Client Data Form Powered by SPF Advisors

PLEASE CHOOSE THE CLIENTS TAX FILING STATUS

Contact Information
Client Spouse
First Name
Last Name
Birth Date
Phone
Email
Street Address
City, State, Zip
Professional Contact Information
Profession Name Email Address Telephone
Accountant
Estate Planning Attorney
Other Information
Question Yes No Updated
Do you own health insurance?
Do you own disability insurance?
Have you named your beneficiaries?
Do you have a will?
Do you have a trust?
Family Information
Name Relationship Date of Birth Spouse’s Name
Beneficiary Information
Name Relationship Date of Birth Address
Goals
Date Description
Notes
Date Description
Software Tab 1 - Income
Employment Income
Client 1 Client 2
Employer
Current Gross Monthly Salary
$
$
Projected Annual Salary Increase %
%
%
Projected Retirement Date
Pension or Employer Sponsored Retirement Plan
Owner Description Start Age Life or End Age Gross Monthly Benefit Projected COLA % to Survivor
$
%
%
$
%
%
Software Tab 2 - Assets
Retirement Assets
Owner Company Tax Classification IRA, 401k, etc Investment Vehicle CD, Bond etc Allocation Account Value Account Number
$
$
$
$
$
$
$
Retirement Assets Continued
Owner Company Tax Classification IRA, 401k, etc Investment Vehicle CD, Bond etc Allocation Account Value Account Number
$
$
$
Additional Assets
Owner Company Description Value
Single Premium Annuities
Owner Company Tax Classification Payout Mode Initial Account Value Benefit Amount Benefit Start Date Benefit End Date
$
$
$
$
Income Benefit Annuities
Owner Company Tax Classification Payout Payout Mode Account Value Benefit Amount Benefit Start Date Benefit End Date
$
$
$
$
$
$
Portfolio Information
Amount
Projected Before Retirement Rate of Return
%
Projected After Retirement Rate of Return
%
Minimum Retirement Funds
$
Software Tab 3 - Expenses
Monthly Expenses
Current Monthly Expenses After Tax Projected Inflation Rate
$
%
Advanced Monthly Budget Worksheet
Household
Description Monthly Amount Inflation % Start Date End Date
Mortgage Principal & Interest
$
%
Real Estate Taxes
$
%
Homeowners Insurance
$
%
Home Equity Loan
$
%
Association Dues
$
%
Rent
$
%
Renters Insurance
$
%
Utilities – Gas – Electric
$
%
Water – Sewer
$
%
Cable – Phone – Internet
$
%
Maintenance & Improvement
$
%
House Cleaning
$
%
Daily Living
Description Monthly Amount Inflation % Start Date End Date
Food
$
%
Dining Out
$
%
Clothing
$
%
Personal Care
$
%
Healthcare & Insurance
Description Monthly Amount Inflation % Start Date End Date
Health Insurance
$
%
Prescriptions
$
%
Life Insurance
$
%
Long Term Care Insurance
$
%
Disability Insurance
$
%
Veterinarian
$
%
Transportation
Description Monthly Amount Inflation % Start Date End Date
Auto Loans
$
%
Auto Insurance
$
%
Fuel
$
%
Repairs
$
%
Debt & Obligations
Description Monthly Amount Inflation % Start Date End Date
Credit Cards
$
%
Tuition – Student Loans
$
%
Alimony
$
%
Child Support
$
%
Entertainment
Description Monthly Amount Inflation % Start Date End Date
Parties & Events
$
%
Sports – Hobbies – Lessons
$
%
Membership Dues
$
%
Vacation & Travel
$
%
Miscellaneous
Description Monthly Amount Inflation % Start Date End Date
Charitable Donations
$
%
Gifts
$
%
Other
$
%
Liabilities
Owner Company Description Value
Future Cash Flows
Owner Description Mode Type Taxation Amount % Change Start Date End Date
$
%
$
%
$
%
Software Tab 6 – Red Line Solves Button
The analysis may show you running out of money during retirement. If this were to occur, how would you rank taking the following steps to help alleviate the red line? Use a scale of 1-6 where 1 would be the most desirable step and 6 the least desirable step.
Red Line Solutions Steps – Rank from 1-6 Ranking
Retire at a later date.
Work a second or part time job after retirement.
Reduce monthly expenses.
If not yet retired, increase contributions to retirement savings.
Reverse mortgage.
Look for other income alternatives.
Software Tab 7 – Life Insurance
Health Information
Client Smoker Health Concerns
Existing Life Insurance Information
Owner Company Type Death Benefit Monthly Premium Cash Value Policy End Date
$
$
$
$
$
$
$
$
$
Software Tab 8 – Long Term Care
Existing Long-Term Care Coverage Information
Owner Company Type Start Date Daily Benefit Years Inflation Type Inflation % Monthly Premium
$
%
$
$
%
$
Client Signatures

I hereby attest that the information on this Client Data Form has been provided by me and to the best of my knowledge is accurate. I further understand that the information provided will be used with your retirement software to create my retirement analysis. The information gathered with this form will be used for the sole purpose of helping create a financial strategy for your retirement. The financial professional providing the analysis does not provide tax or legal advice. Tax or legal advice will come from a qualified professional.