



[pic] General Information

Please take some time to complete this form. It will give us a good overall view of your financial situation, in addition to the financial information we need to work with you. Based on this overall picture, we will be able to make specific recommendations to help you work towards your financial goals.

You will find it helpful to gather all of your financial records before beginning. This will allow you to reference the information on a statement or a tax return without having to go look for it. If you have a current statement for a particular account or accounts, you can simply attach a copy instead of transferring the information to the Fact Finder. If you find that you cannot provide an exact number, please make an estimate. That will be more helpful than no figure.

Please don’t feel like we are going to penalize you if you can’t completely finish the fact finder. Come in for your appointment. We understand how busy you are and we will work with you in any way we can to make your financial situation as strong as possible.

General Information

Your Name __________________________ DOB ___/___/___ SS# __________

Drivers License # _______________ State _____ Expiration Date ______________

Phone Number: ______________ Email _____________________________

Occupation ______________________ Employer ___________________________

Spouses Name ________________________ DOB ___/___/___ SS# __________

Drivers License # _______________ State _____ Expiration Date ______________

Email _____________________________

Occupation ______________________ Employer ___________________________

Street Address _______________________________________

City ____________ State _____ Zip __________

Marital Status: __Single __Married __Widow/Widower __Divorced/Separated

Are You Retired? __Yes __No

[pic] General Information (continued)

Dependents

Name Relationship Social Security # Birth Date

Current Advisors

Advisor Name Firm/Company Address Phone

Attorney

Accountant

Bank/Trust

Officer

Life Ins

Agent

Prop/Casualty

Agent

Financial

Other

Other

[pic] General Information (continued)

General

Are you expecting any major lifestyle changes (eg., marriage __ Yes __ No __ Not Sure

divorce, new baby, retirement, etc)? List below.

Are you comfortable with your current cash flow? __ Yes __ No __ Not Sure

Do you expect any significant changes in the near future? __ Yes __ No __ Not Sure

Are you planning any major expenditures? __ Yes __ No __ Not Sure

Are you committed to working with a financial advisor? __ Yes __ No __ Not Sure

Do you have any assets you wish you didn’t own? __ Yes __ No __ Not Sure

Please list them here. ______________________________________________________________

______________________________________________________________

Concerns ________________________________________________________________________

Cash Management

Annual Income Client $________________ Annual Income Spouse $_________________

Other Income ____________

Do you have an emergency fund? __ Yes __ No __ Not Sure

Are you happy with your portfolio yield? __ Yes __ No __ Not Sure

Are you happy with your portfolio diversification? __ Yes __ No __ Not Sure

Are you saving on a regular basis? __ Yes __ No __ Not Sure

For College $ ____________/ month

Retirement $ ____________/ month

Other $ ____________/ month

Concerns: _____________________________________________________________________

[pic] Risk Management

Do you have any health problems? List below: __ Yes __ No __ Not Sure

____________________________________________________________________________

Do either of you smoke or use tobacco products? __ Yes __ No __ Not Sure

Are you on Medicaid? __ Yes __ No __ Not Sure

Do you have a Medigap policy? __ Yes __ No __ Not Sure

Do you have enough life insurance? __ Yes __ No __ Not Sure

Amount you have $ ___________ Amount you Need $ ____________

Type __ Term __ Universal life __ Whole Life

Needs estimate if you die: Death of Client / Death of spouse

Final Expenses ____________ _____________

Debt ____________ _____________

Mortgage ____________ _____________

College funding ____________ _____________

Income for spouse ($/yr for X years) ____________ _____________

Retirement fund for spouse ____________ _____________

Other __________________ ____________ _____________

Do you have disability Insurance? __ Yes __ No __ Not Sure

Amount $ _______ Length of Coverage _____

Amount $ _______ Length of Coverage _____

Do you have Long Term Care insurance? __ Yes __ No __ Not Sure

Daily Benefit $ _______ Length of Coverage _____

Daily Benefit $ _______ Length of Coverage _____

Do your parents look to you for financial help? __ Yes __ No __ Not Sure

Do your parents have enough Long Term Care insurance? __ Yes __ No __ Not Sure

Concerns: ____________________________________________________________________

____________________________________________________________________

[pic] Goals and Objectives

Investment Planning

What is your main investment objective?

