Green Financial Resources
Consultation Data Form
*Required Fields
Green Financial Consultation Data Form
*This information is for use in providing recommendations only and will not be shared with other parties.
So that we may provide the most thorough review of your situation, please provide in advance or have readily available during your meeting, statements for all financial/investment accounts including all 401k/403b accounts, insurance policies, Social Security statements, and anything else that might be relevant to our understanding of your complete financial situation.
Date
Client A Information
Name
Date
Date of Birth
Life Expectancy
Planned Retirement Age
Already retired?
Yes No
Address Line 1
Street address, P.O. box, company name, c/o
Address Line 2
Apartment, suite , unit, building, floor, etc.
City / Town
State / Province / Region
Zip / Postal Code
Cell Number
Preferred E-mail
Occupation
Employer
* If retired, provide prior occ and employer
Work Address Line 1
Street address, P.O. box, company name, c/o
Work City / Town
Work State / Province / Region
Work Zip / Postal Code
Yearly Income
Annual Salary Increase (%)
Tax Bracket (FED)
Tax Bracket (ST)
Filing Status
Client B Information
Name
Date
Date of Birth
Life Expectancy
Planned Retirement Age
Already retired?
Yes No
Address Line 1
Street address, P.O. box, company name, c/o
Address Line 2
Apartment, suite , unit, building, floor, etc.
City / Town
State / Province / Region
Zip / Postal Code
Cell Number
Preferred E-mail
Occupation
Employer
* If retired, provide prior occ and employer
Work Address Line 1
Street address, P.O. box, company name, c/o
Work City / Town
Work State / Province / Region
Work Zip / Postal Code
Yearly Income
Annual Salary Increase (%)
Tax Bracket (FED)
Tax Bracket (ST)
Filing Status
Children
Child's #1 Name
Child's #1 Age
Expenses
What are your average monthly expenses?
Goals
In the next five years, how much of your investments or savings do you plan on spending?
Year 1
Year 2
Year 3
Year 4
Year 5
Monthly after-tax income desired at retirement in today's dollars?
Do you have a Financial Power of Attorney?
Client A
Yes No
Client B
Yes No
Do you have a Living Will/Healthcare Advance Directive?
Client A
Yes No
Client B
Yes No
Do you have a will?
Client A will
Yes No
Year Last Updated:
Client B will
Yes No
Year Last Updated:
Do you have any trusts?
Client A trusts
Yes No
If yes, please list:
Client B trusts
Yes No
If yes, please list:
Do you expect to support someone outside of normal dependent support (handicapped child, parent, etc)?
Yes No
Details:
Is an inheritance part of your overall financial planning (giving or receiving)?
Yes No
Details:
Investments
Type: PS = Passbook Savings; MM = Money Market; TB = Treasury Bills; I = IRA; R = Roth; 4T = Traditional 401K; 4R = Roth 401(k); SI = SEP-IRA; T = TSA or 403B; S = Stock; MF = Mutual Funds; RE = Real Estate Investment Trust; B = Bonds; CD = CDs; O = Other (explain)
*If your employer matches any contributions, please list amount along with your contribution
Type
Company Name
Amount
Beneficiary
Yearly Contributions*
Insurance/Annuities
Type: T = Term*; U = Universal Life; V = Variable Life; VL = Variable Universal Life; W = Whole Life; VA = Variable Annuity; LT = Long-Term Car; DI = Disability; FA = Fixed Annuity
Company Name
Face Amount
Insured
Type
Premium
Loans Against
Monthly Benefit
Beneficiary
Pensions & Social Security
Client A/B
P/S
Start Year
End Year
Monthly Benefits
Increase? Y/N
Monthly Payments
Real Estate
Type: PR = Primary Residence; SR = Secondary Residence; RR = Rental Residential; RC = Rental Commercial; O = Other
#: F = First Mortgage; S = Second Mortgage; T = Third Mortgage
Type
#
Location
Market Value
Balance
Term
Issue Date
Interest Rate
Monthly Payments
Income
Liabilities/Expenses
Item/Company: Auto, Credit Cards, Student Loans, Charitable Giving, etc.
Item/Company
Balance
Interest Rate
Minimum Payment
Current Payment
Overall estimated monthly expenses including all liabilities listed above:
Other important information
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All recommendations are based upon the information provided by you and other information disclosed in discussions. Any failure to provide complete information or to advise of material changes to retirement plans or financial situation may render such retirement planning recommendations invalid