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Planning Questionnaire
Planning Questionnaire
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2021-09-23T18:44:46+00:00
1. Please enter your name.
(Required)
2. What is your birthday?
(Required)
3. Please describe your investment goals and objectives for this portfolio in detail.
(Required)
4. What is your level of investment knowledge on a scale of 1-10 (1 – no knowledge, 10 – investment pro)?
(Required)
1
2
3
4
5
6
7
8
9
10
5. When will withdrawals be needed from this portfolio?
I do not have any plans for withdrawals
Right away (within 1 year)
1 – 3 years
3 – 5 years
5 – 10 years
Greater than 10 years
6. If you are withdrawing funds from your investments (within the next 3 years) what will be the approximate yearly amount needed (dollar amount or percentage of portfolio)?
(Required)
7. Do you have any of the following estate documents?
a. Will
(Required)
Yes
No
b. Durable Power of Attorney
(Required)
Yes
No
c. Health Care Surrogate / Living Will
(Required)
Yes
No
d. Trust
(Required)
Yes
No
a. Has it been reviewed in the last 2 years?
(Required)
Yes
No
b. Has it been reviewed in the last 2 years?
(Required)
Yes
No
c. Has it been reviewed in the last 2 years?
(Required)
Yes
No
d. Has it been reviewed in the last 2 years?
(Required)
Yes
No
8. Do you have any of the following insurance policies currently?
a. Life Insurance
(Required)
Yes
No
b. Disability Insurance
(Required)
Yes
No
c. Umbrella Liability Insurance
(Required)
Yes
No
d. Identity Theft Insurance
(Required)
Yes
No
a. Has it been reviewed in the last 2 years?
(Required)
Yes
No
b. Has it been reviewed in the last 2 years?
(Required)
Yes
No
c. Has it been reviewed in the last 2 years?
(Required)
Yes
No
d. Has it been reviewed in the last 2 years?
(Required)
Yes
No
9. Please list your sources of income (annual amount).
Salary
Pension
Social Security
Investments (dividends, interest, etc.)
Other
Total
10. Please list your approximate asset values.
Liquid Assets (bank, brokerage, trust accounts)
Retirement Assets (IRA, 401k, Roth IRA, etc.)
Real Estate (primary residence, vacation home, rental property)
Other
Total
11. Please list your approximate liabilities.
Short Term Liabilities (credit cards, car loans)
Mortgage
Other
Total
12. What factors, if any, might impact how this money should be managed (retiring shortly, recently widowed, currently on disability, etc.)?
(Required)
Email
(Required)
Phone
(Required)
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