__ Preserving existing assets above all else

__ Preserving existing assets combined with growth to cover inflation

__ Conservative income with absolute minimum risk

__ Maximum income with some risk

__ Conservative growth of assets, secondary income, some risk

__ Maximum growth of assets, significant risk

Is your investment portfolio sufficiently diversified? __ Yes __ No __ Not Sure

What Percentage is in cash equivalents? _____%

What Percentage is in stocks? _____%

What Percentage is in bonds? _____%

What Percentage is in real estate? _____%

Other (specify): _______________________________ _____%

Is your investment portfolio providing an adequate return? __ Yes __ No __ Not Sure

Are you expecting any major gains or losses soon? __ Yes __ No __ Not Sure

Are there any investment advisors you feel strongly about __ Yes __ No __ Not Sure

(because of past performance, family, friends, etc?)

Are there any investments you are opposed to for any reason? __ Yes __ No __ Not Sure

Does your current investment program reflect your opinion __ Yes __ No __ Not Sure

about the economic outlook?

Are you dissatisfied with any of your current investments? __ Yes __ No __ Not Sure

What are they? ___________________________________

Are there any investments you are planning on making? __ Yes __ No __ Not Sure

What are they? ___________________________________

Concerns: ___________________________________________________________________

___________________________________________________________________

___________________________________________________________________

[pic] Goals and Objectives

Retirement Planning

At what age would you like to retire? ________

What minimum income will you require? (today’s dollars before taxes) $ ________

If you plan on working after retirement, Estimate your annual income? $ ________

Do you have an IRA or Roth IRA? __ Yes __ No __ Not Sure

If yes, are you still contributing? __ Yes __ No __ Not Sure

How much $ _________/ year

Do you participate in a 401k or other type of retirement plan? __ Yes __ No __ Not Sure

Percentage/amount contributed $___________/ year

Company match rules ___________________

Is your plan diversified appropriately? __ Yes __ No __ Not Sure

Is it a self-directed account? __ Yes __ No __ Not Sure

Are there any investment restrictions? __ Yes __ No __ Not Sure

Are you expecting a distribution from your retirement plan soon? __ Yes __ No __ Not Sure

Do you have a company pension? __ Yes __ No __ Not Sure

Do you expect additional income during retirement ? List below. __ Yes __ No __ Not Sure

___________________________________________________________________________

Concerns: ___________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

[pic] Goals and Objectives

Estate Planning

Do you have an updated will? __ Yes __ No __ Not Sure

Do you have updated powers of attorney? (financial & healthcare) __ Yes __ No __ Not Sure

Do you have any trusts? __ Yes __ No __ Not Sure

Are you the beneficiary of any trusts? __ Yes __ No __ Not Sure

Have you considered the effect of estate taxes? __ Yes __ No __ Not Sure

Have you provided adequate estate liquidity for your heirs? __ Yes __ No __ Not Sure

Will your estate avoid probate? __ Yes __ No __ Not Sure

Will you receive a significant inheritance? __ Yes __ No __ Not Sure

Have your parents considered the effects of estate taxes? __ Yes __ No __ Not Sure

