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QCDD-A-003 Data Collection Questionnaire
DATA COLLECTION QUESTIONNAIRE
CONFIDENTIAL
File no.:
Client name 1:
Client name 2:
Client type:
Questionnaire completed on:
Updated:
Financial planner:
*You can insert your logo here to personalize this document. This document was created for informational purposes only. The IQPF can not be held responsible for errors or losses incurred following
its use.
*You can insert your logo here to personalize this document. This document was created for informational purposes only. The IQPF can not be held responsible for errors or losses incurred following its use. 1
QCDD-A-003 Data Collection Questionnaire
SECTION 1: PERSONAL INFORMATION
Residence and job
Client 1: Client 2: Mr. Ms. Mr. Ms.
Address: Since (date): Date and place of birth: Date and place of birth: Start date of residence in Canada: Start date of residence in Canada: Citizenship: Citizenship: S.I.N.: S.I.N.: Home phone: Home phone: Office phone: Office phone: Cell phone: Cell phone: Fax: Fax: Email: Email:
employer self-employed retired
employer self-employed retired
Name: Name: Address: Address: Since (date): Since (date): Position: Position: Job type: 1 2 3 4 Job type: 1 2 3 4
1. Permanent 2. Temporary 3. Independent 4. No job
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QCDD-A-003 Data Collection Questionnaire
Civil and matrimonial statusClient 1: Client 2:
Since (date) Since (date) single single married/civil
union married/civil union
de facto union1 de facto union1 widowed widowed legally
separated legally separated
divorced divorced
Support paymentsClient 1 Client 2
paid received not applicable
paid received not applicable
Marriage or civil union contract (append a copy to the questionnaire) partnership of acquests separation of property community of
property other n/aCohabitation agreement (append a copy to the questionnaire)
yes no not applicableSurrender of family property rights
yes no not applicable
yes no not applicable
1 Also indicate civil status under the Civil Code of Québec.
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QCDD-A-003 Data Collection Questionnaire
Children GrandchildrenFirst
nameDate of
birth Job Annual income
Civil status
Last name
First name
Date of birth
1)
2)
3)
Comments:
Other informationClient 1 Client 2
smoker non-smoker never smoked
smoker non-smoker never smoked
State of health: 1 2 3 4
State of health: 1 2 3 4
1. Excellent 2. Good 3. Fair 4. Poor
Details:
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QCDD-A-003 Data Collection Questionnaire
Professional advisors
Name Firm and address Phone Fax Email
Lawyer Notary Accountant or tax expert
Account manager
Financial security advisor
Broker’s representative
Liability insurance broker or agent
Other:
For the Client 2, if different:
Name Firm and address Phone Fax Email
Lawyer Notary Accountant or tax expert
Account manager
Financial security advisor
Broker’s representative
Liability insurance broker or agent
Other:
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QCDD-A-003 Data Collection Questionnaire
SECTION 2: GOAL SUMMARY
Personal and family situation
Yes No CommentsGet married or enter civil union Live in a de facto union Get divorced Adopt children Have children Separate Other:
Financial situation
Yes No CommentsEvaluate net worth Evaluate cost of living Eliminate personal debts Establish a savings strategy Purchase a home Review investment strategy Help children or grandchildren pursue higher education
Other:
Tax situation
Yes No CommentsReduce income taxes Optimize after-tax investment income Evaluate compensation method Evaluate business structure Use income-splitting strategies Other: Protection situation
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QCDD-A-003 Data Collection Questionnaire
Yes No CommentsDraft or update a mandate in case of incapacity
Draft or update a general power of attorney
Review personal disability protection Review business-related disability protection
Review other personal sickness or accident protections
Review other business-related sickness or accident protections
Other:
Retirement situation
Yes No CommentsRetire at age . Maintain a cost of living of , in today’s dollars.
Evaluate options for cashing out RRSPs, RRIF, annuities, etc.
Choose between a defined benefit pension plan and transfer to a LIRA
Set up an individual pension plan Other:
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QCDD-A-003 Data Collection Questionnaire
Situation at death
Yes No CommentsDraft or update the will Determine life insurance needs Maintain current cost of living for heirs for years
Provide additional bequests for heirs Provide other bequests, such as to a foundation
Minimize taxes payable on death Business: ensure continuation of the
business after death
Other:
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QCDD-A-003 Data Collection Questionnaire
SECTION 3: FINANCE
ActifClient 1 Client 2
PassifClient 1 Client 2
Determination of cost of living
How much do you save annually in your RRSP?
How much do you save annually in your TFSA?
How much do you save annually in an unregistered account?
Are you expecting any unusual income or expenses in the next year (e.g., trips, renovations)?
yes no Comments:
Have you made funeral pre-arrangements? oui non Commentaire
s :
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QCDD-A-003 Data Collection Questionnaire
SECTION 4: TAXATION
Determination of after-tax income
Complete Appendix C using tax returns (or summaries) for the last three years.Client 1 Client 2
Annual earnings: $ $ Form (salary, commissions, business income, dividends):
If earnings are variable, enter possible range:
Client 1 Client 2Gross rental income: $ $ Deductible expenses: $ $ Net rental income before depreciation: $ $ Capital cost allowance: $ $ Net rental income: $ $
Client 1 Client 2Effective (or average) tax rate % %Marginal tax rate % %Net capital losses from prior years $ $ TFSA contribution rights $ $ $
Taxable capital gains declared in last 3 years:
Year: Amount:
In most cases, it is preferable to confirm this information with the tax authorities.
