Financial Planning Questionnaire - capitalinsightfg.com

FinancialPlanningQuestionnaire

JacobJ.ReidLifePlanningStrategist™

[email protected] | www.capitalinsightfg.com2021LasPositasCourt,Suite165,Livermore,CA94551

Phone:925-449-7830 |Fax:(925)449-0598CAInsuranceLicense#0H05483

SecuritiesofferedthroughSecuritiesAmerica,Inc.MemberFINRA&SIPC.AdvisoryservicesofferedthroughSecuritiesAmericaAdvisors,Inc.CapitalInsightFinancialGroupandSecuritiesAmericacompaniesare

separateentities.

PersonalInformation

Title FirstName LastName DateofBirth SocialSecurity# Gender

HomePhone# BusinessPhone# CellPhone# EmailAddress

Street City State Zip


HomePhone# BusinessPhone# CellPhone# EmailAddress


1.

2.

Dependents



1.

Notes

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Relation&Dependent



Relation&Dependent2.

JacobJ.Reid|[email protected]:(925)449-7830CAInsuranceLicense#0H05483

ProfessionalAdvisors

FirstName LastName BusinessPhone# EmailAddress


1. FinancialAdvisor

2. CPA– TaxPreparer





3. Estate/TrustAttorney

4. PropertyCasualtyInsuranceAgent



Notes

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GeneralInformationWhatareyourhobbies,areasofinterest,clubsandassociationsyouparticipatein?

Isthereanyonethatmaybecomefinanciallydependentonyouinthefuture?

Whenyouthinkaboutmoney,whatkeepsyouawakeatnight?

Isthereanyoneelsethatyoulooktoforfinancialadvice?

Attheendofthisprocess,whatwouldyoufeelisasuccessfuloutcome?

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Children’sEducationIsityourgoalforyourchildrentoattendcollege? Yes No

PublicIn-State PublicOut-of-State Private

Doyoucurrentlyhavefundsoraccountsspecificallysetasideforeducation? Yes No

Notes


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Estate/Retirement/TrustBeneficiaries

Name

Name Relation

Name Relation Percentage

Percentage

Percentage

Relation

EstatePlanningDoyouhavealivingtrust? Yes No Ifyes,datesignedDoyouhavewills? Yes No

Doyouandyourspousehavedurablepowersofattorneyforhealth? Yes NoDoyouandyourspousehavedurablepowersofattorneyforfinancialmatters? Yes NoWhatisyourultimategoalforthedistributionofyourwealth?

Inheritancetochildren/grandchildren Charitablepurposesduringlifetime

CharitablepurposesafterdeathIsyourestatevaluationover5.5Million?

Haveyoutakenanystepstoavoidestatetaxes(lifeinsurancetrust,annualgifting,etc.)?

Notes


RetirementPlanningMostDesiredRetirementAge

AcceptableRetirementAge

Desiredpre-taxmonthlyincome

Acceptablepre-taxmonthlyincome

Whichofthefollowingmightbeincludedinyourplans?Relocation:Sellhometopurchaseanother?

Purchasevacationhome?

Workpart-time?

Travel?

Other

Timeshare?

Full-time/newcareerpath?

Aretravelfundsincludedindesiredincome?

RetirementIncomeSources

Client1 Client2

$$

$$

AreyoueligibleforSocialSecurity? Yes No

Client1 Client2

Yes No

PensionIncomeDescription

WhosePension: Description $

Pre-TaxAmount

/monthWillthisamountinflate? Yes No SurvivorBenefit: %WhosePension: Description $ /monthWillthisamountinflate? Yes No SurvivorBenefit: %

Notes

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Employer&IncomeInformation

FamilyMember EmployerName Title YearsEmployed

Occupation&BriefDescription


1.

MonthlyPre-TaxIncome AnnualPre-TaxIncome PensionorRetirementAccount

FamilyMember EmployerName Title YearsEmployed

Occupation&BriefDescription


2.

