INFORMATION FOR RETIREMENT PROFILE
[pic]
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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