High Value Clients - Financial Needs Analysis

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Writing Agent Name

Split Agent Name

Enter details

First Name

Middle Name

Last Name

Client's Date of Birth

Phone *

Email *

Spouse's Name

Spouse's Date of Birth

Spouse's Phone Number

Spouse's Email

Do you smoke?

Yes or No

Yes
No
No elements found. Consider changing the search query.
List is empty.

Smoker?

Client

Spouse

Do you have children?

Yes or No

Yes
No
No elements found. Consider changing the search query.
List is empty.

Child #1

Child #1 Date of Birth

Child #2

Child #2 Date of Birth

Child #3

Child #3 Date of Birth

Other Children name and Date of Birth

Dreams and Goals

Goals

Car

Furniture

Boat

Family Vacation

Buy a new home

Alternate income in case of death or disability

Build savings for unexpected expenses (emergency fund)

Reduce or pay off mortgage

College for child(ren)

Pay off credit card debt

Help support aging parents

Other Goals

Sources Of Income

Source of Income

Name
Employer / Source
Gross Annual Income
Monthly Income

Sources of Income #2

Name
Employer / Source
Gross Annual Income
Monthly Income

Sources of Income #3

Name
Employer / Source
Gross Annual Income
Monthly Income

More Sources?

Yes
No
No elements found. Consider changing the search query.
List is empty.

Sources of Income #4

Name
Employer / Source
Gross Annual Income
Monthly Income

Sources of Income #5

Name
Employer / Source
Gross Annual Income
Monthly Income

Monthly Net Income

$

Spouse's Monthly Net Income

$

Monthly Expenses

Monthly Expenses Breakdown

Yes
No
No elements found. Consider changing the search query.
List is empty.

Mortgage/Rent

$

Car Insurance

$

Utilities

$

Life Insurance

$

Mobile Bill

$

Health Insurance

$

Auto & Transportation

$

Subscriptions

$

Food & Groceries

$

Child Care

$

Investments

$

Entertainment

$

Household Maintenance

$

Debt & Loans

$

Personal Expenses

$

Charity & Gifts

$

Shopping

$

Miscellaneous

$

Total Caculated: $

Monthly total expenses

$

Assets

Taxable Accounts

Savings

Checking

CDs

Mutual Funds

Stocks

Bonds

Treasuries

Tax Deferred Accounts

IRAs

401(k), 403(b) and other pension assets

Roth IRA

Fixed Annuities

Saving Bonds

Other

Tax Advantage Accounts

Roth IRA

Cash Value Life Ins.

529 Plan or College

Savings Programs

Taxable

$

Tax Deferred

$

Tax Advantage

$

Do you have life insurance?

Yes
No
No elements found. Consider changing the search query.
List is empty.

Spouse's Do you have life insurance?

Yes
No
No elements found. Consider changing the search query.
List is empty.

IUL/Cash Value Life Insurance

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

IUL/Cash Value Life Insurance #2

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

IUL/Cash Value Life Insurance #3

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Primary Residence Equity

Yes
No
No elements found. Consider changing the search query.
List is empty.

Primary Residence Equity #1

Investment Asset Name
Balance
Monthly Contributions
Rate of Return

Other Residence Equity

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Other Residence Equity

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Bank Accounts

Yes
No
No elements found. Consider changing the search query.
List is empty.

Bank/Savings/CDs

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Bank/Savings/CDs #2

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Bank/Savings/CDs #3

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

529b Plans

Yes
No
No elements found. Consider changing the search query.
List is empty.

529b #1

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

529b #2

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

529b #3

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Retirement Accounts

Yes
No
No elements found. Consider changing the search query.
List is empty.

401k/403b or Other Qualified Plans

Investment Asset Name
Balance
Monthly Contributions
Rate of Return

401k/403b or Other Qualified Plans #2

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

401k/403b or Other Qualified Plans #3

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Mutual Funds / Stocks / Bonds

Yes
No
No elements found. Consider changing the search query.
List is empty.

