Client Question aire and Document Needs List Financial Planning Client Questionnaire and Document Needs List Curtis Financial Planning, ... with how I respond emotionally to my personal financial issues.

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Curtis Financial PlanningClient Questionnaireand Document Needs List Curtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 2014FINANCIAL PROFILE Date: _______________________________ 1. Personal DataName: ________________________________________________ Age: ______________ Birth Date:____________________ Social Security #: _______________________________________ Spouse/Partner: _________________________________________ Social Security #: _______________________________________ Drivers License #:___________________________________ Age: ______________ Birth Date:____________________ Drivers License #:___________________________________ Home Address:_________________________________________________________________________________________________ Home Phone #: _________________________________________ Work Phone #s:_____________________________________ Cell Phone #s: __________________________________________ Fax #s:_____________________________________________ Email Address(es):______________________________________________________________________________________________ How do you prefer to be contacted for financial matters? Phone Email Text ______________________________________Occupation(s) Employee Self Employed Job Title:_____________________________________________________________________________________________________ Employer or Company Name:____________________________________________________________________________________ Employer or Company Address:__________________________________________________________________________________ Annual Gross Salary Income: ___________________________________________ Bonus: __________________________________ Annual Net Self-Employment Income: ____________________________________________________________________________ Estimated Annual Salary/Income Increase: _________________________________________________________________________ Other Employment Income (Please describe):_______________________________________________________________________ Do you have plans to make a job or career change? (Please describe):___________________________________________________ Promotional Opportunities (Please describe): _______________________________________________________________________ When do you plan to retire?: ____________________________________________________________________________________Curtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 2014Curtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 2014Spouse/Partner Employee Self Employed Job Title: ____________________________________________________________________________________________________ Employer or Company Name:___________________________________________________________________________________ Employer or Company Address: _________________________________________________________________________________ Annual Gross Salary Income: ____________________________________________ Bonus: _____________________________ Annual Net Self-Employment Income: ____________________________________________________________________________ Estimated Annual Salary/Income Increase: ________________________________________________________________________ Other Employment Income (Please describe):______________________________________________________________________ Do you have plans to make a job or career change? (Please describe):__________________________________________________ Promotional Opportunities (Please describe): ______________________________________________________________________ When do you plan to retire?: ____________________________________________________________________________________ If one spouse/partner plans to not work and raise children, will career resume and at what age?: ____________________________ Financial Values/Goals Please list the reasons why you are seeking help from a financial planner; be as specific as you can.______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Dependent(s) Name: ___________________________________________ Age: ___________ Birth Date: _____________ School Year: ________ Name: ___________________________________________ Age: ___________ Birth Date: _____________ School Year: ________ In what year will child(ren) be attending: Preschool: _____________ Middle School: ______________ High School: _______________ College: ________________________ Private or Public Schools?:______________________________________________________________________________________ Do you plan to fully fund or partially fund undergraduate education?: Yes No Post graduate education?: Yes No Are you saving separately for education?: Yes NoAre you, or will you, be helping other family members financially?: Yes No2. AssetsPersonal Assets Primary Residence: _____________________________________ Date of Purchase: ___________________________________Second Home: _________________________________________ Date of Purchase: ___________________________________Investment Property: ___________________________________ Date of Purchase: ___________________________________Automobile (year/model): _______________________________When do you plan to replace your auto?: ___________________How often do you replace your auto?: ______________________2nd Automobile (year/model): ____________________________Art, Jewelry, Household: _________________________________Other Personal Assets: __________________________________Current