Client Profile
Confidential Questionnaire
Required Document Checklist
Most Recent Tax Return - Primary Client
Most Recent Tax Return - Spouse (If Married Filing Separately)
Driver's License - Primary Client
Driver's License - Spouse (If Applicable)
Required Document Upload
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Identification & Contact Information
Primary Client Name
*
Date of Birth
*
-
Month
-
Day
Year
Social Security Number
*
Mobile Phone
*
Email
*
Address
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Spouse
Date of Birth
-
Month
-
Day
Year
Social Security Number
Mobile Phone
Email
Children & Pets
Child
Date of Birth
-
Month
-
Day
Year
Child
Date of Birth
-
Month
-
Day
Year
Child
Date of Birth
-
Month
-
Day
Year
Child
Date of Birth
-
Month
-
Day
Year
Pets
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Primary Client Income
*
Description
Annual Income
Years
1
2
3
4
Spouse Income
Description
Annual Income
Years
1
2
3
4
If your employer(s) provide employee benefits, please upload the benefits brochure for evaluation.
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Assets
You may upload statements instead of filling out this section.
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Accounts (Bank, Investment, etc.)
*
Description
Current Value
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Physical Property (Real Estate, Cars, etc.)
Description
Current Value
1
2
3
4
5
6
7
8
9
10
Other Assets (Business Interests, Pension, etc.)
Description
Current Value
1
2
3
4
5
6
7
8
9
10
Liabilities
You may upload statements instead of filling out this section.
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Collateralized Loans (Mortgages, Car Loans, etc.)
Description
Current Balance
Interest Rate (%)
Term
1
2
3
4
5
6
7
8
9
10
Non-Collateralized Loans (Credit Cards, Student Loans, etc.)
Description
Current Balance
Interest Rate (%)
1
2
3
4
5
6
7
8
9
10
Other Liabilities (Child Support, Alimony, etc.)
Description
Current Balance
1
2
3
4
5
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Health Insurance
Description
Deductible
Annual Cost
Primary
Spouse
Life Insurance
Description
Amount
Annual Cost
Covered Person
1
2
3
4
5
6
Disability Insurance
Description
Benefits
Annual Cost
Primary
Spouse
Property & Casualty Insurance
Description
Company
Coverage
Annual Cost
1
2
3
4
5
6
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Estate
Will(s)
Yes
Date Created
Primary
Spouse
Have any of the following occurred since you last reviewed your estate documents and beneficiaries?
Birth of a child
Marriage or divorce
Sale/purchase of real estate or a vehicle
Sale/purchase of business interests
Other Advisors
Professional Relationships:
Name
Company
Phone
Email
Financial Advisor
Accountant
Lawyer
Coach
Other
Other
Other
When making major decisions, who else needs to be involved in the process? (In addition to the primary client and spouse)
Name
Relationship
Phone
Email
1
2
3
4
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Optional Information
This information is optional, but helps me understand you better.
Primary Client's MBTI Personality Type (www.16personalities.com)
Spouse MBTI Personality Type (www.16personalities.com)
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Name of person filling out this form:
*
First Name
Last Name
Signature
*
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