MonthlyPre-TaxIncome AnnualPre-TaxIncome PensionorRetirementAccount

CurrentAnnualHouseholdIncome(gross)/InsuranceCoveragesPleaseprovideacopyofmostrecentyear’staxreturnsandemployerpaystubs

$100,000to$150,000 $150,001to$200,000

Under$50,000 $50,001to$74,999 $75,000to$99,999

$200,001andover

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HealthInsurance:DisabilityInsurance:LifeInsurance:

Groupcoveragethroughemployer

Groupcoveragethroughemployer

Insured Company Owner Beneficiary Type DeathBenefit AnnualPremium

$$

$$

$$

LongTermCareInsuranceInsured Company DailyBenefit YearscoveredAnnual CashValue

$$

Privateprovider

Privateprovider

CashValue


RealEstate&LifestyleAssets

Description Type:Residence/Rental PurchaseDate PurchaseAmount

Address MarketValue ValuationDate

PropertyTax Frequency

1.

Description Type:Residence/Rental PurchaseDate PurchaseAmount

Address MarketValue ValuationDate

PropertyTax Frequency

2.

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MortgageInformationInformationregardingyourhomeand/orotherrealestateholdings:

Originalcostofyourhome $

Estimateoftoday’smarketvalue $

Currentmortgagebalance

Interestrate

Monthlypayment

$

$

Originalloanamount

Fixed

Dateoffirstpayment

$

Variable #ofYears

SecondMortgage/CreditLine? Yes No

InterestRate Amount MonthlyPayment% $ $

NotesForrentalorotherrealestateholdings,pleaseprovidesimilarinformationonaseparatesheet.

%

Howisthepropertytitled?

Ispropertytaxandhomeinsurancewrappedintomortgage? Yes No


Liabilities

LiabilityName: InterestRate PaymentType

1.

LinkedtoAsset

Amount

PaymentFrequency Amortization(Years) StartDate EndDatePrincipalAmount


2.

LinkedtoAsset

Amount

PaymentFrequency Amortization(Years) StartDate

LiabilityName: InterestRate PaymentAmount

3.

AmountOwed

PaymentFrequency


5.

Amount

PaymentFrequency Amortization(Years)

CreditCards

AutoLoan

EquityLine

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LiabilityName: InterestRate PaymentAmount

4.

AmountOwed

PaymentFrequency

CreditCards

Misc.

Notes

PrincipalAmount

PrincipalAmount


InvestmentAccountsandBankAccounts

Description AccountType Owner

MarketValue$ DateofValue CostBasis(IfKnown)

1.



2.



3.



4.



5.



6.

Notes

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7. AdditionalAssets(Property,Itemsofsignificantvalue)

Description


CashFlowWorksheetGeneralLivingExpenses: Monthly

Food,Groceries

Clothing

Cleaners

HousePayment

HomeMaintenance

HouseholdPurchases

CarLoan

DomesticHelp

Donations/Tithe

Dues/Subscriptions

Gifts/Birthday/Christmas

Associations/Clubs

Utilities(PG&E,Cable,Water,Phone)

AutoMaintenance(Gas,Oil,Repairs)

Medical(Premiums&Co-payments)

$Personal

$Allowances

$Hobbies

$Pets

$Vacations

$Entertainment(EatingOut)

$CarInsurance(Annual)

$HouseInsurance(Annual)

$UmbrellaPolicy(Annual)

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

Notes

GeneralLivingExpenses: Monthly

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PropertyTax(Annual)


FinancialInformationPleaseprovidecopiesofthedocumentslistedbelow(toensureaccuracyofplanresults)

FederalandStateIncomeTaxReturns(mostrecent)

CurrentPayStub

PersonalFinancialStatement(Ifavailable)

MostRecentBankandBrokerageAccountStatements

RetirementPlanStatement(401(k),403(b),etc.)

RetirementPlan– ListofInvestmentOptions

SocialSecurityStatements

TrustDocuments(asGrantororBeneficiary)

Will(s)

PensionFundInformation

LifeandLongTermCareInsurancePolicies

CashValueLifeInsuranceCurrentStatementofValues

DisabilityInsurancePolicies&CurrentStatement

GroupandIndividualAccident&HealthInsurancePolicies

Pro/PostNuptialAgreements

Other

Notes

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Financial Planning Questionnaire - capitalinsightfg.com

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