Mutual Funds #1

Investment Asset Name
Balance
Monthly Contributions
Rate of Return

Mutual Funds #2

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Mutual Fund #3

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

IRA/SEP IRA Question

Yes
No
No elements found. Consider changing the search query.
List is empty.

IRA/SEP IRA

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

IRA/SEP IRA #2

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

IRA/SEP IRA #3

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Annuity

Yes
No
No elements found. Consider changing the search query.
List is empty.

Annuities (Fixed/Variable)

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Annuities (Fixed/Variable) #2

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Annuities (Fixed/Variable) #3

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Roth IRA Accounts

Yes
No
No elements found. Consider changing the search query.
List is empty.

Roth IRA

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Roth IRA #2

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Roth IRA #3

Investment Asset Name
Balance
Monthly Contribution
Rate of Return

Other Retirement Assets

Yes
No
No elements found. Consider changing the search query.
List is empty.

Explain

Liabilities

Mortgages

Yes
No
No elements found. Consider changing the search query.
List is empty.

Mortgage - 1st

Lender
Balance
Interest Rate
Monthly Payment

Mortgage - 2nd or HELOC

Lender
Balance
Interest Rate
Monthly Payment

Mortgage - Investment Property

Lender
Balance
Interest Rate
Monthly Payment

Car Loans

Yes
No
No elements found. Consider changing the search query.
List is empty.

Car Loan #1

Lender
Balance
Interest Rates
Monthly Payments

Car Loan #2

Lender
Balance
Interest Rates
Monthly Payments

Car Loan #3

Lender
Balance
Interest Rates
Monthly Payments

Student Loans

Yes
No
No elements found. Consider changing the search query.
List is empty.

Student Loan

Lender
Balance
Interest Rate
Monthly Payment

Student Loan #2

Lender
Balance
Interest Rates
Monthly Payments

Student Loan #3

Lender
Balance
Interest Rates
Monthly Payments

Personal Loans

Yes
No
No elements found. Consider changing the search query.
List is empty.

Personal/Signature Loan

Lender
Balance
Interest Rate
Monthly Payment

Personal/Signature Loan #2

Lender
Balance
Interest Rates
Monthly Payments

Tax Payment Plan

Yes
No
No elements found. Consider changing the search query.
List is empty.

Tax Payment Plan #1

Lender
Balance
Interest Rates
Monthly Payments

Credit Cards

Yes
No
No elements found. Consider changing the search query.
List is empty.

Credit Card #1

Lender
Balance
Interest Rate
Monthly Payment

Credit Card #2

Lender
Balance
Interest Rate
Monthly Payment

Credit Card #3

Lender
Balance
Interest Rate
Monthly Payment

Credit Card #4

Lender
Balance
Interest Rate
Monthly Payment

Other Debts or Loans

Yes
No
No elements found. Consider changing the search query.
List is empty.

Explain other Debts and Loans

Retirement Questions

At what age would you like to be in a position to retire?

Spouse: At what age would you like to be in a position to retire?

How much money would you need to have saved up in order to retire?

$

What would you need as a monthly income in order to be able to retire?

$

Let's do the math real quick to figure out how much you’d need saved total based on that monthly amount
For example, let’s say you live up to age of 90.
So $__each month X 12, for the whole year you’ll need $___. I'm going to multiply that $__ by the amount of years you’ll be retired___.
That's a total of ___million dollars.

Let’s say you were at a place where you get $/month in retirement, what would your retirement look like for you?

With what you currently have in place or have saved now, would you say you are on track to hitting that goal?

Yes or No

Yes
No
No elements found. Consider changing the search query.
List is empty.

If a plan could be put in place to meet all of your financial goals, what amount of money would you be willing to save per month for you & your family's future?

Budget Savers: $100-$300

Average Savers: $500-$1000

Elite Savers: $1500+

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