Market Value: _____________________________ Purchase Price: ___________________________________ Current Value: ___________________________________ Purchase Price: ___________________________________ Current Value: ___________________________________ Purchase Price: ___________________________________ Current Value: ____________________________________ Do you typically pay cash or finance?: _________________Current Value: ____________________________________Current Value: ____________________________________Current Value: ____________________________________Checking/Savings Accounts Cash/Checking Account(s): Money Market Account(s): CD, Credit Union, Other: Taxable Assets Please list the total value of accounts and attach statements with details of investment holdings. Institution Current Value Brokerage Account(s):Annuity Account(s): Stock Options: Other Investment Assetts:___________________________________________________________________________________________________________________ Owner___________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________ Institution Current Value ____________________________________________________________________________________________Owner________________________________________________________________________________________________________________________________________________________________________________________Curtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 2014Curtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 2014 Current Value ______________________________________ __________________________________________________________________________________________________________________ Retirement Assets Regular (Traditional) IRA:Roth IRA: Company Retirement Plans: Current Value 401(k)/403(b)/457/SimpleSEP IRA Deferred Comp Plan ______________________________________ ______________________________________ ______________________________________ ______________________________________ ______________________________________ Expected Monthly Pension Benefit: Expected Social Security Income: At age 62 ______________________________________ At age 66 ______________________________________ At age 70 ______________________________________ Please attach copies of latest statements for all accounts and Social Security statement. 3. Other IncomeInheritance, Hobby Income, Royalties, Etc.:______________________________________________________________________ ___________________________________________________________________________________________________________ 4. Liabilities Current Balance Monthly Payment Interest Rate Date Opened/Term of Loan Residence Mortgage: _____________________ ________________ _________________ ___________________________ Home Equity Line: _____________________ ________________ _________________ ___________________________ 2ndHome Loan: _____________________ ________________ _________________ ___________________________ Investment Property: _____________________ ________________ _________________ ___________________________ _____________________ ________________ _________________ ___________________________ _____________________ ________________ _________________ ___________________________ Auto Loan: 2nd Auto Loan: Credit Card Debt: _____________________ ________________ _________________ ___________________________ _____________________ ________________ _________________ ___________________________ _____________________ ________________ _________________ ___________________________ _____________________ ________________ _________________ ___________________________ Owner ____________________________ ____________________________________________________________________________________ Owner____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ Curtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632Current Balance Monthly Payment Interest Rate Date Opened/ Term of Loan Personal Loan: Student Loans: 401(k) Loan(s): _____________________ ________________ _________________ ___________________________ _____________________ ________________ _________________ ___________________________ _____________________ ________________ _________________ ___________________________ 5. Income TaxesPlease provide your most recent Federal and State Tax Returns, including W2s, and pay stubs covering 30 days. Monthly Tax Deductible Items Medical/Dental Care (out-of-pocket): Prescription Drugs: Medical Insurance Premium:Dental/Vision Costs____________________________ ____________________________ ________________________________________________________ Annual _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ Taxes Property (Real Estate) Taxes: ____________________________ Personal Property Taxes (Auto License Fee): _________________________ Charitable Contributions ____________________________ Cash: Goods: Other Miscellaneous Deductions Unreimbursed Employee Expenses: Tax Preparation Fee: Financial Advisor Fee: Safe Deposit Box: Other: ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ________________________________________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________ _____________________________6. Insurance Premiums Monthly Annual ____________________________ _____________________________ ____________________________ _____________________________ ____________________________ _____________________________ ____________________________ _____________________________ ____________________________ _____________________________ ____________________________ _____________________________ ____________________________ _____________________________ Homeowners or Renters insurance: Earthquake Insurance: Auto Insurance: Life Insurance:Long Term Care Insurance: Disability Insurance:Liability/Umbrella: Legal Insurance: ____________________________ _____________________________ Curtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 20147. Cash Flow Worksheet. Please use the Excel Cash Flow Worksheet to detail personal Expenses. 