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QCDD-A-003 Data Collection Questionnaire
Have you sold any property since the beginning of the year? yes no
If so, complete the following chart.
Description Year of acquisition Quantity
Net proceeds of disposition
ACB UCC Gain or loss
Recapture of depreciation
1) 2) 3)
Home Buyer’s Plan (HBP) or Lifelong Learning Plan (LLP)
HBP LLP Client 1 Client 2Year of withdrawal Amount withdrawn $ $ Amount of annual reimbursement
$ $
Balance no January 1st $ $
Comments:
What amount is available for the capital gains deduction from the sale of qualified small business corporation shares? What amount is available for qualified farming or fishing property?
Client 1 Type of property Amount availableQSMCSs Qualified farming or fishing property
Client 2 Type of property Amount availableQSMCSs Qualified farming or fishing property
Have any of your investments been chosen mainly for tax reasons?
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QCDD-A-003 Data Collection Questionnaire
Do you have foreign investment property ?
yes no Comments: For all the years when the total cost of foreign investment assets exceeds the CA$100,000 threshold, a declaration must be made in the federal tax return and federal form T1135 must be filed.
Did you make an election in your 1994 tax return in relation to property you owned on February 22, 1994?
yes no
If so, complete the following table:
Description QuantityAmount of election
$
Other: SECTION 5: RETIREMENT
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QCDD-A-003 Data Collection Questionnaire
Client 1 Client 2yes no yes no
Are you eligible for the Old Age Security pension (OAS)?Are you eligible for the Québec Pension Plan or the Canada Pension Plan (append a statement of contributions)?Do you belong to a registered pension plan (RPP), a supplemental pension plan, a stock option plan, etc.?If so, please append a copy of the most recent statement of participation and all documentation concerning the plan (brochures, regulations, etc.) and complete note 15 in the personal balance sheet.
Do you belong to a group RRSP or group DPSP offered by your employer?If so, append a copy of the most recent statement of participation .
Do you always contribute the annual maximum to your RRSP* or spousal RRSP?When do you make your annual RRSP or spouse RRSP contribution?End of yearBeginning of yearSystematic savings program
Additional information about the RRSP:Deduction limit for Minus: Unused contributions previously reported and available to deduct in
Available contribution room for Excess contributions Obtain Appendix 7 and the most recent federal notice of assessment
Other information:
SECTION 6: LEGAL ASPECTS AND ESTATES
Details about the investments held inside the RRSP are provided in Section 3 – Finances, of this question, in the personal balance sheet.
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QCDD-A-003 Data Collection Questionnaire
Client 1 Client 2
yes no N/A yes no N/A
Do you have a will?If so, append a copy.
Is there a “last survivor” clause in your marriage or civil union contract?Does your will still reflect your last wishes?Do you want to leave a bequest to a charity?Have you drawn up a protection mandate (mandate in case of incapacity)?Do you have a general power of attorney?Do you have commitments arising from a previous marriage or union?Do you serve as the administrator of the assets of another person (tutor, liquidator, trustee or mandatary)?Do you have a shareholders’ or partners’ agreement?
Comments:
Note: It is important to get a copy of all existing legal documents.SECTION 7: INVESTMENTS
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QCDD-A-003 Data Collection Questionnaire
Client 1%
Client 2%
Determination of investor profileCash securities Fixed-income securities Growth securities
100 100Do you subscribe to an RESP?
yes no n/a Comments: If so, please provide the most recent account statements.
yes no n/a yes no n/aAre any of your loans for investment purposes?
yes no yes noAre any of your investments accounts to finance a specific plan or project?
SECTION 8: INSURANCE
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QCDD-A-003 Data Collection Questionnaire
Client 1 Client 2yes no N/A yes no N/A
Do you have life insurance ?Do you have disability insurance *?Do you have critical illness insurance *? Long-term care? Access to care?Are your loans covered by life insurance with the lending institution?Are your loans covered by disability or critical illness insurance with the lending institution?Does a corporation hold insurance on your life?
You must obtain recent statements to understand the provisions of the contracts.
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QCDD-A-003 Data Collection Questionnaire
APPENDIX A
PERSONAL BALANCE SHEET AS AT
Client 1$
Client 2$
Total$
ASSETSCash and near-cash assetsBank accounts (note 3) Life insurance cash surrender value (note 4) Non-registered investments (note 5) Tax-free savings account (note 6) Advances receivable (note 7) Other:
Total cash and near-cash assets Personal assetsPrincipal residence (note 8) Secondary residence (note 9) Automobiles (note 10) Antiques, works of art, jewellery, collections (note 11)
Other: Total personal assets
Income-producing assetsEquity ownership in a private corporation or partnership (note 12)
Rental property (note 13) Other:
Total income-producing assets Deferred taxation plansRRSP, RPDB or RRIF (note 14) Registered Pension Plan (note 15) LIRA or LIF (note 16) RESP or RDSP (note 17) Québec pension plan (QPP) (note 18) Other assets:
Total deferred taxation plans
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QCDD-A-003 Data Collection Questionnaire
Client 1$
Client 2$
Total$
TOTAL ASSETS LIABILITIESAccounts payable (note 19)Unpaid credit card balances Credit purchases Taxes payable Other:
Total accounts payable
Personal loans (note 20)Bank overdraft Line of credit Car RRSP Investments Advances received from a private corporation Other:
Total personal loans Mortgage loans (note 21)Principal residence Secondary residence Rental property Other:
Total mortgage loans Future income taxes (note 22)
TOTAL LIABILITIES
NET WORTH
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QCDD-A-003 Data Collection Questionnaire
Notes to the personal balance sheet
NOTE 1: Personal, professional and family situation
NOTE 2: Accounting conventionsAssets and liabilities are evaluated at their estimated current value.
