Client Questionnaire

LIFE PLANNING QUESTIONNAIRE

FAMILY & HOUSEHOLD

Are you married?
 
 
 
 
 
 

FINANCIAL PRIORITIES

Please place a number next to your top 6 priorities from the list below:

Client Spouse
Creating Retirement Income Creating Retirement Income
Saving for Major Purchases Saving for Major Purchases
Minimizing Taxes Minimizing Taxes
Insuring your assets Insuring your assets
Caring for Parents Caring for Parents
Planning fora Business Planning fora Business
Saving For College Saving For College
Managing a Budget Managing a Budget
Insuring your Life Insuring your Life
Providing a Legacy Providing a Legacy
Contributing to Charity Contributing to Charity

RETIREMENT ASSUMPTIONS

MISCELLANEOUS ASSUMPTIONS

GOALS

Duration Short Term/LongTerm

NET WORTH

Joint Client Spouse

INCOME & SAVINGS

INSURANCE PROTECTION

Disability Insurance
Long-term Care Insurance
Umbrella Liability Coverage

ESTATE PLAN

Do you have will/trust documents currently in place?

ADDITIONAL REMARKS

Is there any information you would like us to know which was not covered in this questionnaire?

7474 North Figueroa Street
Los Angeles, CA 90041

Phone: 323.254.3072
Toll Free: 888.988.401K
Fax: 323.395.0714

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