8. Savings You____________________________ ____________________________ Contribution to 401(k)/403(b)/457/Simple: Company Match - %/dollars: IRA Contributions: ____________________________ Spouse/Partner _____________________________ _____________________________ _____________________________ (Traditional, Roth, SEP, Non-deductible) Savings to taxable accounts or reserves: ____________________________ _____________________________ (brokerage, individual accounts, joint accounts) 9. Insurance PoliciesLife Insurance Company Name_____________________________________________ Term Insurance What is the death benefit and term of the policy? ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Whole Life What is the death benefit and the current cash value? ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ Disability Insurance Company Name_____________________________________________ Employee Benefit or Bought Individually?: _______________________________________________________________________ Short or Long Term Disability?: ________________________________________________________________________________ Own Occupation or Any Occupation?:___________________________________________________________________________ Amount of Monthly Benefit?:__________________________________________________________________________________ Long Term Care Insurance Company Name______________________________________________ What is the total $ value of the insurance?: ________________________________________________________________________ What is the elimination period?: ________________________________________________________________________________ Did you buy inflation protection?: _______________________________________________________________________________ California Partnership Benefits?: ________________________________________________________________________________ 10. Estate PlanningWhat kind of estate planning have you done? Do you have a will or trust?: ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ 11. Emergency FundDo you have 6 months living expenses saved and in a liquid investment account?: Yes No AnnualCurtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 201412. Retirement PlanningHave you considered when you want to stop working?: Yes No If yes, when?:___________________________________________________________________________________________ How do you envision your retirement years? Where do you want to be living and what would you like to be doing?: __________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ What is the longevity in your family?: ___________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ Please provide any other information that you think is pertinent to your current financial situation:________________________ ___________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ 13. Personal AdvisorsSometimes it is necessary to collaborate with your other advisors; these advisors will NOT be contacted without your permission. Accountant or CPA: _________________________________________________________________________________________ Estate Planning Attorney:_____________________________________________________________________________________ Long Term Care Representative: _______________________________________________________________________________ Life Insurance Representative: ________________________________________________________________________________ Coach: ____________________________________________________________________________________________________ Business Lawyer: ___________________________________________________________________________________________ Mortgage Broker: ___________________________________________________________________________________________ Would you feel comfortable recommending these advisors to other people?: Yes No Are you happy with the service they provide?: ___________________________________________________________________ Do you need a referral to a professional?: Yes No If yes, what type of professional: ___________________________________________________________________________ Curtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 2014FINANCIAL QUESTIONNAIRE AND FINANCIAL SATISFACTION SURVEY Name:____________________________________________________________Date:______________________________ Money Personality Questions: 1. What keeps you up at night (or at least feeling anxious) when it comes to your personal finances? ______________________________________________________________________________________________________2. If you could change one thing about your personal finances, what would it be?_____________________________________________________________________________________________________3. Do you know where your money goes?4. Do you ever feel guilty about what you spend your money on or how much you spend?5. Do you feel you have all you need and want now?6. If you had more money to spend, what would you spend it on?7. Do you ever feel afraid you won't have enough?8. Do you feel secure about your financial future?9. Where do you see the state of your finances in 5 years? 