FPC Guide

Personal Financial Planner

The Financial Planning Guide is the first step in planning for your financial future. Your first meeting with us would be spend discussing all of the information contained in this form to determine your needs, goals, and risk tolerance. The second meeting with us would be to discuss specific recommendations we have for you and your financial future. PLEASE NOTE THAT ALL OF THIS INFORMATION IS STRICTLY CONFIDENTIAL. There is no cost or obligation to attend one of our seminars or to meet with us.

Please take a moment to fill this out and submit it to us. As soon as we receive it someone will contact you to set up your first appointment.

[FrontPage Save Results Component]

Name	Spouse's Name
Address	Address
City	City
State	State
Zip	Zip
Phone	Phone
DOB	DOB
SS#	SS#
Employer	Employer
Occupation	Occupation
Employer's Address	Employer's Address
Employer's Phone	Employer's Phone
Children	Age	Status

Bank

Do you have a will? Yes No Date

Does you spouse have a will? Yes No Date

Do you have a Trust Agreement? Yes No Date

Do you have a Durable Power of Attorney? Yes No Date

Indicate general provisions of wills or trusts:

Your Attorney

Your Tax Person

Your Personal Insurance Agent

Have you used any tax shelters? Yes No

List Below tax shelters:

List any relations who are now or are apt to be financially dependent on you:

Do you expect any inheritances? Yes No

Husband Estimated Amount

Wife Estimated Amount

2. Personal Financial Objectives:

Indicate primary objective with a 1 and secondary objective with a 2

Income Now
Income at Retirement
Education Fund
Capital Growth
Tax Reduction
Estate Planning
Other

How many years before retirement?
Current value of IRA
Where invested?
Current value of spouse's IRA
Where invested?

Sources of Monthly Retirement Income:

Social Security - Self
Social Security - Spouse
Projected Company Pension - Self
Project Company Pension - Spouse
Keogh / Sep
401 (K) / 403 (B)
I.R.A. - Self
I.R.A. - Spouse
Dividend Income
Bond Interest
Savings Interest
Partnerships
Net Rental Income
Total

Desired Monthly Income at Retirement:

Insert here the amount of short fall income at retirement, if any, to meet your objective:

We suggest you add a minimum of 5% of each year left before retirement for possible future inflation.

3. Asset Inventory:

a. Fixed Assets:	Current Balance	Percentage Rate	Maturity Date
Checking Account
Savings Account
Savings Account
Certificate of Deposit
Certificate of Deposit
Certificate of Deposit
Certificate of Deposit
Money Market Funds
Money Market Funds
IRA Certificate of Deposit
IRA Certificate of Deposit
IRA Certificate of Deposit
Total Fixed Dollars

b. Variable dollars: (stocks, convertible bonds, mutual funds and variable annuities)

*Ownership - Indicate (H - Husband, W - Wife, P - Pension, JT - Joint Tenancy)

Number of Shares	Preferred or Common	Name of Company	Date Acquired	Cost	Market Value	Ownership*

Total Value of Variable Investment $

c. Fixed dollars: (corporate, municipal, government, E, EE or HH bonds, church & hospital bonds)

*Ownership - Indicate (H - Husband, W - Wife, P - Pension, JT - Joint Tenancy)

Quantity	Rating	Name	% Rate	Maturity Date	Cost	Market Value	Ownership*

Total Value of Fixed Investment

d. Present Insurance and fixed annuities:

Company	Type	Face Amount	Cash Value	Annual Premium	Insured	Ownership	Beneficiary











	Total

e. Real Estate:

Estimated Value of Home
Remaining Mortgage
Equity in Home
Mortgage Rate
Years to Pay
Equity in other Real Estate
Net Income from other Real Estate
Real Estate is:	Income Producing
Real Estate is:	Vacation
Real Estate is:	Raw Land
Total Value of All Real Estate

4. Current Income & Expenses:

Current Monthly Gross Income
Spouse's Monthly Gross Income
Current Monthly Expenses
Amount I could save per month
Last year's taxable income (Line 37, IRS Form 1040)
Last Year's tax paid (Line 38, IRS Form 1040)
Income
Assets