Client Intake

About You / Background

Name(Required)

Email Address:(Required)

Relationship Status

Marital Status:

Single

In a long-term relationship

Married

Separated

Divorced

Widowed

Spouse's Name

Spouse's Email Address:

Let’s discuss your goals/objectives:

Your Goals & Objectives

Short-Term: (3-5 Years)

Mid-Term: (4-10 Years)

Long-Term: (10+ Years)

What Topics Would You Like To Be Sure That We Cover During Our Time Together(Required)

Personal & Family Information:

Nickname

Spouse's Nickname

Place Of Birth

Spouse's Place Of Birth

Date of Birth(Required)

Spouse's Date of Birth(Required)

Home Address:

Address

Primary Phone(Required)

Mobile Phone

Chidren's' Names:

Name

Gender

Date of Birth

Name

Gender

Date of Birth

Name

Gender

Date of Birth

Name

Gender

Date of Birth

Are You Planning To Have More Children?

More Children

Yes

No

How Many More Children?

Are There Any Special Considerations That Relate To The Future Of Your Children?

Education:

Special Talents:

Disabilities:

Tell Me About Your Extended Family (Parents, Grandparent, Brothers, Sisters, Names, Ages, Jobs)

Mother

Spouse's Mother

Father

Spouse's Father

Brothers & Sisters

Spouse's Brothers & Sisters

Employment:

Name of Employer

Name of Spouse's Employer

How long have you worked there?

How long has your spouse worked there?

Job Title

Spouse's Job Title

Specific Job Duties

Spouse's Specific Job Duties

Future Career Plans

Spouse's Future Career Plans

Interest / Hobbies:

Activities / Organizations?

Spouse's Activities / Organizations?

Anything Dangerous? (Hang-Gliding, Skydiving, Rock Climbing?)

Spouse - Anything Dangerous? (Hang-Gliding, Skydiving, Rock Climbing?)

Objectives:

On A Scale Of 1-10, How Important Are The Following?

Funding Your Children's Education

Funding A Comfortable Retirement

Providing For Your Family In The Event Of Death

Providing Long-Term Care Needs

Properly Addressing Your Estate Settlement Needs

Evaluating Your Investment Portfolio

General Notes (Objectives)

Savings Philosophy:

What Is The Most Important Thing You’ve Learned About Money And Investing?

What Is The Most Important Thing Your Spouse Learned About Money And Investing?

Do You Consider Yourself A Disciplined Saver?

Does Your Spouse Consider Themselves A Disciplined Saver?

What % Of Your Total Income Do You Feel Should Be Set Aside To Meet Your Financial Goal?

What % Of Your Total Income Does Your Spouse Feel Should Be Set Aside To Meet Their Financial Goal?

What Does This Mean In Dollars Annually?

What Does This Mean In Dollars Annually For Your Spouse?

Are You Currently Doing This?

Is Your Spouse Currently Doing This?

If Not, What Would Help You Save More?

If Not, What Would Help Your Spouse Save More?

Who Manages Your Finances And Pays Your Monthly Expenses?

Who Manages Your Spouse's Finances And Pays Their Monthly Expenses?

Retirement:

What Thoughts Do You Have Regarding Retirement?

How Do You Feel About Your Current Plans?

At What Age Would You Like To Be In A Position To Not Have To Work?

If You Retired Today, Would You Continue Your Current Lifestyle / Spending?

How Much After-Tax Monthly Income Would You Need Today To Support This Lifestyle?

To What Age Would You Like This Income To Continue?

Does This Amount Consider The Cost Of Health Insurance In Retirement?

What Will You Do If Your Retirement Goal Is Not Met? (Work Longer/Retire On Less)

How Would You Fund Your Retirement If You Were To Become Sick Or Disabled?

Inheritance:

Are You And/Or Your Spouse Anticipating Any Inheritance?

Inheretence?

Yes

No

How Much?

Should We Include This Amount In Your Resources Towards Your Retirement Goal?

Yes

No

Are You Currently Covered By Social Security?

Yes

No

Assets / Liabilities / Income:

Taxable Assets:

Savings:

Spouse's Savings:

Cds:

Spouse's Cds:

Mutual Funds:

Spouse's Mutual Funds:

Stocks:

Spouse's Stocks:

Private Equity / Credit / Alts:

Spouse's Private Equity / Credit / Alts:

Real Assets: Art / Baseball Cards / Jewelry Etc.:

Spouse's Real Assets: Art / Baseball Cards / Jewelry Etc.:

Tax-Deferred Assets:

401k / TSP:

Spouse's 401k / TSP:

Annuities:

Spouse's Annuities:

IRAs:

Spouse's IRAs:

529 Plans:

Spouse's 529 Plans:

Pension:

Spouse's Pension:

Personal / Business

Residence Current Value

Residence Purchase Price

Are You The Owner?

