Retirement Strategies Questionnaire

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Select All That Apply

Making sure my savings last through retirement

Protecting my spouse if something happens to me

Keeping what I've built safe from market loss

Leaving something behind for my family

Reducing taxes on my retirement income

Understanding coverage I already have

About You

First Name*

Last Name*

Middle Initial

Gender

Date of Birth*

Birthplace

State if US-born, or country

Marital Status*

Contact Information

Street Address*

City*

State*

Zip Code*

Years at This Address

Home Phone

Cell Phone

Email*

This should match the email you used to access this form.

Citizenship

Are you a U.S. Citizen?*

Yes

No

Type of Visa

Years Resided in the USA

Your Employment

Employment Status*

Occupation

Current or most recent occupation

Job Duties

Brief description of your primary duties

Company / Employer Name

Years with Company

Company Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Email

Work Phone

Spouse / Partner Information

Spouse's First Name

Spouse's Last Name

Spouse's Date of Birth

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

Yes

No

Spouse's Employment

Spouse's Employment Status

Spouse's Occupation

Spouse's Company / Employer

Years with Company

Spouse's Work Email

Spouse's Work Phone

Your Assets

Bank accounts, retirement accounts, taxable accounts.
(Approximate amounts are fine for now)

Checking Account Balance

Savings / Money Market Balance

All CDs Balance

Other Bank Accounts

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

Retirement Accounts

Include 401(k), 403(b), 457, IRA, Roth IRA, annuities, and any other tax-deferred accounts. Add a row for each account.

Retirement Accounts

Account Name

Held At (Custodian)

Owner

Balance ($)

Taxable Accounts

Include brokerage accounts, joint accounts, trusts, TODs, PODs, non-qualified annuities, and individual accounts.

Taxable Accounts

Account Name

Held At (Custodian)

Owner

Balance ($)

Education Savings

Do you have education savings accounts for dependents?

Yes

No

Education Accounts

Account Name

Type (529, etc.)

Owner

Beneficiary

Balance ($)

Property & Business

Real estate, personal property, business ownership, education savings

Do you have direct ownership in any businesses?

Yes

No

Business Details

Business Name

Owner

Business Type

Appraised Value ($)

Do you plan to sell your business to fund retirement?

Yes

No

Approximate year you plan to sell

Assumed annual growth rate

Other Growth Rate %

Personal Property

Include collectibles, boats, automobiles, and other significant personal property.

Personal Property

Description

Owner

Estimated Value ($)

Real Estate

Real Estate Properties

Property Description

Investment or Personal

Owner

Estimated Value ($)

List your personal residence, second homes, and investment properties.

Annual pre-tax income from investment properties

Which properties could be sold to fund retirement?

Obligations

Mortgages, HELOC, other debt

Mortgages

Property

Balance ($)

Years Remaining

Interest Rate (%)

Home Equity Line of Credit — Current Balance

Home Equity Line of Credit — Amount Available

Other Debt

Other Debts

Debt Type (Vehicle, Credit Card, etc.)

Balance ($)

Interest Rate (%)

Income & Retirement

Income, pensions, Social Security, other income, spending
(This helps us understand your current financial picture and retirement goals.)

Your Current Annual Income.*

Include salary, wages, or self-employment income.
We'll ask about investment income, pensions, and Social Security separately.

Annual Unearned Income

Source of Unearned Income

Expected Retirement Age*

If already retired, enter your current age.

Annual Retirement Contributions

Include any employer match or profit sharing.

Spouse's Income & Retirement

Spouse's Current Annual Income

Annual Retirement Contributions

Include any employer match.

Expected Retirement Age

If already retired, enter their current age.

Retirement Spending

Additional Annual Savings (outside retirement plans)

Type of Account for Additional Savings

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

Include taxes, think in today's dollars. If you're not sure, leave blank and we'll estimate 85% of your current income.

Pensions

If you or your spouse receive or will receive pension income, add each pension below.

Pensions

Name

Monthly Amount ($)

Age Payments Start

Has COLA? (Yes/No)

Pension Payout Option

If unsure, we'll assume Joint and 50% Survivor.

Social Security Income

Social Security

Name

Age to Start Payments

Anticipated Monthly Payment ($)

Other Income & Anticipated Expenses

Do you expect to work part-time during retirement?

Yes

No

For how many years?

At what annual salary (today's dollars)?

Does your spouse expect to work part-time during retirement?

Yes

No

Spouse: for how many years?

Spouse: at what annual salary?

Expected inheritance or gifts

Estimated year of inheritance

Anticipated major expenses or purchases

Other than education expenses.

Year for those expenses

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

Wrap Up

Referral, remarks, submit

Who may we thank for referring you?

Any additional remarks or things you'd like us to know?