Strategic Point Questionnaire PDF Details

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QuestionAnswer
Form NameStrategic Point Questionnaire
Form Length8 pages
Fillable?Yes
Fillable fields397
Avg. time to fill out27 min 9 sec
Other namesTSA, Julia, financial planning questionnaire pdf, fact finder template

Form Preview Example

Financial Planning

Questionnaire

To complete this form by hand:

Print all pages of this form and bring the completed form to our meeting.

To complete this form electronically:

Visit www.StrategicPoint.com/Forms and save the writable PDF to your computer, then open it using Adobe’s Acrobat Reader.

Complete the form by typing into the designated fields and/or checking the appropriate buttons. Tip: you can tab from field to field.

When finished, save the form and email it to clients@StrategicPoint.com. Or you can bring a copy with you to our meeting.

GENERAL INFORMATION

YOUR First & Last Name:

 

 

 

 

 

 

 

Today’s Date:

/

/

 

 

 

 

 

 

 

 

 

 

Marital Status: Single

Married

 

Partner Separated Divorced

Widowed

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

State:

 

 

 

Zip Code:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Home Phone: (

)

 

 

 

 

Email:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Your Date of Birth:

/

/

 

 

 

 

Are You a U.S. Citizen? Yes

No

 

 

 

 

 

 

 

 

 

 

SPOUSE’S/PARTNER’S (CO-CLIENT’S) First & Last Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Spouse’s/Partner’s Date of Birth:

/

/

 

 

Is your Spouse/Partner a U.S. Citizen? Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

Spouse’s/Partner’s Email:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

EMPLOYMENT INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

YOUR Employment: Self-Employed

 

Company Owner

Employee

Retired

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Occupation:

 

 

 

 

 

 

 

 

Years with Company:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

State:

 

 

 

Zip Code:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Phone: (

)

 

 

Ext:

 

Fax: (

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Email:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SPOUSE’S/PARTNER’S Employment: Self-Employed Company Owner

Employee Retired

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Company Name:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Occupation:

 

 

 

 

 

 

 

 

Years with Company:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Street Address:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City:

 

 

 

 

 

 

State:

 

 

 

Zip Code:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Phone: (

)

 

 

Ext:

 

Fax: (

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Work Email:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM CONTINUES

Questions? Please call (401) 273-1500.

1

Financial Planning Questionnaire (continued)

ASSETS

Bank Accounts

Type of Account

Owner

Balance

 

 

 

Checking

 

$

 

 

 

Money Market / Savings

 

$

 

 

 

All CDs

 

$

 

 

 

Crypto/Other:

 

$

 

 

 

How much of the above amount do you want earmarked for retirement?

 

$

 

 

 

Retirement Accounts

List tax-deferred accounts separately and include accounts labeled: 401(k), 403(b), 457, ESOP, SEP, SIMPLE, Profit Sharing,

TSA, Annuities, Traditional IRA and Roth IRA. Please attach copies of most recent statements.

Name of Account

At

Owner

Balance

 

 

 

 

Example: Lifespan 403(b)

Fidelity

Mary

$42,000

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

$

 

 

 

 

Taxable Accounts

List accounts separately and include: brokerage accounts, joint accounts, trusts, TODs, PODs, non-qualified annuities and accounts in an individual name. Please attach copies of most recent statements.

 

Name of Account

At

Owner

Balance

 

 

 

 

 

 

 

 

Example: Individual Account

Vanguard

John

$51,000

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM CONTINUES

 

 

 

 

 

 

Questions? Please call (401) 273-1500.

2

Financial Planning Questionnaire (continued)

Business Ownership

Include businesses in which you have direct ownership.

Name of Business

 

Owner

Business Type

Appraisal (your share)

 

 

 

 

 

Example: Peter’s Painting Co.

 

Peter

S-Corp

$250,000

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

$

 

 

 

 

Do you plan to sell your business to create retirement assets?

