confidential financial questionnaire -...
TRANSCRIPT
ConfidentialFinancialQuestionnaire
JACQUES FINANCIAL, LLC15430 AVERY ROAD www.JacquesFinancial.com ph (301) 738-1303ROCKVILLE, MD 20855 e-mail: [email protected] fax (301) 738-1305
IMPORTANT INFORMATION about procedures for opening a new account: To help the government fight the funding of terrorism and money laundering activities, Federal law requires allfinancial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, you are required to provide your name, residential address,date of birth, and identification number. We may require other information that will allow us to identify you.
Personal data
Occupational dataspouse self-employed?Are either you or your
CitizenshipSocial Security NumberDate of BirthMarital StatusName
Client
Spouse
Child
Child
Child
Child
Child
Child
Driver's License State, #
SpouseClient
EMailLegal Residence
ClientAddressStreet
ZIPCity, State &
SpouseTelephoneHome
‘ Corporation ‘ Partnership ‘ Sole Proprietorof business:If yes, type
SpouseClient
Your Title
Employer
AddressStreetEmployer
ZIPCity, State &
Telephone
ServiceYears of
Occupational data
short-term disability?Does your employer provide
_____________Income/percent of salary:
ContributionsPlan Allowing Voluntary
_____________Income/percent of salary:
MedicalComprehensive Major
much do you contribute?Are any of these plans contributors? If yes, how
Year drafted:executed wills? Do you have valid
deposit box?Do you have a safe
name:attorney? If yes,Do you have an
name:accountant? If yes,Do you have an
Smokers?medical problems? member have anyDo you or any family
Work-Related Benefits
Does your employer provide life insurance? ____Does your company have (check as many as appropriate)
Coverage:SpouseClient
Amount of Contribution:Pension Plan
401k Plan
Profit Sharing
of time:Length
Thrift/Savings Plan
Long-term disability?Stock Option Plan
of time:Length
Deferred Compensation
Dental Benefits
$ _________________________
Income Sources
JointSpouseClient
Base Salary
Bonuses
Fees and Commissions
Rental Income
Royalties
Trust Income
Business Income
Income Sources
Asset Inventory1. Savings
Maturity Date% ReturnAmountTitled Owner
Passbook Savings
Passbook Savings
Credit Union Account
Credit Union Account
Checking Account
Checking Account
Certificate of deposit
Certificate of deposit
Certificate of deposit
Certificate of deposit
Money Market Fund
Money Market Fund
Savings bonds
Treasury bills
IRA
IRA
IRA
IRA
Custodial accounts
Custodial accounts
Annuities
Annuities
Other
Other
Asset Inventory2. Marketable Securities (Stocks, bonds, mutual funds)
Annual IncomeCMVCost BasisDate Bought# of SharesItemTitled Owner
3. Real Estate
CurrentImprovementsTitlePriceYearMarket ValueCapital ExpendituresBought
ResidencePrimary
HomeOther
HomeOther
LandUndeveloped
LandUndeveloped
Other
Debt
loans, car loans, credit cards, store charges, checking credit line, etc.)2. Loans (includes personal loans, college loans, home improvement loans, passbook
1. Mortgages
Monthly PrincipalApproximateInterest and TaxesBalanceInterest RateAmountTermLoan Date
ResidencePrimary
InsuredPay-off DateBalanceMonthlyType ofYes/NoRemainingPaymentLoan
Protection Analysis
FeatureHome Health Care
1. Life Insurance
Policy #4Policy #3Policy #2Policy #1
Name of insured
Insurance Company
Premium amount
Dividends
Dividend Use
Policy loans
Type of policy
Amount of coverage
2. Disability Insurance
Policy #4Policy #3Policy #2Policy #1
Name of insured
Insurance Company
Amount of coverage
Individual or Group
Premium/Mode
Waiting period
Benefit period
3. Long-Term Care Insurance
Policy #4Policy #3Policy #2Policy #1
Name of insured
Insurance Company
Premium amount
Waiting period
Benefit period
Daily benefit
Asset Inventory
primary source of cash assets?savings, etc.) If no, what was theand by what method (i.e. payrollsaving? If yes, in what amountIs there a regular pattern of
current rate of saving:Attitude toward
vehicles:selecting savingsUsual method of
repositioned. Explain.client feels cannot bespecific objectives and those theIdentify accounts earmarked for
Education
What is a reasonable after-tax return?Attitude toward current performance:
Annual financial obligation for education
Type ofPlannedExistingAnnual Expense in Today's DollarsAgeChild
AccountAnnual SavingsSavingsGraduateUndergraduate
Spouse to answer.read the questions aloud. Allow both Client andintroductory comment in quotation marks andbelow with the appropriate information. Read theNote: be prepared to fill in the items lined outFamily Needs
were to die today:family's financial situation if youGive a brief description of your
your present home?or opportunity to continue living in(mention names) the financial optionIs it important to give your family
self-sufficient?Children) until the children areincome to (name Spouse andIs it important to provide a monthly
is paid for.a monthly basis; assume your housedollars--would you want provided onWhat amount--in today's
complete their education?children have the opportunity toIs it important to you that your
provide each child for this?What amount would you want to
be?What will the source of these funds
Risk Tolerance
your financial objectives?risk is reasonable to take to meetinvolve some risk, what amount ofKeeping in mind that all investments
5
Speculative (high risk)
"The next questions are a little unusual because we need to assume you have passed away
SpouseClient
Are you happy with this situation?
What do you feel is a realistic future inflation rate?
101
Conservative (low risk)
and objectivesFinancial goals
has not been discussed?you (from a financial standpoint) that1. Is there anything of importance to
plans?might cause a change in your futureother unusual circumstances thatfinances, personal situation or anyelse we should know about your2. Do you feel that there is anything
make decisions on your own?seek or do you (and your spouse)there someone whose advice youinvestment or savings decisions, is3. When it comes to making
planning to do for you?4. What do you expect financial