• Individual CES Questionnaire

• Basic Info

• Name
  First Name Last Name
• DOB
   - Month  - Day Year

  Date
• Email
  example@example.com
• Cell Phone
   - Area Code Phone Number
• Work Phone
   - Area Code Phone Number
• Address
  Street Address

  Street Address Line 2

  City State / Province

  Postal / Zip Code
• Occupation/Position

• Goals & Objectives

• Planning

• Are you Frustrated with the Limits on your Qualified Plan Contributions?
  Yes No
• Provide Details
• Are you accumulating sufficient capital to ensure your financial independence?
  Yes No
• Provide Details
• How much of your Net Worth is Creditor Protected?
  A Little About Half Most All
• Provide Details
• Would Tax-Free Income in Retirement be Attractive to you?
  Yes No
• Provide Details

• Wealth Management

• How Important is Reducing income Tax liabilities driven by your investment portfolio?
  Not Important Semi-Important Very Important
• Provide Details
• Are you Interested in Hedging Strategies to help reduce risks in your investment portfolio?
  Yes No
• Provide Details
• How Important is Tax-Advantaged Liquidity within your investment portfolio?
  Not Important Semi-Important Very Important
• Provide Details
• Have you protected your investment portfolio against untimely death?
  Yes No
• Provide Details

• Assets, Retirement & Qualified Plan Info

• Plan/Asset Type

  	Current Value	Annual Contributions	Company Match	How Many Accounts
  401(k)
  403(b)
  Roth IRA
  Trad. IRA
  SEP IRA
  Brokerage
  Savings
  Annuity
  Profit Sharing
  Cash Balance
  Partner Equity
  Defined Benefit Plan
  Other 1
  Other 2
  Other 3
  Other 4

• Provide Details

• Other & Next Steps

• What type of Income do you have?
  1099 W-2 K-1
  
• Provide Details
• Are there others in your firm maxing out on their contributions and looking for a tax benefit? (Explain that over 2 people can split the $100K Premium)
  Yes No
• Provide Details
• On an Annual basis, how much would you like to contribute to a Tax-Advantage Plan?
• Are you in Good Health/On any Medications?
• Follow-Up Meeting Date
   - Month  - Day Year

  Date
• Follow-Up Meeting Time
  1 2 3 4 5 6 7 8 9 10 11 12  : Hour 00 10 20 30 40 50 Minutes AM PM AM/PM Option
• Submit
• Should be Empty: