Basic Data Gathering Form

Transcription

1 Basic Data Gathering Form Steps towards your financial security Client Name: Date Taken: Date Updated: National Life Insurance Company Life Insurance Company of the Southwest 10 % National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. Each company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Centralized Mailing Address: One National Life Drive, Montpelier, VT MK7475(1213) TC77174(1213)P

2 Personal Information Name DOB Health Social Security Number US Citizen Address Home Phone Cell Phone Office Phone Personal Business Fax Name DOB Health Social Security Number US Citizen Address Home Phone Cell Phone Office Phone Personal Business Fax Children Name DOB Health Parent Parent Name DOB Health Financial Status 1

3 Personal Information continued Tell me about your goals for yourself and your family. (College for the kids, how and when you want to retire.) What are your financial concerns? How do you feel you are doing? Is your family financially competent? What do you think the inflation rate will be? What is your ordinary income tax rate? What is your capital gains tax rate? Growth of income? What do you think is a typical rate of return for invested assets? What return on investment are you happy with? 2

4 Employment Information 1. Name Occupation Employer How Long? Income Bonus Commissions Qualified Plan Contributions 2. Name Occupation Employer How Long? Income Bonus Commissions Qualified Plan Contributions 3. Benefits Provided by Employer? If yes, please provide details. 4. Are you happy with your work? Do you think you will be staying with your current employer? 3

5 Seeking peace of mind through risk protection documents Your risk protection documents should be designed to help you achieve your goals and to carry out your wishes. They are an expression of your sentiments and desires as well as a means of realizing tax efficiencies. Protection Documents Name Will Revocable Trust Health Care Proxy Medical Directive Durable Power of Attorney Letter of Intent Irrevocable Life Insurance Trusts Irrevocable Trusts - Other Name Will Revocable Trust Health Care Proxy Medical Directive Durable Power of Attorney Letter of Intent Irrevocable Life Insurance Trusts Irrevocable Trusts - Other How/Why did you choose the terms in your documents? When were they last reviewed? Have there been any changes in your family/life/finances since you last reviewed these documents? Do you feel you have a good understanding of what s in these vital documents? Who is your attorney? Where have you stored your documents? 4

6 Seeking peace of mind through risk protection products Risk protection products are assets that are designed to bring you and your family protection by providing financial recovery against a particular loss. For instance, Home Owner s Insurance provides you with funds when your home is damaged. Disability Insurance gives you and your family cash flow when you become disabled replacing a portion of your lost income. Life Insurance death benefits provide income tax free * funds to your family and may effectively replace the loss of your income. Risk protection products provide stability to your financial model. Please provide an overview of your coverage when the coverage was last reviewed and any concerns you have about your protection. Annual Premium Deductible Coverage Elimination Period Own Occ Comments Home Owner Insurance Home Owner Insurance Auto Insurance Auto Insurance Auto Insurance Umbrella Insurance Disability Insurance Disability Insurance Long Term Care Long Term Care Why did you purchase these policies? Have circumstances changed since you entered into this coverage? Do you feel that you understand the product, what it does, how it works and its current status? When were these policies last reviewed? * Internal Revenue Code 101(a)(1). There are some exceptions to this rule. Please consult a qualified tax professional for advice concerning your individual situation 5

7 Seeking peace of mind through risk protection products continued Risk protection products are assets that are designed to bring you and your family protection by providing financial recovery against a particular loss. For instance, Home Owner s Insurance provides you with funds when your home is damaged. Disability Insurance gives you and your family cash flow when you become disabled replacing a portion of your lost income. Life Insurance death benefits provide income tax free * funds to your family and may effectively replace the loss of your income. Risk protection products provide the stability to your financial model. Please provide an overview of your coverage when the coverage was last reviewed and any concerns you have about your protection. Life Insurance Insured Death Benefit Annual Premium Current Cash Value Policy Loan Type of Coverage Policy Owner Type of coverage: Term, Whole Life, Universal Life, Indexed Universal Life, Survivorship, Indexed Survivorship Please identify the beneficiary(ies) under each policy and why they were selected. Why did you purchase these policies? Have circumstances changed since you entered into this coverage? Do you feel that you understand the product, what it does, how it works and its current status? When were these policies last reviewed? * Internal Revenue Code 101(a)(1). There are some exceptions to this rule. Please consult a qualified tax professional for advice concerning your individual situation 6

8 Overview - Assets Annual Additions Total Additional Details or Information Cash/CE Includes Cash and Cash Equivalents. Please attach statements for each account or additional information in the space below. Real Estate Residential - Owner Vacation - Owner Please show current value - be sure to include property debt on the liabilities page. Qualified Plans 401(k) - Owner 401(k) - Owner Traditional IRA - Owner 403(b) - Owner Defined Benefit - Owner Please indicate owner and current value for each applicable area. Please attach statements for each account or additional information in the space below (including average return on investment). Non-Qualified Taxable - Ordinary Income - Owner Taxable - Ordinary Income - Owner Taxable - Capital Gains - Owner Taxable - Capital Gains - Owner Roth IRA - Owner NonTaxable/Tax Deferred - Owner Please indicate owner and current value for each applicable area. Please attach statements for each account or additional information in the space below (including average return on investment). This may include certain bonds, mutual funds. This may include mutual funds, equities, etc. They include certain bonds, annuities, etc. Business Please indicate name, owner, current value. Be sure to complete a business owner s data form on the business. How have you made your accumulation decisions? Which assets do you feel are performing the best? The worst? Under the Non-Qualified assets please note whether you have dividend/income reinvested. Please provide copies of supporting materials. 7

9 Liabilities and Additional Information Annual Payments Total Additional Information Credit Cards Please show month to month balance. Mortgage Please show current balance on the mortgage debt, the current interest rate, type of mortgage and years remaining. Real Estate Taxes Enter the total real estate tax due on each property. 401(k) Loans If you have taken out a loan against your 401(k) please indicate the total outstanding loan and the annual payments you are making to repay the loan. Life Insurance Loans If you have a loan against your life insurance please indicate the policy, the outstanding loan amount, if any, you are repaying each year. Car Loans Misc. What are your average monthly expenses? (Look over your checking account take three normal months and take their average). Please provide copies of supporting materials. 8

10 Additional Information Other Income and Assets Do you have sources of income other than previously reviewed? If yes, please give details: Do you anticipate receiving an inheritance? Other Expenses Do you anticipate any other large expenses? If yes, please give details: Retirement Retirement Age: Anticipated Income Desired Post Retirement: If You Had Died Yesterday What liabilities current and future would you like retired so that your family has a more secure financial base? Will the impact of your death hurt your family financially? Do you want them to be able to live the life you would have given them? Are there new expenses that might occur for the family such as medical insurance? 9

11 Estate Planning Information Initial considerations Who What When How Family Friends Charity Government Specific Bequests? Family Businesses? Family Heirlooms? Lifetime At Death Outright In Trust Transfer tax considerations In Assets you own and control Out Assets you do not own or control Personal Property Life Insurance Real Property Liquid Investments Illiquid Investments Qualified Plans Business Interests Annual Exclusion Exemption Equivalent Gift Savings Devices Outright or in trust Outright or in trust ILIT GRATS IDGTS SCINS Note Sales CRTS CLTS Discounted Transfers Beneficiary Controlled Trust Please review the initial considerations posed above. In addition, please note whether you are using any of the strategies listed under Transfer Tax Considerations and provide details. 10

12 Notes/Additional Information This information is not intended as tax or legal advice. Please consult with your Attorney or Accountant prior to acting upon any of the information contained in this correspondence. 11