 

Yes No

 

 

 

 

If yes, in what approximate year?

 

 

 

 

 

Assumed annual growth rate of business: (If left blank, we will grow your business by 8% until sold.)

%

 

 

 

 

 

Personal Property

Include collectibles, boats, automobiles, etc.

Property

Example: Art Collection

Owner

Value

Mary/John

$75,000

 

$

 

$

 

 

Real Estate

For additional properties, please attach a separate sheet.

Property

Investment or Personal

Owner

Value

 

 

 

 

Example: 212 Windham

Personal Residence

Joint

$315,000

 

 

 

 

 

Personal Residence

 

$

 

 

 

 

 

Second Home

 

$

 

 

 

 

 

Investment Property (1)

 

$

 

 

 

 

 

Investment Property (2)

 

$

 

 

 

 

 

Other:

 

$

 

 

 

 

How much pre-tax income do you receive each year from your investment properties?

$

 

 

Which of these real estate properties is available to be sold with the proceeds used for retirement?

 

 

 

 

In what year would you like to sell the property?

 

 

 

 

 

 

Children and Other Dependents

Please list names, dates of birth, and relation for children, grandchildren, or any other dependents.

Name

Example: Julia

Date of Birth

Relation

2/23/2001

Daughter

 

 

 

FORM CONTINUES

Questions? Please call (401) 273-1500.

3

Financial Planning Questionnaire (continued)

Assets Held for Education

List separately for each child or grandchild and include 529 Plans, Coverdell IRAs, Custodial Accounts,

Education Savings Bonds, Mutual Fund Accounts, etc.

Name of Account

Type

Owner

Beneficiary

Balance

 

 

 

 

 

Example: CollegeBoundFund

529 Plan

Mary

Julia

$15,000

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

FUNDING NEEDS FOR CHILDREN AND OTHER DEPENDENTS

We will use the college savings information from the Assets section to determine our education funding projections.

Name

Date of Birth

College Start Year

Years to Fund

 

 

 

 

Example: Julia

2/23/2001

September 2013

4 years

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Annual Cost

What is the annual cost of college you are willing to fund for each child?

Keep in mind that your children may get financial aid or choose to take out student loans to help pay for expenses. Therefore, list only the amount you are willing to pay in current dollars. For instance, if you expect a year of college (graduate school) to cost $15,000 and you plan to pay two-thirds of that amount, then you would give “$10,000” as your estimated cost.

$

Annual expenses for other dependents (for example, parents):

$

LIABILITIES

Mortgages

Primary Residence

 

Start Date:

/

/

Original Amount: $

 

 

Balance Remaining: $

 

 

 

 

 

 

 

 

 

 

 

 

Term:

 

 

Interest Rate:

%

Property Taxes: $

Insurance: $

 

 

 

 

 

 

 

 

 

 

 

Second Home

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Start Date:

/

/

Original Amount: $

 

 

Balance Remaining: $

 

 

 

 

 

 

 

 

 

 

 

Term:

 

 

Interest Rate:

%

Property Taxes: $

Insurance: $

 

 

 

 

 

 

 

 

 

 

Investment Property

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Start Date:

/

/

Original Amount: $

 

 

Balance Remaining: $

 

 

 

 

 

 

 

 

 

 

 

Term:

 

 

Interest Rate:

%

Property Taxes: $

Insurance: $

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM CONTINUES

 

 

 

 

 

 

 

 

Questions? Please call (401) 273-1500.

 

 

 

4

 

Financial Planning Questionnaire (continued)

Other

Start Date:

/

/

Original Amount: $

 

 

Balance Remaining: $

 

 

 

 

 

 

 

 

 

Term:

 

 

Interest Rate:

%

Property Taxes: $

Insurance: $

 

 

 

 

 

 

 

Home Equity Line of Credit Balance:

 

 

 

 

$

 

 

 

 

 

 

 

 

Amount Available:

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

Other Debt

Debt

Vehicle

Vehicle

All Credit Cards

Student Loans

Other:

Balance

Interest Rate(s)

$

%

$

%

$

%

$

%

$

%

 

 

 

INCOME AND RETIREMENT ANALYSIS

 

 

 

 

 

 

 

 

 

 

 

 

YOUR Current Annual Income?