NOTE 3: Bank accounts
Financial institution Type of account Balance$
1) 2) 3)
Total:
NOTE 4: Life insurance cash surrender value
Type of contract Cash surrender value$ Comments
1) 2)
Total:
NOTE 5: Non-registered investments
LIQUID SECURITIESSavings bonds
Issuer Series Interest rate Maturity Face value$
Accrued value
$1) 2)
Total:
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QCDD-A-003 Data Collection Questionnaire
Term deposits or guaranteed investment certificates maturing in less than 1 year
Financial institution Date of deposit Date of
maturity Interest rate Accrued value$
1) 2) 3)
Total: Bonds maturing in less than 1 year
Issuer Date of acquisition
Cost of acquisition
$Interest rate Maturity
Market value
$1) 2) 3)
Total: Money market mutual fund
Description
Date of acquisition MER ACB
$Number of
unitsMarket value
$Total
$
1) 2) 3)
Total:
Other liquid securities
Total:
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QCDD-A-003 Data Collection Questionnaire
FIXED-INCOME SECURITIESTerm deposits or guaranteed investment certificates
Financial institution Date of deposit Date of
maturity Interest rate Accrued value$
1) 2) 3)
Total:
Bonds
Issuer Date of acquisition
Cost of acquisition
$Interest rate Maturity
Market value
$1) 2) 3)
Total:
Stripped bonds
Issuer Date of acquisition
Cost of acquisition
$Rate of return
Market value$
1) 2)
; Total Note: Also indicate interest declared each year on income tax return.Redeemable preferred shares
Description
Date of acquisitio
nACB
$Rate of return Maturity Quantity
Market value
$Total
$
1) 2) 3)
Total:
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QCDD-A-003 Data Collection Questionnaire
Fixed income mutual funds
Description
Date of acquisition
ACB$
Rate of return Maturity Quantity Market
value $1) 2) 3)
Total:
Other fixed income securities
Total: GROWTH SECURITIESCommon shares
Description
Date of acquisition
ACB$
Annual dividend Quantity
Market value
$Total
$
1) 2) 3) 4)
Total:
Perpetual preferred shares
Description
Date of acquisiti
onACB
$Rate of return Maturity Quantity
Market value
$Total
$1) 2) 3)
Total:
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QCDD-A-003 Data Collection Questionnaire
Growth securities mutual funds
Description
Date of acquisition MER ACB
$Number of
unitsMarket value
$Total
$
1) 2) 3)
Total:
Income trusts
Description
Date of acquisition
ACB$
Annual distributio
ns$
QuantityMarket value
$Total
$
1) 2) 3)
Total: Note: The ACB should be adjusted downward each year to reflect capital distributions.
Other growth securities
Total:
NOTE 6: Tax-free savings account (TFSA)
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QCDD-A-003 Data Collection Questionnaire
LIQUID SECURITIESSavings bonds
Issuer Series Interest rate Maturity Face value$
Accrued value$
1) 2)
Total: Term deposits or guaranteed investment certificates maturing in less than 1 year
Financial institution Date of deposit Date of
maturity Interest rate Accrued value$
1) 2) 3)
Total:
Bonds maturing in less than 1 year
Issuer Date of acquisition
Cost of acquisition
$Interest rate Maturity
Market value
$1) 2) 3)
Total:
Money market mutual fund
Description
Date of acquisition MER ACB $ Number of
unitsMarket value
$Total
$
1) 2) 3)
Total:
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QCDD-A-003 Data Collection Questionnaire
Other liquid securities
Total: FIXED-INCOME SECURITIESTerm deposits or guaranteed investment certificates
Financial institution Date of deposit Date of
maturity Interest rate Accrued value$
1) 2) 3)
Total:
Bonds
Issuer Date of acquisition
Cost of acquisition
$Interest rate Maturity
Market value
$1) 2) 3)
Total:
Stripped bonds
Issuer Date of acquisition
Cost of acquisition $ Rate of return Market value
$1) 2)
Total:
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QCDD-A-003 Data Collection Questionnaire
Redeemable preferred shares
Description
Date of acquisitio
nACB
$Rate of return Maturity Quantity
Market value
$Total
$
1) 2) 3)
Total:
Fixed income mutual funds
Description
Date of acquisition
ACB$
Rate of return Maturity Quantity Market
value $1) 2) 3)
Total:
Other fixed income securities
Total: GROWTH SECURITIESCommon shares
Description
Date of acquisition ACB $ Annual
dividend Quantity Market value $ Total $
1) 2) 3) 4)
Total:
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QCDD-A-003 Data Collection Questionnaire
Perpetual preferred shares
Description
Date of acquisiti
onACB $ Rate of
return Maturity Quantity Market value $ Total $
1) 2) 3)
Total:
Growth securities mutual funds
Description
Date of acquisition MER ACB
$Number of
unitsMarket value $ Total $
1) 2) 3)
Total:
Income trusts
Description
Date of acquisition ACB $
Annual distributio
ns $Quantity Market
value $ Total $
1) 2) 3)
Total:
Other growth securities
Total:
Total TFSA:
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QCDD-A-003 Data Collection Questionnaire
NOTE 7: Advances receivable
NOTE 8: Principal residence
Address Year of acquisition
Price paid$
Municipal evaluation
$Market value
$
Note: Include the price paid for major improvements or renovations. If the market
value differs from the municipal evaluation, identify the evaluation method.
