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Your Profile

Financial Profile

This form is designed to get a general assessment of your financial picture. Please complete the following information, using estimates when necessary.

You may complete the form below by filling in the fields and press "Submit Profile" or Click here to use our printable form version.

(*) Required field

Social Security:

Spouse SSN:

Spouse Name:

*Client Name:

Birth Place:

Birth Date:

Company:

Home Address:

Company:

Hospitalization Plan:

Occupation:

Bus. Phone:

*Bus. Phone:

Home Phone:

*Home Phone:

Health Concerns:

*Email:

Company Pension Plan and/or Profit Sharing:

Children (list names, birthdates, and ages:

Attorney's name/firm:

Accountant's name/firm:

Estimated monthly household expenses:

Insurance Agent:

Investment Advisor:

Client Salary:

Spouse Salary:

Client Bonus:

Spouse Bonus:

Client Net Investments:

Spouse Net Investments:

Client Other Income:

Spouse Other Income:

Client Total:

Spouse Total:

Do you have a will?

Do you have a trust?

Do you have a regular savings plan?

List your short term financial objectives:

List your long term financial objectives:

Explain what you are looking for from the financial planning process:

How did you hear about Financial Architects?

Balance Sheet

Assets

Fair Market Value

Owner

Checking:

Savings/Ct. Union:

Money Mkt. Fund:

Listed Securities:

Bus. Int. (FMV):

Residence:

Real Estate:

Notes: accts. rec.

Autos:

Personal Property:

Cash Values/
Life Insurance:

Pension/PR. Sharing:

KEOGH:

IRA:

401 (k):

Other Assets:

Total Assets:

Liabilities

Notes payable, unsecured:

Notes payable, secured:

Home Mortgage:

Second Mortgage:

Real estate Mortgage:

Loans, Autos:

Unpaid Income Tax:

Charge Accounts/Bills:

Credit Cards:

Other Debts:

Total Liabilities:

Net Worth:

Life Insurance

Insured:

Company:

Amount:

Type:

Individual Disability Insurance

Insured:

Company:

Mo. Benefit:

Benefit Period:

505 South Third Street, Suite #300
Louisville, Kentucky 40202
(502) 589-1772

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