Will your parents estate avoid probate? __ Yes __ No __ Not Sure

Concerns: __________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

[pic] Assets and Liabilities

Checking, Savings, Money Markets, CD’s, Cash

Account type Balance Bank of Institution Maturity Date Interest Rate

___________ __________ ________________ __________ __________

___________ __________ ________________ __________ __________

___________ __________ ________________ __________ __________

___________ __________ ________________ __________ __________

___________ __________ ________________ __________ __________

___________ __________ ________________ __________ __________

___________ __________ ________________ __________ __________

___________ __________ ________________ __________ __________

___________ __________ ________________ __________ __________

Stocks and Mutual Funds

Description # of Shares Market Value Original Cost Divident/Sh Date Acquired

___________ ___________ ___________ ___________ __________ ____________

___________ ___________ ___________ ___________ __________ ____________

___________ ___________ ___________ ___________ __________ ____________

___________ ___________ ___________ ___________ __________ ____________

___________ ___________ ___________ ___________ __________ ____________

___________ ___________ ___________ ___________ __________ ____________

___________ ___________ ___________ ___________ __________ ____________

___________ ___________ ___________ ___________ __________ ____________

Bonds

Date Date

Description # of Bonds Market Value Original Cost Int Rate Maturity Acquired

___________ _________ _________ ___________ ______ ___________ _________

___________ _________ _________ ___________ ______ ___________ _________

___________ _________ _________ ___________ ______ ___________ _________

___________ _________ _________ ___________ ______ ___________ _________

___________ _________ _________ ___________ ______ ___________ _________

___________ _________ _________ ___________ ______ ___________ _________

___________ _________ _________ ___________ ______ ___________ _________

___________ _________ _________ ___________ ______ ___________ _________

[pic] Assets and Liabilities

Annuities

Issuer Face amount Cash Value Original Cost Premium Int Rate Issue Date

___________ ___________ ___________ ___________ __________ ______ _________

___________ ___________ ___________ ___________ __________ ______ _________

___________ ___________ ___________ ___________ __________ ______ _________

___________ ___________ ___________ ___________ __________ ______ _________

___________ ___________ ___________ ___________ __________ ______ _________

___________ ___________ ___________ ___________ __________ ______ _________

___________ ___________ ___________ ___________ __________ ______ _________

___________ ___________ ___________ ___________ __________ ______ _________

Real Estate

Year Capital Current

Purchased Price Improvements Market Value

Your Residence: _______ $_________ $ _________ $ _________

Other Home: _______ $_________ $ _________ $ _________

Land: _______ $_________ $ _________ $ _________

Land: _______ $_________ $ _________ $ _________

Other: _______ $_________ $ _________ $ _________

Other: _______ $_________ $ _________ $ _________

Mortgages/Equity Line of Credit:

Monthly Interest Months Unpaid

Payment Rate Remaining Balance

Your Residence: $_______ _____ % _________ $ _________

Other Home: $_______ _____ % _________ $ _________

Other: $_______ _____ % _________ $ _________

Other: $_______ _____ % _________ $ _________

Other: $_______ _____ % _________ $ _________

Other: $_______ _____ % _________ $ _________

[pic] Assets and Liabilities

Debt (credit card/auto loans etc)

Monthly Minimum Months Unpaid

Type of Loan Payment Payment Remaining Balance

_________________ $________ $________ _______ $_______

_________________ $________ $________ _______ $_______

_________________ $________ $________ _______ $_______

_________________ $________ $________ _______ $_______

_________________ $________ $________ _______ $_______

_________________ $________ $________ _______ $_______

_________________ $________ $________ _______ $_______

_________________ $________ $________ _______ $_______

_________________ $________ $________ _______ $_______

_________________ $________ $________ _______ $_______

[pic] Risk Management

Insurance

Amt of

Company Insured Coverage Type Premium Loans

________________ _________ $________ ____ $________ $________

________________ _________ $________ ____ $________ $________

________________ _________ $________ ____ $________ $________

________________ _________ $________ ____ $________ $________

________________ _________ $________ ____ $________ $________

________________ _________ $________ ____ $________ $________

________________ _________ $________ ____ $________ $________

Long Term Care Insurance:

Daily Years of Inflation Monthly

Who Benefit Coverage Coverage Premium Company

_____________ $_______ ______ ______ $ ______ _________________

_____________ $_______ ______ ______ $ ______ _________________

Disability Insurance:

Monthly Amount of

Who Coverage Premium Company

_____________ $_______ $ ______ _________________

_____________ $_______ $ ______ _________________

Critical Illness Insurance:

Monthly

Who Benefit Premium Company

_____________ $_______ $ ______ _________________

_____________ $_______ $ ______ _________________

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