NOTE 9: Secondary residence
Address Year of acquisition
Price paid$
Municipal evaluation
$Market value
$
Note: Include the price paid for major improvements or renovations. If the market
value differs from the municipal evaluation, identify the evaluation method.
NOTE 10: Cars
Model Year Cost of acquisition$
Market value$
1) 2)
Total:
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QCDD-A-003 Data Collection Questionnaire
NOTE 11: Antiques, works of art, jewellery, collections
Description ACB$
Market value$
1) 2) 3)
Total Note: Specify how market value was established.
If there are charitable objectives, indicate the date and circumstances of acquisition of these assets.
NOTE 12: Equity ownership in a private corporation or partnership
Description % ownership
ACB$
Market value$
1) 2)
Total:
Note: Identify the evaluation method. The company’s financial statements can be.
NOTE 13: Rental property
Description Address Date of acquisition
ACB$
UCC$
Municipal evaluation
$
Market value
$1)
Land portion n/a
2)
Land portion n/a
Total
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QCDD-A-003 Data Collection Questionnaire
NOTE 14: Registered Retirement Savings Plan (RRSP), Deferred Profit-Sharing Plan (DPSP) or Registered Retirement Income Fund (RRIF)
LIQUID SECURITIESSavings bonds
Issuer Series Interest rate Maturity Face value$
Accrued value
$1) 2)
Total:
Term deposits or guaranteed investment certificates maturing in less than 1 year
Financial institution Date of deposit Date of
maturity Interest rate Accrued value$
1) 2) 3)
Total:
Bonds maturing in less than 1 year
Issuer Date of acquisition
Cost of acquisition
$Interest rate Maturity
Market value
$1) 2) 3)
Total
Money market mutual fund
Description
Date of acquisition MER ACB
$Number of
unitsMarket value $
Total$
1) 2)
Total:
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QCDD-A-003 Data Collection Questionnaire
*You can insert your logo here to personalize this document. This document was created for informational purposes only. The IQPF can not be held responsible for errors or losses incurred following its use. 31
QCDD-A-003 Data Collection Questionnaire
Other liquid securities
Total: FIXED-INCOME SECURITIESTerm deposits or guaranteed investment certificates
Financial institution Date of deposit Date of
maturity Interest rate Accrued value$
1) 2) 3)
Total:
Bonds
Issuer Date of acquisition
Cost of acquisition
$Interest rate Maturity
Market value
$1) 2) 3)
Total:
Stripped bonds
Issuer Date of acquisition
Cost of acquisition $ Rate of return Market value
$1) 2)
Total:
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QCDD-A-003 Data Collection Questionnaire
Redeemable preferred shares
Description
Date of acquisitio
nACB
$Rate of return Maturity Quantity
Market value
$Total
$
1) 2) 3)
Total:
Fixed income mutual funds
Description
Date of acquisition
ACB$
Rate of return Maturity Quantity Market
value $1) 2) 3)
Total:
Other fixed income securities
Total: GROWTH SECURITIESCommon shares
Description
Date of acquisition ACB $ Annual
dividend Quantity Market value $ Total $
1) 2) 3) 4)
Total:
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QCDD-A-003 Data Collection Questionnaire
Perpetual preferred shares
Description
Date of acquisiti
onACB
$Rate of return Maturity Quantity
Market value
$Total
$1) 2) 3)
Total:
Growth mutual funds
Description
Date of acquisition MER ACB
$Number of
unitsMarket value $
Total$
1) 2) 3) 4)
Total:
Income trusts
Description
Date of acquisition
ACB$
Annual distributio
ns $Quantity Market
value $Total
$
1) 2) 3)
Total:
Other growth securities
Total: Total RRSP or RRIF:
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QCDD-A-003 Data Collection Questionnaire
NOTE 15: Registered Pension Plan
Defined benefits
Participant Contribution rate
Pension accumulation
rate
Earnings subject to
contributions$
Current value $
Other features
1) 2)
Other relevant information: Defined contribution
ParticipantContributio
nrate
Employer contribution
rate
Earnings subject to
contributions$
Market value $
Other features
1) Investment characteristics:
2) Investment characteristics:
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QCDD-A-003 Data Collection Questionnaire
NOTE 16: Voluntary Retirement Savings Plan (VRSP), Locked-In Retirement Account (LIRA) or Life Income Fund (LIF)
LIQUID SECURITIESSavings bonds
Issuer Series Interest rate Maturity Face value$
Accrued value
$1) 2)
Total:
Term deposits or (Guaranteed investment certificates) maturing in less than 1 year
Financial institution Date of deposit Date of
maturity Interest rate Accrued value$
1) 2) 3)
Total:
Bonds maturing in less than 1 year
Issuer Date of acquisition
Cost of acquisition
$Interest rate Maturity
Market value
$1) 2) 3)
Total:
Money market mutual funds
Description
Date of acquisition MER ACB
$Number of
unitsMarket value $
Total$
1) 2) 3)
Total:
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QCDD-A-003 Data Collection Questionnaire
*You can insert your logo here to personalize this document. This document was created for informational purposes only. The IQPF can not be held responsible for errors or losses incurred following its use. 37
