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Why Request a Retirement Review
Client Data Gathering & Goals
Mobile-friendly intake. No downloads needed.
Contact Information
Combined Household Retirement Income Need ($/month)
Desired Retirement Lifestyle (brief description)
Household & Timing
Marital Status...
Married
Single
Divorced
Widowed
Goals & Priorities (Rate the importance)
1 = Least important · 5 = Most important
1
2
3
4
5
I want to make sure that I have enough retirement income and that it lasts throughout my lifetime.
I would like to ensure that my assets are protected from losses.
I would like to protect myself and my family from catastrophic long-term care costs.
I would like to save more money for retirement than the IRS currently allows under today’s IRA rules and limitations.
I would like to grow my retirement savings so that I have access to it without IRS age 59½ restrictions.
I would like to pass my retirement assets on to the next generation in an orderly, tax-efficient manner.
I would like a retirement program that reduces tax liability.
Income Sources
Assets
List account name, description, and balance. Choose ownership and type.
Ownership...
His Account
Her Account
Joint Account
Type...
Qualified
Non-Qualified
Ownership...
His Account
Her Account
Joint Account
Type...
Qualified
Non-Qualified
Ownership...
His Account
Her Account
Joint Account
Type...
Qualified
Non-Qualified
Ownership...
His Account
Her Account
Joint Account
Type...
Qualified
Non-Qualified
Ownership...
His Account
Her Account
Joint Account
Type...
Qualified
Non-Qualified
Ownership...
His Account
Her Account
Joint Account
Type...
Qualified
Non-Qualified
Ownership...
His Account
Her Account
Joint Account
Type...
Qualified
Non-Qualified
Ownership...
His Account
Her Account
Joint Account
Type...
Qualified
Non-Qualified
Ownership...
His Account
Her Account
Joint Account
Type...
Qualified
Non-Qualified
Ownership...
His Account
Her Account
Joint Account
Type...
Qualified
Non-Qualified
Liabilities
Insurance
Estate Planning
Do you have a Will?
Yes
No
Do you have a Financial Power of Attorney?
Yes
No
Do you have a Medical Power of Attorney?
Yes
No
Is your MPOA electronically filed?
Yes
No
Do you have a Trust?
Yes
No
Additional Notes
I consent to be contacted for planning purposes.
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