10 years?10. What would being financially successful look like to you?Yes No Explain: _____________________________________________________________________ Yes No Explain: ________________________________________________________________________ Yes No Explain: ________________________________________________________________________ _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Yes No Explain: _________________________________________________________________________ Yes No Explain: _________________________________________________________________________ Curtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 2014Financial Satisfaction Survey I am satisfied 1. with my ability to meet my financial obligations. Yes No Explain: ____________________________________________________________________ 2. with the income my current job or career provides me. Yes No Explain: ____________________________________________________________________ 3. with my spending habits. Yes No Explain: ____________________________________________________________________ 4. with the level of debt I carry. Yes No Explain: ____________________________________________________________________ 5. with the level and quality of insurance protection I currently have. Yes No Explain: ____________________________________________________________________ 6. with the amount of money I save and invest on a regular basis. Yes No Explain: ____________________________________________________________________ 7. with my current investment choices. Yes No Explain: ____________________________________________________________________ 8. that I am on track to build a sufficient retirement nest egg. Yes No Explain:____________________________________________________________________ 9. Are you interested in sustainable, socially responsible investing?Yes No Explain:____________________________________________________________________ 10. with the level of employee benefits I receive. Yes No Explain: ____________________________________________________________________ 11. with my style of personal bookkeeping and financial record management. Yes No Explain: ____________________________________________________________________ I am satisfied Curtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 201411. with my ability to provide financial help to my family members. Yes No Explain: ____________________________________________________________________ 12. with my estate plan. Yes No Explain: ____________________________________________________________________ 13. with my level of charitable giving. Yes No Explain: ____________________________________________________________________ 14. with the level of financial education I have attained. Yes No Explain: ____________________________________________________________________ 15. with how I respond emotionally to my personal financial issues. Yes No Explain: ____________________________________________________________________ 16. with my ability to communicate about my financial matters. Yes No Explain: ____________________________________________________________________ 17. with the feelings I have about my money life. Yes No Explain: ____________________________________________________________________ 18. that financial issues do not cause stress or strain in the relationships that are important to me. Yes No Explain: ____________________________________________________________________ 19. with the working relationships I have with my financial service providers (i.e., insurance agent, banker, broker, financial planner, accountant). Yes No Explain: ____________________________________________________________________ Financial Satisfaction Survey - Page 2 I am satisfied Curtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 2014I plan to begin withdrawling money from my investments for major needs within (major needs may include retirement, child's education, home purchase, etc.); Once I begin withdrawing money from my investments, I plan to spend all of the funds within: Which of the following best describes your expectations for performance? My level of return doesn't matter as long as I dont lose money over any morethan a few monthsI am willing to accept a little lower return than the stock market in exchangefor a little greater safetyMy performance should a least equal the stock marketI want to beat the stock market and am willing to assume above-average risk in pursuit of capital growthAdditional Comments with regards to financial goals with this account: Less than 3 years 3 - 5 years6 - 10 years11 years or moreLess than 2 years 2 - 5 years6 - 10 years11 years or moreI am retired0 - 5 years6 - 15 yearsMore than 15 yearsIn how many years do you expect to retire?RISK TOLERANCE QUESTIONNAIRECurtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 2014I would describe my knowledge of investments as: Review the following list and select the investments you currently own or have owned in the past. Then choose the one with the highest number of points. Capital preservation investments (1 point) Bonds and/or bond mutual funds (3 points) Stocks and/or stock mutual funds (7 points) International securities and/or international funds (10 points) Which statement explains your greatest concern when selecting an investment? Potential for lossMostly potential for loss, but some concern about potentialfor gainMostly potential for gain, but some concern about potential for lossPotential for gainConsider this scenario: Imagine that over the past three months, the overall stock market lost 25% of its value. An individual stock investment you own also lost 25% of its value. What would you do? I would: If you made a long-term investment of $100,000, how much of a loss in a single year would you withstand before selling? 