QCDD-A-003 Data Collection Questionnaire
Other liquid securities
Total: FIXED INCOME SECURITIESTerm deposits or guaranteed investment certificates
Financial institution Date of deposit Date of
maturity Interest rate Accrued value$
1) 2) 3)
Total:
Bonds
Issuer Date of acquisition
Cost of acquisition
$Interest rate Maturity
Market value
$1) 2) 3)
Total:
Stripped bonds
Issuer Date of acquisition
Cost of acquisition
$Rate of return Market value
$
1) 2)
Total:
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QCDD-A-003 Data Collection Questionnaire
Redeemable preferred shares
Description
Date of acquisitio
nACB
$Rate of return Maturity Quantity
Market value
$Total
$
1) 2) 3)
Total:
Fixed income mutual funds
Description
Date of acquisition
MER$
ACB$
Nomber of units
Market value
$Total
$
1) 2) 3)
Total:
Other fixed income securities
Total: GROWTH SECURITIESCommon shares
Description
Date of acquisition ACB $ Annual
dividend QuantityMarket value
$Total
$
1) 2) 3) 4)
Total ;
*You can insert your logo here to personalize this document. This document was created for informational purposes only. The IQPF can not be held responsible for errors or losses incurred following its use. 39
QCDD-A-003 Data Collection Questionnaire
Growth mutual funds
Description
Date of acquisition MER ACB
$Number of
unitsMarket value $
Total$
1) 2) 3) 4)
Total:
Income trusts
Description
Date of acquisition
ACB$
Annual distributio
ns $Quantity Market
value $Total
$
1) 2) 3)
Total:
Other growth securities
Total: Total LIRA or LIF:
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QCDD-A-003 Data Collection Questionnaire
NOTE 17: Registered Education Savings Plan or Registered Disability Savings Plan
Note: The RESP should only appear in the subscriber’s personal balance sheet and the value is equal to contributions made. The total value of the RDSP should appear in the beneficiary’s personal balance sheet.
NOTE 18: Québec Pension Plan
ClientAccrued
pension at age 65
Discount rate Life expectancy
Current value
$Before 65
65 and +
Comments:
NOTE 19: Accounts payable
Description Maturity date Interest rate Amount$
1) 2) 3) 4) 5)
Total:
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QCDD-A-003 Data Collection Questionnaire
NOTE 20: Personal loans
Description Date of loan Date of maturity
Payments$ Interest rate
Original amount
$Balance
$
1) 2) 3) 4) 5)
Total:
NOTE 21: Mortgage loans
Lender Description
Date of
loan
Date of maturit
y
Payments$
Amortization
Frequency
Interest rate
Original amount
$Balance
$
1) 2) 3) 4)
Total
NOTE 22: Future income taxes
Client 1
Asset FMV$ Estimated tax rate Future income tax
$
Client 2
Asset FMV$ Estimated tax rate Future income tax
$
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QCDD-A-003 Data Collection Questionnaire
NOTE 23: Life, disability and other insurance contracts
Life insurance
Issuer
Underwritin
g year
Type of
contract
Owner
Adheren
tInsured
Beneficiary
$
Annual premiu
m$
Cash surrender value
$
Adjusted cost base
$
Capitalization fund
Death bene
fitPayer
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Comments:
Disability insuranceSalary (group insurance)
Issuer
Premium$
Waiting period
Monthly income
$
Taxation of
benefits
Duration of
benefits
%indexa
tion
Profession
protected for
(years)
Comments: Income loss
Issuer
Underwriting year
Premium $
Waiting
period
Monthly
income $
Duration of
benefits
% indexat
ion
Profession protected for (years)
Comments:
Overhead
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IssuerUnderwriting year
Premium$
Waiting period
Monthly protection
$Duration
of benefitsOther
features
Comments:
Critical illness, long-term care insurance and other insurance coverage
Issuer Underwriting year
Premium$
Insured capital
$Illnesses covered
Comments:
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QCDD-A-003 Data Collection Questionnaire
NOTE 24: Legal documents
NOTE 25: Tax information
NOTE 26: Contractual commitments
NOTE 27: Contingencies
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QCDD-A-003 Data Collection Questionnaire
NOTE 28: Employee stock program
NOTE 29: Events subsequent to the balance sheet date
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QCDD-A-003 Data Collection Questionnaire
APPENDIX B
BUDGETNAME:
PROJECTED BUDGET FOR THE YEAR
EXPENSES Client 1$
Client 2$
Total$
FoodGroceries Restaurant
Subtotal AccommodationsRent, mortgage payment Maintenance and repairs Insurance premiums (home and contents)
Property and school taxes Heat, electricity, water Phone, cable, internet Other
Subtotal
Household operationsDomestic help, maintenance Child care Animal expenses Cleaning products Yard work Other
Subtotal
Furnishings and equipment Clothing (purchases, cleaning)
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QCDD-A-003 Data Collection Questionnaire
EXPENSES Client 1$
Client 2$
Total$
Transportation costsAutomobile purchase (cash) Loan payments Insurance, permits Maintenance and repairs Gas and oil Parking Public transit
Subtotal
Health careHealth, dental insurance premiums, etc.
