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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 Place:
Birth Date:
Birth Date:
Company:
Home Address:
Home Address:
Company:
Hospitalization Plan:

Hospitalization Plan:

Occupation:
Occupation:
Bus. Phone:
*Bus. Phone:
Home Phone:
*Home Phone:
Health Concerns:
Health Concerns:
*Email:
Company Pension Plan and/or Profit Sharing:
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:
Insured:
Company:
Company:
Amount:
Amount:
Type:
Type:
Individual Disability Insurance
Insured:
Insured:
Company:
Company:
Mo. Benefit:
Mo. Benefit:
Benefit Period:
Benefit Period:
 
 
 

 

4350 Brownsboro Road, Suite #110
Louisville, Kentucky 40207
(502) 589-1772

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