Don't Just Retire... Retire With MoreLet's get to know you better. Fill out the form below before your first meeting.Retire With MoreStep 1 of 128%What do you do for a living?What are your most important goals?What is your tax plan regarding retirement accounts?How often do you check your investment accounts to incorporate current trends or changing tax environment?How much risk are you willing to take to achieve your financial goals?In a perfect world, what would you want to retire with more of?Retirement goals: When would you like to retire and what percent of your current income would you like to enjoy in retirement? (80% is typical)Is leaving a legacy important to you? What financial legacy would you like to leave your family now and in the future?You may never need extended care, but if you did how would you pay for it?Client Profile Tab- Basic InformationMarital Status Single MarriedName First Last Spouse's Name First Last Birth Date MM slash DD slash YYYY Spouse's Birth Date MM slash DD slash YYYY PhoneSpouse's PhoneEmail Spouse's Email 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 Spouse's Address (if different) 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 Client Profile Tab- Additional InformationAccountant NameAccountant Email Accountant PhoneEstate Planning Attorney NameEstate Planning Attorney Email Estate Planning Attorney PhoneOther Professional NameOther Professional Email Other Professional PhoneDo you own health insurance? Yes NoDo you own disability insurance? Yes NoHave you named your beneficiaries? Yes NoDo you have a will? Yes NoDo you have a trust? Yes NoFamily InformationNameRelationshipDate Of BirthSpouse's Name Add RemoveGoalsAdd as many rows as you needDateGoal Description Add RemoveClient Income InformationAre You Currently Retired? Yes NoEmployment IncomeOnly complete if you do not have paystubsEmployerCurrent Gross SalaryProjected Salary Increase %Projected Retirement Date Add RemoveIs Your Spouse Currently Retired? Yes NoSpouse's Employment IncomeOnly complete if you do not have paystubsSpouse's EmployerCurrent Gross SalaryProjected Salary Increase %Projected Retirement Date Add RemoveSocial Security BenefitsOnly complete if you do not have statements. Add Lines if needed.OwnerStart Age & MonthLife or End AgeGross Monthly Benefit $Projected COLA Increase%% To Survivor Add RemoveAssetsComplete only if you do not have statementsRetirement AssetsAdd Rows as necessaryOwnerCompanyTax Classification (IRA, 401k, etc)Investment Vehicle (CD, Bond, etc)Allocation (Low Risk/At Risk)Account Value $Monthly Contributions $ Add RemoveAdditional AssetsAdd Rows as necessaryOwnerCompanyDescriptionAccount Value $ Add RemoveSingle Premium Immediate AnnuitiesAdd Rows as necessaryOwnerCompanyTax ClassificationPayout (Single/Joint)Mode (Annual)Account Value $Benefit Amount $Benefit Start DateBenefit End Date (or Life?) Add RemoveGuaranteed Income Benefit AnnuitiesAdd Rows as necessaryOwnerCompanyTax ClassificationPayout (Single/Joint)Mode (Monthly/Annually)Account Value $Benefit Amount $Benefit Start DateBenefit End Date (or Life?) Add RemoveAdditional InformationProjected Before Retirement Rate of Return %Projected After Retirement Rate of Return %Minimum Retirement Funds $Desired Risk Level (Please reference the Risk Assessment Questionnaire below)ExpensesPlease complete prior to our first meetingMonthly ExpensesCurrent Monthly Expenses After Tax $Projected Inflation Rate % Add RemoveSelect the Household Expenses You Currently Have Mortgage Principal and Interest Real Estate Taxes Homeowner's Insurance Home Equity Loan Association Dues Rent Renter's Insurance Utilities-Gas-Electric Water-Sewer Cable-Phone-Internet Maintenance & Improvement House CleaningMortgage Principal & InterestMonthly Amount $Inflation %Start DateEnd Date (or Life?) Add RemoveReal Estate TaxesMonthly Amount $Inflation %Start DateEnd Date (or Life?) Add RemoveHomeowners InsuranceMonthly Amount $Inflation %Start DateEnd Date (or Life?) Add RemoveHome Equity LoanMonthly Amount $Inflation %Start DateEnd Date (or Life?) Add RemoveAssociation DuesMonthly Amount $Inflation %Start DateEnd Date (or Life?) Add RemoveRentMonthly Amount $Inflation %Start DateEnd Date (or Life?) Add RemoveRenter's InsuranceMonthly Amount $Inflation %Start DateEnd Date (or Life?) Add RemoveUtilities-Gas-ElectricMonthly Amount $Inflation %Start DateEnd Date (or Life?) Add RemoveWater-SewerMonthly Amount $Inflation %Start DateEnd Date (or Life?) Add RemoveCable-Phone-InternetMonthly Amount $Inflation %Start DateEnd Date (or Life?) Add RemoveMaintenance & ImprovementMonthly Amount $Inflation %Start DateEnd Date (or Life?) Add RemoveHouse CleaningMonthly Amount $Inflation %Start DateEnd Date (or Life?) Add RemoveSelect the Daily Living Expenses You Currently Have Food Dining Out Clothing Personal CareFoodMonthly Amount $Inflation %Start DateEnd Date (or Life?) Add RemoveDining OutMonthly Amount $Inflation %Start DateEnd Date (or Life?)ClothingMonthly Amount $Inflation %Start DateEnd Date (or Life?)Personal CareMonthly Amount $Inflation %Start DateEnd Date (or Life?)Select the Healthcare and Insurance Expenses You Currently Have Health Insurance Prescriptions Life Insurance Long Term Care Insurance Disability Insurance VeterinarianHealth InsuranceMonthly Amount $Inflation %Start DateEnd Date (or Life?)PrescriptionsMonthly Amount $Inflation %Start DateEnd Date (or Life?)Life InsuranceMonthly Amount $Inflation %Start DateEnd Date (or Life?)Long Term Care InsuranceMonthly Amount $Inflation %Start DateEnd Date (or Life?)Disability InsuranceMonthly Amount $Inflation %Start DateEnd Date (or Life?)VeterinarianMonthly Amount $Inflation %Start DateEnd Date (or Life?)Select the Transportation Expenses You Currently Have Auto Loans Auto Insurance Fuel RepairsAuto LoansMonthly Amount $Inflation %Start DateEnd Date (or Life?)Auto InsuranceMonthly Amount $Inflation %Start DateEnd Date (or Life?)FuelMonthly Amount $Inflation %Start DateEnd Date (or Life?)RepairsMonthly Amount $Inflation %Start DateEnd Date (or Life?)Select the Debt and Obligations You Currently Have Credit Cards Tuition - Student Loans Alimony Child Support OtherCredit CardsMonthly Amount $Inflation %Start DateEnd Date (or Life?)Tuition-Student LoansMonthly Amount $Inflation %Start DateEnd Date (or Life?)AlimonyMonthly Amount $Inflation %Start DateEnd Date (or Life?)Child SupportMonthly Amount $Inflation %Start DateEnd Date (or Life?)OtherMonthly Amount $Inflation %Start DateEnd Date (or Life?)Select the Entertainment Costs You Currently Have Parties and Events Sports-Hobbies-Lessons Membership Dues Vacation and TravelParties and EventsMonthly Amount $Inflation %Start DateEnd Date (or Life?)Sports-Hobbies-LessonsMonthly Amount $Inflation %Start DateEnd Date (or Life?)Membership DuesMonthly Amount $Inflation %Start DateEnd Date (or Life?)Vacation and TravelMonthly Amount $Inflation %Start DateEnd Date (or Life?)Select Miscellaneous Expenses You Currently Have Charitable Donations Gifts OtherCharitable DonationsMonthly Amount $Inflation %Start DateEnd Date (or Life?)GiftsMonthly Amount $Inflation %Start DateEnd Date (or Life?)OtherMonthly Amount $Inflation %Start DateEnd Date (or Life?)Liabilities/LoansAdd More Rows As NeededOwnerCompanyDescriptionValue $ Add RemoveFuture Cash FlowsAdd More Rows As NeededOwnerDescriptionMode (Annual/Monthly)Type (Outflow/Inflow)Taxable/Non-Taxable?$ Amount% ChangeStart DateEnd Date Add RemoveΔ