Non-refundable medical expenses Subtotal
Personal careHair care, aesthetician, beauty products
Supplies and other services Subtotal
Leisure and entertainmentPleasure vehicles Sports, camping Shows, outings Books, newspapers, CDs, DVDs, photos, etc.
Collections, crafts Vacations, trips Other
Subtotal
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QCDD-A-003 Data Collection Questionnaire
EXPENSES Client 1$
Client 2$
Total$
EducationTuition Books, supplies Other
Subtotal Contributions, donations, gifts Tobacco and alcohol Debt repayment (other than car and mortgage)
Income taxes (federal and provincial)
Financial securityLife insurance Disability insurance (income insurance)
Accident insurance, liability insurance, etc.
Drug insurance Pension plan contributions Other
Subtotal
Miscellaneous expensesFinancial fees Professional fees Union or professional dues Lottery tickets Charitable donations Other
Subtotal
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EXPENSES Client 1$
Client 2$
Total$
TOTAL EXPENSES
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QCDD-A-003 Data Collection Questionnaire
APPENDIX C
DETERMINATION OF AFTER-TAX INCOME AVAILABLE AND COST OF LIVINGYEAR: NAME:
Client 1 Client 2 Total$ $ $
SOURCES OF INCOME
Employment income Employment or self-employment income (net) Rental income Investment income Support payments received (paid) Annuities and other pensions Other income TOTAL GROSS INCOME
INCOME TAXES AND CONTRIBUTIONSQPP or CPP contributions Employment insurance contributions QPIP contributions Pension plan contributions Provincial taxes Federal taxes TOTAL TAXES AND CONTRIBUTIONS
INCOME AVAILABLE LESS: NON-RRSP SAVINGS
RRSP CONTRIBUTIONS
CHANGE IN CASH AND DEBT2
COST OF LIVING APPENDIX D
2 The change in debt equals the difference in the balance of personal loans.
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ESTATE STATEMENT AS AT
Death of the client
1$
Death of the
Client 2$
Simultaneous death
$Net worth according to balance sheet
Plus:Life insurance3 - - - - Insured liabilities Future income taxes Other: Sub-total: Less:Life insurance cash surrender value Death-related expenses Taxes payable on death (note 1) Specific bequests Charitable donations Other Subtotal:
ESTATE ASSETS Plus: Sums received by heirs as
beneficiaries
Less: Income taxes assumed by heirs
Value transferred to universal heirs
3 The life insurance proceeds must be payable to the estate.
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NOTE 1: Taxes payable on death
a) Death of the client 1Description Income (loss)
$Capital gain (loss)
$ Total:
×50% = Taxable income
Tax rate: Income taxes: Charitable donations: × rates applicable to the donationTax credit for charitable donations: Income taxes payable on death:
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QCDD-A-003 Data Collection Questionnaire
b) Death of the client 2Description Income (loss)
$Capital gain (loss)
$ Total:
×50% =
Taxable income Tax rate: Income taxes: Charitable donations: × rates applicable to the donationTax credit for charitable donations: Income taxes payable on death:
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QCDD-A-003 Data Collection Questionnaire
c) Simultaneous deathDescription Income (loss)
$Capital gain (loss)
$ Total:
×50% = Taxable income Tax rate: Income taxes: Charitable donations: × rates applicable to the donationTax credit for charitable donations: Income taxes payable on death:
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QCDD-A-003 Data Collection Questionnaire
APPENDIX E
CASH POSITION OF THE ESTATE AS AT
Client 1$
Client 2$
Simultaneous death
$Cash and near-cash assets according to personal balance sheet
Plus:Life insurance Registered retirement savings4 Other: Subtotal: Less:Liability to be repaid Cash surrender value – life insurance Death-related expenses Taxes payable on death Specific bequests of cash or near-cash securities
Charitable donations of cash or near-cash securities
Other:
CASH SURPLUS (DEFICIT) Plus: Sums received by heirs as beneficiaries
Less: Income taxes assumed by heirs Cash available for universal heirs
4 If the registered assets are not left to the spouse and are instead included in the calculation of taxes payable on death in the estate statement.
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QCDD-A-003 Data Collection Questionnaire
APPENDIX F
RISK TOLERANCE QUESTIONNAIRE NAME:
1. In general, how would your best friend describe you as a risk taker? a) A real gambler b) Willing to take risks after completing adequate research c) Cautiousd) A real risk avoider
2. You are on a TV game show and can choose one of the following. Which would you take? a) $1,000 in cashb) 50% chance at winning $5,000 c) A 25% chance at winning $10,000 d) A 5% chance at winning $100,000
3. You have just finished saving for a “once-in-a-lifetime” vacation. Three weeks before you plan to leave, you lose your job. You would:a) Cancel the vacation b) Take a much more modest vacation c) Go as scheduled, reasoning that you need the time to prepare for a job
search d) Extend your vacation, because this might be your last chance to go first-class
4. If you unexpectedly received $20,000 to invest, what would you do? a) Deposit it in a bank account, money market account, or an insured CD?b) Invest it in safe high-quality bonds or bond mutual funds c) Invest it in stocks or stock mutual funds
5. In terms of experience, how comfortable are you investing in stocks or stock mutual funds? a) Not at all comfortable b) Somewhat comfortablec) Very comfortable
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QCDD-A-003 Data Collection Questionnaire
6. When you think of the word “risk,” which of the following words comes to mind first? a) Lossb) Uncertaintyc) Opportunityd) Thrill
7. Some experts are predicting prices of assets such as gold, jewels, collectibles, and real estate (hard assets) to increase in value; bond prices may fall, however, experts tend to agree that government bonds are relatively safe. Most of your investment assets are now in high interest government bonds. What would you do? a) Hold the bonds b) Sell the bonds, put half the proceeds into money market accounts, and the
other half into hard assets c) Sell the bonds and put the total proceeds into hard assets d) Sell the bonds, put all the money into hard assets, and borrow additional
money to buy more
8. Given the best and worst case returns of the four investment choices below, which would you prefer? a) $200 gain best case; $0 gain/loss worst case b) $800 gain best case; $200 loss worst case c) $2,600 gain best case; $800 loss worst case d) $4,800 gain best case; $2,400 loss worst case
9. In addition to whatever you own, you have been given $1,000. You are now asked to choose between: a) A sure gain of $500 b) A 50% chance to gain $1,000 and a 50% chance to gain nothing.