$

 

 

 

 

 

 

 

 

 

 

 

At what age do YOU expect to retire? (If you are already retired, put in your current age.)

 

 

 

 

 

(We will use this age to run your retirement projections.)

 

 

 

 

 

 

 

 

 

 

 

 

How much do you contribute to YOUR retirement plans each year?

$

 

 

 

 

 

 

 

 

 

Is there an Employer match?

Yes

No

 

 

 

 

 

 

 

 

Amount ($ or %) matched by Employer?

$

 

%

 

 

 

 

 

 

 

 

 

SPOUSE’S/PARTNER’S Current Annual Income?

$

 

 

 

 

 

 

 

 

 

 

 

At what age does your SPOUSE/PARTNER expect to retire?

 

 

 

 

 

(If she/he has already retired, put in her/his current age.)

 

 

 

 

 

 

 

 

 

 

 

 

How much does your SPOUSE/PARTNER contribute to her/his retirement plans each year?

$

 

 

 

 

 

 

 

 

 

Is there an Employer match?

Yes

No

 

 

 

 

 

 

 

 

Amount ($ or %) matched by Employer?

$

 

%

 

 

 

 

 

 

 

 

 

How much will you need to spend each month in retirement?

 

 

 

 

 

(Exclude taxes and think in terms of today’s dollars.)

 

 

 

 

 

(If you leave this question blank, we will assume you will need 85% of your current income.)

$

 

 

 

 

 

 

 

 

 

 

 

Additional Annual Savings:

$

 

 

 

 

 

 

 

 

 

 

 

Type of Account:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM CONTINUES

 

 

 

 

 

 

 

Questions? Please call (401) 273-1500.

5

Financial Planning Questionnaire (continued)

Pensions

Client Name

Monthly Amount at Start

Age at Start

 

Inflation COLA

 

 

 

 

 

 

 

 

Example: Mary

$1,200

 

 

65

 

Yes

No

 

$

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

$

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

$

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

What payout option does this pension represent? (We will assume joint and 50% survivor unless otherwise indicated.)

 

 

 

 

 

 

 

 

Single Life

Name Applicable Pension(s):

 

 

 

 

 

 

 

 

 

 

 

 

Joint and 50% Survivor

Name Applicable Pension(s):

 

 

 

 

 

 

 

 

 

 

 

 

Joint and 100% Survivor

Name Applicable Pension(s):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Social Security

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Current Payment

Payment Amount

Payment Amount at

Payment Amount

Client Name

Amount (if applicable)

at age 62

Full Retirement Age

at age 70

 

 

 

 

 

 

 

 

Example: John

 

 

$1,474

 

$2,057

 

$2,822

 

 

 

 

 

 

 

 

 

$

 

$

 

$

 

$

 

 

 

 

 

 

 

 

 

$

 

$

 

$

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER INCOME AND EXPENSES

 

 

 

 

 

 

 

 

 

 

 

 

Do YOU expect to work part-time during retirement?

 

 

 

Yes

No

 

 

 

 

 

If yes, for how many years?

 

At what salary (in current dollars)?

$

 

 

 

 

 

 

 

Does your SPOUSE/PARTNER expect to work part-time during retirement?

 

Yes

No

 

 

 

 

 

If yes, for how many years?

 

At what salary (in current dollars)?

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What is the value of any expected inheritance/gifts?

 

 

 

$

 

 

 

 

 

In what year would you estimate that you might receive this inheritance?

 

 

 

 

 

 

 

 

 

What is the value of any anticipated expenses or major purchases (other than education)?

$

 

 

 

 

 

 

 

In what year should these expenses be applied?

 

 

 

 

 

 

 

 

 

Is there anything else we should know about when we plan for your retirement?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM CONTINUES

Questions? Please call (401) 273-1500.

6

Financial Planning Questionnaire (continued)

INSURANCE ANALYSIS

For how many years will you need life insurance?

If you leave blank, we will assume until the first year of retirement.

Life Insurance: Term Policies

Please attach your latest statement.

Face Value

Insured

Group or Individual

Term Remaining

Premium per Year

 

 

 

 

 

Example: $500,000

John

Individual

10 years

$700

 

 

 

 

 

$

 

 

 

$

 

 

 

 

 

$

 

 

 

$

 

 

 

 

 

$

 

 

 

$

 

 

 

 

 

$

 

 

 

$

 

 

 

 

 

 

Life Insurance: Permanent Policies

 

 

 

 

 

 

 

 

 

 

 

Please attach your latest statement.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Year

 

 

 

 

 

 

 

Premium

 

 

Face Value

Type

Purchased

 

Insured

 

Cash Value

 

per Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Example: $100,000

Whole Life

1998

 

 

Mary

 

$10,000

 

 

$1,000

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

$

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

$

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

$

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

 

$

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Long Term Disability Insurance

 

 

 

 

 

 

 

 

 

 

 

Please attach policies if available.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

Monthly Benefit

 

Group or Individual

 

Premium per Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Example: John

 

$3,000

 

 

Individual

 

 

$2,100

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

 

 

 

 

 

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Long Term Care Insurance

 

 

 

 

 

 

 

 

 

 

 

Please attach policies if available.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

Daily Benefit

 

Inflation Rider

Term

 

 

Premium per Year

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Example: Mary

 

$150

 

Yes

No

3 years

 

 

$1,500

 

 

 

 

$

 

Yes

No

 

 

years

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

$

 

Yes

No

 

 

years

$

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FORM CONTINUES

 

 

 

 

 

 

 

 

 

 

 

 

Questions? Please call (401) 273-1500.

 

 

 

 

 

 

 

7

 

Financial Planning Questionnaire (continued)

ESTATE PLANNING

Do you have updated wills?

 

Yes

No

 

 

 

 

Do you have powers of attorney?

 

Yes

No

 

 

 

 

Have you executed health care proxies?

 

Yes

No

 

 

 

 

When were these documents last updated?

 

 

 

 

 

 

 

Have you established any trusts?

 

Yes

No

 

 

 

 

If yes, names of trust(s) you have established:

 

 

 

 

 

 

 

1)

2)

 

 

 

 

 

 

3)

4)

 

 

 

 

 

 

General Notes

Whom may we thank for referring you?

Please bring your completed Financial Planning Questionnaire along with any appropriate supporting documents to the meeting with your StrategicPoint advisor.

Please DO NOT complete this section PRIOR to meeting with your advisor.

I acknowledge receipt of StrategicPoint Investment Advisor’s Privacy Policy, Form ADV Part 2,

Proxy Voting Policy and the BCP disclosure statement.

Client Signature

Print Name

Questions? Please call (401) 273-1500.

8

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Filling in Adobes stage 3

The Name, of, Account Example, Individual, Account Vanguard, Owner, John, Balance, and FORM, CONTINUES area allows you to specify the rights and obligations of each party.

Adobes NameofAccount, ExampleIndividualAccount, Vanguard, Owner, John, Balance, and FORMCONTINUES blanks to insert

Terminate by looking at the following fields and filling them out as required: Example, Peters, Painting, Co Peter, S, Corp If, yes, in, what, approximate, year Yes, No Property, Example, Art, Collection Property, Example, Windham Investment, or, Personal Personal, Residence Personal, Residence Second, Home Investment, Property and Owner.

Filling out Adobes step 5

Step 3: When you have clicked the Done button, your file will be ready for transfer to any gadget or email you indicate.

Step 4: Ensure you remain away from possible future problems by preparing around a pair of copies of the file.

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