L.I.F.E. Report Fact Finder
Client’s Name: (*)
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Client's Date Of Birth: (*)
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Spouse’s Name:
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Spouse’s Age / D.O.B.:
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Address:
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City, State, Zip: (*)
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Home Phone:
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Cell Phone:
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Work Phone:
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Please list all individuals involved in the decision making process:
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Please list the client’s top 3 goals they would like to address from your initial meeting
Goal #1:
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Goal #2:
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Goal #3:
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Please write the client’s overall financial objectives they would like to accomplish within the next 12 months:
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Retirement Income
What is your Total Earned Income from the previous year:
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What is your Desired Annual Income for Retirement? (*)
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When do you plan to begin receiving Income Distribution for Retirement? (*)
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Current or Future Income Resources
Income from Pension Plan (*)
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Spousal Income Pension Plan:
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Additional Income from other sources:
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Monthly Expenses
Home Mortgage:
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Auto Loan:
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Electric Bill:
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Gas Bill:
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Cable Bill:
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Auto Insurance:
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Home Owners Insurance:
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Disability Insurance:
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Life Insurance:
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Credit Cards:
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Other Expenses: (Gas, Groceries, etc…)
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Client’s Assets
Home Value:
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Mortgage Loan(s) Amount:
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Bank account Assets(Please specify: Individual Asset, Spousal Asset, or Joint Asset)
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Investment Or Brokerage Accounts:Please specify: Individual Asset, Spousal Asset, or Joint Asset) Are the funds IRA or Non-Qualified Funds? (Please specify)Account Value:
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Life Insurance Policies - (Please specify: Individual or Survivorship,Product Name,Term, UL, EIL, Whole Life, or Variable, Remaining Surrender Charges, Account Value:
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Annuities - (Please specify: Individual Asset, Spousal Asset, or Joint Asset, Product Name, Fixed or Variable, IRA or Non-Qualified, Remaining Surrender Charges,(if any) and Account Value:
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Emergency Cash Position
What is your current emergency cash position Amount?
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Current Location of Emergency Cash?
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Is this amount calculated into your entire financial portfolio?
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The Following Is Required Agent Information
Agent Name (*)
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Agent Email (*)
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