10.In addition to whatever you own, you have been given $2,000. You are now asked to choose between: a) A sure loss of $500 b) A 50% chance to lose $1,000 and a 50% chance to lose nothing
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11.Suppose a relative left you an inheritance of $100,000, stipulating in the will that you invest ALL the money in ONE of the following choices. Which one would you select? a) A savings account or money market mutual fundb) A mutual fund that owns stocks and bonds c) A portfolio of 15 common stocks d) Commodities like gold, silver, and oil
12.If you had to invest $20,000, which of the following investment choices would you find most appealing? a) 60% in low-risk investments 30% in medium-risk investments 10% in high-
risk investments b) 30% in low-risk investments 40% in medium-risk investments 30% in high-
risk investmentsc) 10% in low-risk investments 40% in medium-risk investments 50% in high-
risk investments
13.Your trusted friend and neighbour, an experienced geologist, is putting together a group of investors to fund an exploratory gold mining venture. The venture could pay back 50 to 100 times the investment if successful. If the mine is a bust, the entire investment is worthless. Your friend estimates the chance of success is only 20%. If you had the money, how much would you invest? a) Nothingb) One month’s salaryc) Three months’ salaryd) Six months’ salary
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QCDD-A-003 Data Collection Questionnaire
SCORING
1. a = 4; b = 3; c = 2; d = 1
6. a = 1; b = 2; c = 3; d = 4 10. a = 1; b = 3
2. a = 1; b = 2; c = 3; d = 4
7. a = 1; b = 2; c = 3; d = 4
11. a = 1; b = 2; c = 3; d = 4
3. a = 1; b = 2; c = 3; d = 4
8. a = 1; b = 2; c = 3; d = 4 12. a = 1; b = 2; c = 3
4. a = 1; b = 2; c = 3 9. a = 1; b = 3 13. a = 1; b = 2; c = 3; d = 4
5. a = 1; b = 2; c = 3
According to John Grable: “Average and mean scores were relatively constant over time, ranging from 25 to 27 after addition.” Even though it is not an official scoring system, it appears that the following scores are reliable with regard to risk tolerance: 18 or less = Low19 to 22 = Below average23 to 28 = Average or moderate29 to 32 = Above average33 and over = HighSource: J.E. Grable and R. H. Lyton, “Financial Risk Tolerance Revisited: The Development of a Risk Assessment Instrument,” (1999) 8 Financial Services Review 163. Reproduced with permission.For the purposes of applying John Grable’s risk tolerance measure, the following chart was developed by the IQPF to convert the score to a target asset allocation:
Score Fixed income Growth shares13 100% 0%
14 to 15 80% 20%16 to 18 70% 30%19 to 22 60% 40%23 to 28 50% 50%29 to 32 40% 60%
33 and over 30% 70%The purpose of this grid is not just to establish the investor profile but to offer a guide on asset allocation that will reflect the client’s risk tolerance. Remember that risk tolerance is just one factor to take into consideration in developing a target asset distribution. Financial planners should also bear in mind the client’s goals, investment horizon, investment knowledge and financial capacity to take risk.
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QCDD-A-003 Data Collection Questionnaire
APPENDIX G
DATA TO ENTER IN YOUR RETIREMENT PROJECTION SOFTWARE
Type of income OwnerAnnual income
$
Indexation before
start%
Start
Subsequent
indexation%
End
Salary Client 1 Salary Client 2 Business income Client 1 Business income Client 2 QPP Client 1 QPP Client 2 OAS Client 1 OAS Client 2 RPP Client 1 RPP Client 2 RPP Client 1 RPP Client 2 Rental Client 1 Rental Client 2 Dividend Client 1 Dividend Client 2 Non-taxable Client 1 Non-taxable Client 2 Retirement allowance
Client 1
Retirement allowance
Client 2
Client 1 Client 2
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QCDD-A-003 Data Collection Questionnaire
Type of expense
Amount$
Frequency
Annual indexati
on before start
%
Start
Subsequent annual indexatio
n%
End
Cost of living
Mortgage
Account type HolderContribution rights
$
Locked-in amount
$
Market value
$Return
%
RRSP Client 1 RRSP Client 2 TFSA Client 1 TFSA Client 2 DC RPP, VRSP, LIRA
Client 1
DC RPP, VRSP, LIRA
Client 2
Net capital losses
$
ACB$
Non-registered Client 1 Non-registered Client 2
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Annual savings Owner Payer
$
Annual
amount$
StartIndexati
on%
End
RRSP Client 1 RRSP Client 2 DC RPP or VRSP Client 1
Employee
Employer DC RPP or VRSP Client 2
Employee
Employer DB RPP Client 1 Employee DB RPP Client 2 Employee TFSA Client 1 TFSA Client 2 Non-registered Client 1 Non-registered Client 2
Locked-in
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APPENDIX H
ASSET ALLOCATION ANALYSIS CHARTNAME:
UNREGISTERED INVESTMENTS REGISTERED INVESTMENTS TOTAL INVESTMENTS
Total value After-tax return Total
value Return Combined total
Allocation Profile Risk5 Liquidi
ty
$ % $ $ % $ $ % %
Fixed-income securities
Short term Medium term Long term
Total Growth shares
Canadian International
Total Speculative securities
Canadian International
Total Income-producing assets
Shares of private corporation
Real property Other
Total
Total
5 High, medium, low
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QCDD-A-003 Data Collection Questionnaire
APPENDIX I
ESTATE PLANNING ANALYSIS
CAPITAL REQUIRED AT DEATH
Death of the Client 1
$
Death of the Client 2
$Family cost of living Less:Expenses of the deceased Payments for mortgages repaid at death Cost of living after the death Income available after the deathSurvivor’s income after taxes and savings QPP survivor’s pension after taxes Other income Total income available after the death Annual surplus or shortfall (Income available – cost of living after the death)
Capital required1 Less:- Cash available for universal heirs - Current value of QPP orphan’s pension - Current after-tax value of assets to be sold Additional life insurance required
1 Capital required to achieve net indexed annual incomeBGN (the income must be available at the beginning of the period)FV = $0PMT = Annual shortfallI/Y = After-tax rate of return on investments corrected for inflation: { ( 1 + after-tax return) / (1 + expected inflation rate) } – 1n = Number of years when survivors will need the income.PV = Capital required
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QCDD-A-003 Data Collection Questionnaire
APPENDIX J
Professional service contract (template)
City, date
To
Address
Subject: Financial planningRef. no.: File No.____________
Dear Mr./Ms. Client,
Further to our recent meeting, we would like to offer you our services to prepare an integrated personal financial plan, develop an action plan and formulate recommendations that will allow you to meet the financial goals we discussed together.
We are authorized to act in the following fields: financial planning, individual insurance, group savings, (specify other disciplines). We also offer the following financial products and services: financial planning, life and disability insurance, mutual funds (specify).
In particular, our services include an examination of the following: Personal and family situation Financial situation Tax situation Protection situation Retirement situation Situation at death
For each of the areas mentioned above, we take into consideration the financial, accounting and tax consequences, both in the analysis of the current situation and in the formulation of recommendations.
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Consideration
For these services, you agree to pay us the sum of ______________ dollars for every hour of work undertaken in relation to this contract, which we estimate to be approximately __________ hours.
The appropriate taxes (GST, QST), along with any fees and expenses incurred, will be added to this price.
You agree to make a down payment of __________ dollars, deductible from the total sum invoiced, the balance of which will be due thirty (30) days after invoicing. Interest of ________% will be levied on any amount unpaid after 30 days.
The present contract may be rescinded at any time. If you rescind the contract, you agree to pay for any hours worked and any expenses incurred up to the date of revocation.
Charges and conditions
As your financial planners, we agree to provide you with a written report that covers all of the items listed below, including analysis charts and recommendations where relevant.
We will inform you of the progress of our work and submit the final report to you in about _________________________. We will then invite you to a meeting at which we will explain our analysis and our recommendations. If additional work is required, you will be informed and additional fees may be charged.
You should understand that the report provided within the scope of this contract may require regular updating. The fees for periodically updating the file can be agreed upon at a later date.
You agree to respond to all questions and to provide the documents required for the execution of the contract, whether they are held by you or by third parties. To this end, you agree to immediately sign letters authorizing us to obtain information directly from third parties. The information obtained from these third parties will remain confidential at all times and will not be used for any other purposes
You understand that our responsibility is limited by access to the documents provided and to their content. The recommendations are based on assumptions and must be updated from time to time to take account of your social and family situation, changes in tax and other laws, as well as developments in the economy and fluctuating markets.
Should the implementation of the recommendations in the report require the services of specialists, our co-ordination and integration fees will be charged over and above their fees.
Sincerely,
(Signature)Name of financial planner (BLOCK LETTERS)Name of financial institution or firm
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I, first and last name of client , accept the terms of the present service contract and agree to meet all the conditions outlined.
Signed at
, this th day of (month, year)
(Signature)Client’s name (BLOCK LETTERS)
Note: If remuneration is to be based on commissions on financial products sold, this must be clearly indicated. In such a case, before the purchase of any financial products, it is recommended that an alternative type of remuneration be provided, such as an hourly rate, in case the contract is rescinded, if the financial planner wishes. Financial planners must also disclose in writing to the client any other form of compensation they will receive for the products sold or services rendered, if such is the case. The content of this contract and this note does not provide an exhaustive statement of all the obligations of the financial planner, who is responsible for ensuring that the contract concluded with the client and the presentation of the financial planner’s services comply with the rules that govern the profession.
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