5%, or $5,000 on a $100,000 investment10%, or $10,000 on a $100,000 investment20%, or $20,000 on a $100,000 investmentI would not sell my investments based on a single year loss NoneLimitedGoodExtensiveSell all of my sharesSell some of my sharesDo nothingBuy more sharesCurtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 2014Describe the kind of risk with which you are comfortable: I don't want to lose any money ever. I could handle only a very small loss overa few months at mostI could handle losses over one or two quarters, but would not be comfortablesubjecting myself to longer down periodsI could handle a one-year loss, but do not want to pursue a strategy that couldresult in longer periods of lossI could handle being down over a three-year period, but no longerI could accept being down over longer than 3 years if my long-term returnpotential was above averageAny additional comments on investor risk tolerance: What is your liquid net worth (excludes home)? Under $250,000$250,000 - $500,000$500,000 - $1,000,000Over $1,000,000 What percentage of your total investment assets will this account represent? Are you interested in socially responsible investing?Financial PositionLess than 20%21% - 50%51% - 75%76% - 100%Yes NoCurtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 2014What is your approximate household annual income? Under $50,000$50,000 - $100,000$100,000 - $250,000Over $250,000 What portion of your monthly net income goes toward paying off debt? Is this a taxable account? YesAre you retired? Less than 10%10% - 30%30% - 50%Greater than 50%NoYesNoOther Comments:Curtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 2014DOCUMENTS NEEDED Most recent federal and state tax returns, all schedules. Bank and brokerage statements with details of investment holdings. 401(k), 403(b), 457 and IRA (Regular, SEP, Roth, Simple) pension statements. Pay stubs(s) covering the last 30 days. Latest Year W-2 Form Trust documents Employee benefits package/booklet.RSU and stock option details.Social Security Administration Estimate of Benefits form. Statement of estimated pension benefits. Deferral compensation details.Annuity statements. Copies of personal insurance declaration statements: Auto, home, liability, earthquake. Copies of life, disability, long-term care insurance policies. Information regarding medical insurance: premium, benefits. Completed cash flow spreadsheet. For self-employed Projections for income for next 5 years. For self-employed P&L for current year. Mortgage: Latest billing statement and original document (if can locate easily). Equity Line of Credit: Latest billing statement and original document. If you dont have time to make copies of the above documents, bring the originals. They will be scanned and returned to you promptly. YES N/A Curtis Financial Planning, LLC | 3824 Grand Avenue, Suite 100, Oakland, CA 94610 | 510-451-3528 | fax: 510-339-9632 2014Blank PagePersonal Loan: Student Loans: 401k Loans: Payment 2_2: Payment 3_2: Payment 4_2: Interest 2_2: Interest 3_2: Interest 4_2: Date Opened Term of Loan Bank 2: Date Opened Term of Loan Bank 3: Date Opened Term of Loan Bank 4: Monthly 1: Monthly 2: undefined_5: Personal Property Taxes License Fee: 1_4: 2_4: Other Miscellaneous Deductions: Unreimbursed Employee Expenses 1: Unreimbursed Employee Expenses 2: Unreimbursed Employee Expenses 3: Monthly 1_2: Monthly 2_2: Monthly 3_2: Monthly 5: Monthly 6: Monthly 7: Monthly 8: Annual 1: Annual 2: 1_5: 2_5: 1_6: 2_6: 3_4: 4: 5: 6: Annual 1_2: Annual 2_2: Annual 3_2: Annual 5: Annual 6: Annual 7: Annual 8: Contribution to 401k403b457 1: Contribution to 401k403b457 2: Contribution to 401k403b457 3: Savings to taxable accounts or reserves: Annual 1_3: Annual 2_3: Annual 3_3: undefined_6: Company Name: Term Insurance What is the death benefit and term of the policy 1: Term Insurance What is the death benefit and term of the policy 2: Whole Life What is the death benefit and the current cash value 1: Whole Life What is the death benefit and the current cash value 2: Company Name_2: Employee Benefit or Bought Individually: Short or Long Term Disability: Own Occupation or Any Occupation: Amount of Monthly Benefit: Company Name_3: What is the total value of the insurance: What is the elimination period: Did you buy inflation protection: California Partnership Benefits: What kind of estate planning have you done Do you have a will or trust 1: What kind of estate planning have you done Do you have a will or trust 2: If yes when: How do you envision your retirement years Where do you want to be living and what would you like to be doing 1: How do you envision your retirement years Where do you want to be living and what would you like to be doing 2: How do you envision your retirement years Where do you want to be living and what would you like to be doing 3: How do you envision your retirement years Where do you want to be living and what would you like to be doing 4: What is the longevity in your family 1: What is the longevity in your family 2: What is the longevity in your family 3: Please provide any other information that you think is pertinent to your current financial situation 1: Please provide any other information that you think is pertinent to your current financial situation 2: 1_7: 2_7: 3_5: 4_2: Accountant or CPA: Estate Planning Attorney: Long Term Care Representative: Life Insurance Representative: Coach: Business Lawyer: Mortgage Broker: Are you happy with the service they provide: If yes what type of professional: Name_4: Date_2: with my ability to meet my financial obligations: with the income my current job or career provides me: Explain_7: Explain_8: with the level and quality of insurance protection I currently have: Explain_14: Explain_15: Explain_16: Explain_17: Explain_18: Explain_19: Explain_20: Explain_21: Explain_22: Date: Name: Age: Birth Date: Social Security: Drivers License: SpousePartner: Birth Date_2: Social Security_2: Drivers License_2: Home Address: Home Phone: Work Phone s: Cell Phone s: Fax s: Email Addresses: Job Title_2: Employer or Company Name_2: Employer or Company Address_2: Annual Gross Salary Income_2: Bonus_2: Annual Net SelfEmployment Income_2: Estimated Annual SalaryIncome Increase_2: Other Employment Income Please describe_2: Do you have plans to make a job or career change Please describe_2: Promotional Opportunities Please describe_2: If one spousepartner plans to not work and raise children will career resume and at what age: Please list the reasons why you are seeking help from a financial planner be as specific as you can 1: Please list the reasons why you are seeking help from a financial planner be as specific as you can 2: Please list the reasons why you are seeking help from a financial planner be as specific as you can 3: Primary Residence: Date of Purchase: Second home: Date of Purchase_2: Investment Property: Date of Purchase_3: 2nd Automobile year model: Art Jewelry Household: Other Personal Assets: Current Value: Purchase Price: Current Value_2: Purchase Price_2: Current Value_3: Purchase Price_3: Current Value_4: Current Value_5: Current Value_6: Current Value_7: CashChecking Accounts 1: CashChecking Accounts 2: Money Market Accounts: CD Credit Union Other: undefined_4: Inheritance Hobby Income Royalties Etc 1: Current Balance: Home Equity Line: 2nd Home Loan: Investment Property 1: Investment Property 2: 2nd Auto Loan: Credit Card Debt 1: Credit Card Debt 2: Credit Card Debt 3: Credit Card Debt 4: Payment 1: Payment 2: Payment 3: Payment 4: Payment 5: Payment 6: Payment 7: Payment 8: Payment 9: Payment 10: Interest 1: Interest 2: Interest 3: Interest 4: Interest 5: Interest 6: Interest 7: Interest 8: Interest 9: Interest 10: Date OpenedTerm of Loan 1: Date OpenedTerm of Loan 2: Date OpenedTerm of Loan 3: Date OpenedTerm of Loan 4: Date OpenedTerm of Loan 5: Date OpenedTerm of Loan 6: Date OpenedTerm of Loan 7: Date OpenedTerm of Loan 8: Date OpenedTerm of Loan 9: Date OpenedTerm of Loan 10: Contact for financial matters: Job Title: Employer or Company Name: Employer or Company Address: Annual Gross Salary Income: Bonus: Annual Net SelfEmployment Income: Estimated Annual SalaryIncome Increase: Other Employment Income Please describe: Do you have plans to make a job or career change Please describe: Promotional Opportunities Please describe: Name_2: Age_2: Birth Date_3: School Year: Name_3: Birth Date_4: School Year_2: Preschool: Middle School: High School: College: Private or Public Schools: Post graduate education: Undergraduate: Retire_1: Retire_2: Brokerage: Mutual Funds: Annuity: Stock: Other Investments: Brokerage Current Value: Mutual Funds Current Value: Annuity Current Value: Stock Current Value: Other Current Value: Brokerage Owner: Mutual Funds Owner: Annuity Owner: Stock Owner: Other Owner: Current Value 1: Current Value 2: Current Value 3: Current Value 4: Owner 1: Owner 2: Owner 3: Owner 4: Plan to replace: Replace how often: Automobile year model: Cash or finance: IRA Current Value: IRA Current Value 2: Roth Current Value: Roth Current Value 2: IRA Current Owner: IRA Current Owner 2: Roth Current Owner: Roth Current Owner 2: 401k 403 457 Simple Current Value: Current Value 4_2: Current Value 5: Current Value 6: Current Value 7: 1_3: 2_3: 3_3: Current Value 4_2 Owner: 401k 403 457 Owner: Current Value 5 Owner: Current Value 6 Owner: Current Value 7 Owner: 1_3 Owner: 2_3 Owner: 3_3 Owner: Monthly 3: Annual 3: Monthly 4: Annual 4: Unreimbursed Employee Expenses 4: 7: Unreimbursed Employee Expenses 5: 8: Explain_5: Explain_6: Do you feel you have all you need and want now: If you had more money to spend what would you spend it on: Do you ever feel afraid you wont have enough: Do you feel secure about your financial future: Where do you see the state of your finances in 5 years: What would being financially successful look like to you: Feeling Anxious: Change one thing: Explain_9: Explain_10: Explain_12: Explain_13: Explain_11: Explain_11a: Social: Withdrawl: spend: retire: expectations: highest points: greatest concern: knowledge: scenario: loss before selling: 0comforable risk: net worth: investment assets: houshold income: net income for debt: taxable account?: retired?: separately for education: family help: money goes: risk1: risk2: risk3: risk4: comments1: comments2: comments3: comments4: goals1: goals2: goals3: money spend: need and want: afraid: financial future: obligations: job provides: spending habits: debt carried: insurance: save regular: investment choices: responsible investing: nest egg: employee benefits: record management: help family: recommend advisor: need referral: stop working: liquid investment account: estate plan: charitable giving: financial education: personal financial issues: communicate about financial: feeling money life: no stress: working relationships: Occupation: 0Spouse Occupation: Choice2returns: bank statements: 401K: pay stubs: w2: trust docs: employee benefits package: RSU: soc sec: pension: deferral compensation: annuity stmt: personal insurance declarations: life long term: medical insurance: cash flow spreadsheet: projected income: p&l: mortgage: equity line of credit: Contact_Email: Contact_Phone: Contact_Text: Age_3: Age_4: Monthly Insurance: Annual Insurance:

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