General information
Name
*
First Name
Last Name
Address
Phone Number
-
Area Code
Phone Number
Date of birth
Email
*
example@example.com
Marital Status
Single
Divorced
Common Law
Married
Smoking Status
*
Non-Smoker
Smoker
Health Concerns
Spouse Name
First Name
Last Name
Spouse date of birth
Smoking Status
Non-Smoker
Smoker
Health Concerns
Employment & Income
Employment Type
Self-Employed
Commissioned Employee
Salaried Employee
Unemployed
Student
Stay-at-home
Annual Gross Income
Pension Information
Spouse Employment Type
Self-Employed
Commissioned Employee
Salaried Employee
Unemployed
Student
Stay-at-home
Spouse Annual Gross Income
Spouse Pension Information
Family
Dependents
0
1
2
3
4
5
6
7
Children's Names + Dates of Birth
Assets
Market Value of Primary Residence
Market Value of Other Properties
Value of other investments
Value of vehicles or other assets owned
Life, Critical Illness, Disability Insurance (in-force)
Debts & Cashflow
After-Tax Monthly Income
Rent/Mortgage Payment
Fixed Expenses
Balance of mortgage
Mortgage Rate
Mortgage Renewal Date
Balance of lines of credit + credit cards
Total Minimum Payments
Balance of vehicle loans
Monthly Vehicle Loan Payments
Balance of student loans
Student Loan Payments
Main Concerns
Top 3 Goals
Expectations of your Financial Advisor
Advisor Information for Clients Concerning Glen Martins:
Signature
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