Liquid? Y/N?

Autos Current Value?

Autos Purchase Price?

Are You The Owner?

Liquid? Y/N?

Personal Property Current Value?

Personal Property Purchase Price

Are You The Owner?

Liquid? Y/N?

Business Interest Current Value

Business Interest Purchase Price?

Are You The Owner?

Liquid? Y/N?

Liabilities:

Home Mortgage:

Amount Owed:

Monthly Payment:

Interest Rate:

Are You The Owner?

Equity Loans:

Amount Owed:

Monthly Payment:

Interest Rate:

Are You The Owner?

Personal / Student Loans:

Amount Owed:

Monthly Payment:

Interest Rate:

Are You The Owner?

Auto Loans:

Amount Owed:

Monthly Payment:

Interest Rate:

Are You The Owner?

Credit Cards:

Amount Owed:

Monthly Payment:

Interest Rate:

Are You The Owner?

Total Liabilities: $

Assets (-) Liabilities = Total Net Worth: $

What Are Your General Thoughts/Feelings Around Debt?

Do You Have A Broker Or Someone You Turn To For Financial Advice?

What Have You Liked Most About Your Previous Investment Experience?

What Have You Liked Least About Your Previous Investment Experience?

Are There Any Investments You Currently Hold That We Have Not Discussed?

Income:

Salary This Year:

Spouse's Salary This Year:

Salary Last Year:

Spouse's Salary Last Year:

Salary Next Year:

Spouse's Salary Next Year:

Salary Next 5 Years:

Spouse's Salary Next 5 Years:

Bonus This Year:

Spouse's Bonus This Year:

Bonus Last Year:

Spouse's Bonus Last Year:

Bonus Next Year:

Spouse's Bonus Next Year:

Bonus 5 Years From Now:

Spouse's Bonus 5 Years From Now:

Other Income This Year:

Spouse's Other Income This Year:

Other Income Last Year:

Spouse's Other Income Last Year:

Other Income Next Year:

Spouse's Other Income Next Year:

At What Rate Do You Expect Your Income To Grow Long Term?

Do You Anticipate Any Changes In Your Total Income In The Future? (Special Bonus Etc.)

Do You Feel It Is Important To Save All Or Part Of Your Future Raises?

What % Of Your Total Income Do You Pay In Income Taxes?

Do You Normally Receive A Tax Refund? (How Much?)

What Is Your Monthly Take-Home Pay?

What Is The Amount Of Your Monthly Living Expenses?

How Is The Difference Being Used For Your Benefit?

Risk Management:

What Are Your Thoughts Around Life Insurance In General?

What Are Your Spouse's Thoughts Around Life Insurance In General?

Tell Me About Your Existing Life Insurance Coverage (Employer / Personal)

Tell Me About Your Spouse's Existing Life Insurance Coverage (Employer / Personal)

Do you have disability Insurance?

Does your spouse have disability Insurance?

Existing Debt / Final Expenses:

What Amount Would You Want To Provide To Pay Off:

Mortgage:

Existing Debt:

Cost Of Education:

How Much?

How Many Children:

Income Needs:

If The Mortgage, Final Expenses, And Education Are Taken Care Of, How Much After Tax Monthly Income Would Your Family Need To Maintain Their Current Lifestyle?

Minus Surviving Spouses Monthly Income

The Approximate Additional Capital You Would Need To Achieve Your Survivor Income Goal Is:

How Do You Feel About This Number?

Have You Ever Lost Someone Close To You?

What Impact Did Life Insurance Have In That Situation?

Health:

How Is Your Health?

How Is Your Spouse's Health?

Tell Me About Your Health Insurance:

Tell Me About Your Spouse's Health Insurance:

Do You Regularly See Doctor?

Does Your Spouse Regularly See Doctor?

When Was Your Last Physical Examination?

Spouse's When Was Your Last Physical Examination?

Blood Pressure / Cholesterol / Medications?

Spouse's Blood Pressure / Cholesterol / Medications?

Other Than Regular Visits, Have You Had To See Other Physicians?

Other Than Regular Visits, Has Your Spouse Had To See Other Physicians?

Have You Used Tobacco Or Any Form Of Nicotine In The Past 3 Years?

Has Your Souse Used Tobacco Or Any Form Of Nicotine In The Past 3 Years?

Disability Income:

How Do You Feel About Your Current Disability Insurance Coverage?

Would you be willing to share your companies Benefits Brochure with me, so that I may doublecheck the coverage being offered by your employer?

Is It Reasonable To Assume That If You Were Sick Or Injured And Unable To Work, Your Family Would Need The Same Amount Of Income You Currently Earn?

What Would This Mean In Monthly After-Tax Income?

What Concerns Do You Have Regarding Protecting Your Income Against Loss Due To Injury Or Illess?

Long-Term Care:

Tell Me About Your Current Long-Term Care Insurance Coverage (Employer Provided / Personal)

Employer:

Spouse's Employer:

Personal:

Spouse's Personal:

Do You Know Anyone Who Has Needed Long-Term Care Services At Home Or In A Facility?

Have You Considered Long-Term Care Yourself?

Who Would You Consider Capable And Willing To Take Care Of You?

How Would This Impact That Caregivers Lifestyle?

Are You Familiar With The Approximate Costs Of Long-Term Care?

Costs In A Nursing Home Typically Range From $100-$300 Per Day. How Much Would You Like To Plan For?

If You Or Your Spouse Needed Long-Term Care, How Would This Impact Your Family?

Should I Use Current Or Retirement Income To Offset Any Long-Term Care Costs In My Analysis?

Wealth Preservation & Distribution / Wills:

Do you have a written will?

Do You Have A Written Will?

Yes

No

When And Where Was Your Will Executed?

Who Will Be The Guardian Of Your Children?

Are You The Chosen Guardian For Someone Else?

Are You A Us Citizen?

Yes

No

Have You Worked With An Attorney?

Yes

No

Name/Firm

Do You Have Any Distribution Strategies For Your Estate? (Trusts / Gifting / Charitable Giving)

Tithing:

Are You Currently Making Any Charitable Or Educational Gifts / Pledges?

Are You A Us Citizen?

Yes

No

Would You Like To See Them Continue If Something Happened To You?

Yes

No

Have You Made Other Substantial Gifts In The Past?

Yes

No

To What Organizations?

How Do You Feel About Making Gifts To Avoid Estate Taxes At Your Death?

Investor Profile:

How Comfortable Are You With The Topic Of Investing?

Tell Me About The Best Financial Decision You’ve Ever Made.

Tell Me About The Worst Financial Decision You’ve Ever Made.

What Is The Primary Goal For These Invested Assets?

How Many Years Do You Plan To Invest These Assets Before Anticipating Making Withdrawals?

How Long Do You Plan To Make Withdrawals On These Assets In Retirement? (Years)

At Times, Conservative Investments May Earn Less Than The Rate Of Inflation. This May Result In The Loss Of Purchasing Power. How Do You Feel About This, And How Do You Feel About The Risk Associated With Investing To Keep Up With The Rise Of Inflation?

Should I Take Into Account Your Other Secure Assets, Such As Permanent Cash Value Life Insurance, Personal Savings Accounts, Pension, And Fixed Income Assets, When Determining My Asset Allocation Model For You?

Let’s Discuss Risk, And The Potential Amounts Of Risk You Are Willing To Take When Investing.

Successful: Attorneys, Cpas, Salespeople, Business Owners, Other Professionals Neighbors, Associates, Friends, Family Recently Married, Promoted, Purchased A Home, Changed Jobs, Or Had A Child

What Best Describes Your Philosophy And Strategy Towards Investing?

I Am Unaffected By Short-Term Market Movements And Stay Focused On My Long Term Strategy Of Capital Appreciation And Growth.

Although I May Have Some Concerns, I Am Typically A Very Patient Investor With A Wait And See Attitude In Regards To My Long-Term Growth Strategy.

I Can Get Anxious During Market Swings And At Times May Change My Strategies.

Am Uncomfortable With Market Volatility, Which Is Why I Typically Focus On Preservation Of Capital And Current Income.

I Have Never Invested Before.

Favorable Introductions:

How Did You Feel When I First Called You To Set This Appointment?

Now That You’ve Seen The Process To This Point, How Do You Feel About It? Why?

Introductions:

What Best Describes Your Philosophy And Strategy Towards Investing?

Introduction:

Friends Wealth Management is committed to protecting your information. Your information will be used in accordance with all applicable data privacy laws where we operate, and our own privacy policy as well.

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Client Intake Questionnaire

About You / Background

Let’s discuss your goals/objectives:

Personal & Family Information:

Employment:

Interest / Hobbies:

Objectives:

Savings Philosophy:

Retirement:

Inheritance:

Assets / Liabilities / Income:

Income:

Risk Management:

Existing Debt / Final Expenses:

Cost Of Education:

Income Needs:

Health:

Disability Income:

Wealth Preservation & Distribution / Wills:

Tithing:

Investor Profile:

Favorable Introductions:

Introductions:

Services

Investments

COMPANY

resources

Important Disclosure Information