Step 1 of 14 7% Date MM slash DD slash YYYY Please fill in prior to your appointment. If not sure, leave blank. OK to approximate amounts. Please bring most recent account statements & tax return or upload with this form.Please select all that apply:* Select All Real Estate Bank or Credit Union Accounts IRA Accounts Employer Retirement Accounts Individual Stocks and Bonds Mutual Funds or Brokerage Accounts Annuities Promissory Notes or Trust Deeds Limited or General Partnerships Debts Long-Term Care Insurance Life Insurance Other Assets Name First Last Nickname Birth Date MM slash DD slash YYYY Occupation/Former Occupation Target Retirement Date MM slash DD slash YYYY Email Cell/Home PhoneName First Last Nickname Birth Date MM slash DD slash YYYY Occupation/Former Occupation Target Retirement Date MM slash DD slash YYYY Cell/Home PhoneEmail Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country ChildrenList children and ages below.Child 1 Full Name Child 1 Age:Child 2 Full Name Child 2 Age:Child 3 Full Name Child 3 Age:Do you have a will or trust? When was it last updated? MM slash DD slash YYYY Residence and Other Real Estate OwnedProperty Address 1: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Original Cost 1:Debt 1:Approximate Value 1:(Payment)/ Income 1:Property Address 2: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Original Cost 2:Approximate Value 2:Debt 2:(Payment)/ Income 2:Property Address 3: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Original Cost 3:Approximate Value 3:Debt 3:(Payment)/ Income 3: Banks and Credit Unions (Non-IRA)Institution Owner 1: Type of Account 1: Maturity Date 1: MM slash DD slash YYYY Interest Rate 1: Approximate Balance 1: Institution Owner 2: Type of Account 2: Maturity Date 2: MM slash DD slash YYYY Interest Rate 2: Approximate Balance 2: Institution Owner 3: Type of Account 3: Maturity Date 3: MM slash DD slash YYYY Interest Rate 3: Approximate Balance 3: IRA AccountsCustodian/Owner 1: Approximate Value 1:Type 1: Roth Traditional Custodian/Owner 2: Approximate Value 2:Type 2: Roth Traditional Custodian/Owner 3: Approximate Value 3:Type 3: Roth Traditional Employer Retirement AccountsCustodian/Owner 1: Approximate Value 1:Type 1: 401k TSA 457B Custodian/Owner 2: Approximate Value 2:Type 2: 401k TSA 457B Custodian/Owner 3: Approximate Value 3:Type 3: 401k TSA 457B Individual Stocks And BondsWhere you hold the certificates yourself.Stocks/Bonds/Owner 1: Cost Basis 1:Approximate Value 1:Stocks/Bonds/Owner 2: Cost Basis 2:Approximate Value 2:Stocks/Bonds/Owner 3: Cost Basis 3:Approximate Value 3: Mutual Funds and/or Brokerage AcountsNon-IRACompany/Owner 1: Amount Deposited 1:Approximate Value 1:Company/Owner 2: Amount Deposited 2:Approximate Value 2:Company/Owner 3: Amount Deposited 3:Approximate Value 3: AnnuitiesNon-IRAAnnuitant/Owner 1: Company 1: Rate 1:Value 1:Purchased 1:Annuitant/Owner 2: Company 2: Rate 2:Value 2:Purchased 2:Annuitant/Owner 3: Company 3: Rate 3:Value 3:Purchased 3: Promissory Notes and Trust DeedsWhere someone owes or is paying you on the note.Name of Debtor 1: Interest Rate 1:Approximate Balance on Note 1:Name of Debtor 2: Interest Rate 2:Approximate Balance on Note 2:Name of Debtor 3: Interest Rate 3:Approximate Balance on Note 3: Limited or General PartnershipsName of Partnership 1: Type of Investment 1: Value 1:Name of Partnership 2: Type of Investment 2: Value 2:Name of Partnership 3: Type of Investment 3: Value 3: Other AssetsName 1: Value 1:Asset 2: Value 2:Asset 3: Value 3: Long-Term Care InsuranceInsured 1: Company 1: Daily Coverage 1:Total Coverage 1:Insured 2: Company 2: Daily Coverage 2:Total Coverage 2:Insured 3: Company 3: Total Coverage 3:Total Coverage 3:Life InsuranceCompany 1: Insured 1: Approximate Death Benefit 1:Loan Against 1?Type 1: Whole Life Term Company 2: Insured 2: Approximate Death Benefit 2:Loan Against 2?Type 2: Whole Life Term Company 3: Insured 3: Approximate Death Benefit 3:Loan Against 3?Type 3: Whole Life Term Company 4: Insured 4: Approximate Death Benefit 4:Loan Against 4?Type 4: Whole Life Term DebtsAsset 1: Cost 1:Balance 1:Loan % 1:Payment 1:Debt 2: Cost 2:Balance 2:Loan % 2:Payment 2:Asset 3: Cost 3:Balance 3:Loan % 3:Payment 3:Total Debts: Household Cash FlowHusband Wages:Source: Wife Wages:Source: Other Income 1:Source 1: Other Income 2:Source 2: Other Income 3:Source 3: Other Income 4:Source 4: Total Yearly Income:Yearly Expenses:Net Yearly Income - Expenses:If Not Retired:Social Security Income:Name 1: Expected Yearly Social Security 1:Name 2: Expected Yearly Social Security 2:Pension Income:Name 1: Expected Yearly Pension Income 1:Survivor % 1:Name 2: Expected Yearly Pension Income 2:Survivor % 2:What are your most important financial concerns in order of importance?1. 2. 3. 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