Prudential Financial Planners Financial Profile Questionnaire

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Gwenda McDowell
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1 Prudential Financial Planners Financial Profile Questionnaire Neither Prudential Financial, its affiliates, nor its financial professionals, render tax or legal advice. Please consult with an attorney, accountant, and/or tax advisor for advice concerning your particular circumstances. Offering financial planning and investment advisory services through Pruco Securities, LLC (Pruco), doing business as Prudential Financial Planning Services (PFPS), pursuant to separate client agreement. Offering insurance and securities products and services as a registered representative of Pruco, and an agent of issuing insurance companies Prudential Financial, Inc. and its related entities. Prudential, the Prudential logo, the Rock symbol and Bring Your Challenges are service marks of Prudential Financial, Inc., and its related entities, registered in many jurisdictions worldwide. D

2 DOCUMENT CHECKLIST Cash Flow Documents Expense Worksheet Credit card statement Personal loan statements Mortgage statements Family budget Legal Documents Current wills and codicils Trust documents Power of Attorney Healthcare proxy Living Wills Divorce Agreement Prenuptial Agreement Tax Documents Income tax returns (last 2 yrs.) Trust tax returns Gift or Estate tax returns (last 2 yrs.) Corporate tax returns (last 2 yrs.) Partnership tax returns (last 2 yrs.) Most recent paystubs Notes payable Notes receivable W-2s Investment Documents Money market statements (within 30 days) Mutual fund statement (within 30 days) Brokerage account statements (within 30 days) Limited Partnership statements Savings account statements (within 30 days) IRA statements (within 90 days) Insurance Policies Life insurance policies and statements Disability income insurance policies Medical insurance policies Auto insurance policies (Dec Page) Homeowners/Liability insurance (Dec page) Annuities and statements Employee Benefits 401(k) or SEP statements 403(b) statements Employer benefits booklet Employee Stock Options statement Annual Benefits statement DB Pension: Spousal Options ESOP Statement Verification of Social Security benefits Business Documents Business Valuation Profit & Loss statements (last 2 yrs.) Balance Sheets (last 2 yrs.) Buy-Sell Agreements Employment Contracts Corporate By-laws and Book Deferred Compensation Agreement Partnership Agreement Miscellaneous Documents Names of other advisors Location of documents PERSONAL INFORMATION Peferred Name Client 1 Client 2 Full Legal Name Date of Birth Citizenship Mailing Address Street Address Cell Phone Home Phone 2

3 EMPLOYMENT INFORMATION Occupation Client 1 Client 2 Employer Employer Address Business Phone Business Fax Years Employed ANNUAL INCOME INFORMATION Employment Client 1 Client 2 Sources Social Security Pension HOUSEHOLD INFORMATION Residence Own Rent Years There No. of Dependents DEPENDENT INFORMATION Children s Names Date of Birth (mm/dd/yyyy) Anticipated Annual Education Expense Years at School Current Savings Per Year $ $ $ $ 3

4 EXPENSE WORKSHEET Monthly Annual Monthly Annual Housing Expenses Alarm Service Cable/Satellite Electric Housekeeping/Cleaning HOA Dues Internet Lawn/Pool/Snow Removal Maintenance/Repair Oil/Gas Pest Control Phone/Cell Phone/Pager Property Tax Service Contracts Water/Sewer Transportation Auto Tag & License Gas & Oil Maintenance/Repair Property Tax Rental/Replacement Tolls & Parking Charitable Charitable Religious Tithe Misc. Cash Donations Children s Expenses After-school Expenses Allowance Entertainment & Gifts Nursery & Daycare School Supplies Tuition Food Expenses Adult Lunches Children s Lunches Dining Out Groceries Clothing Expenses Adult Clothing Children s Clothing Dry Cleaning Medical & Dental Co-pays & Deductibles Dental & Orthodontics Prescriptions Vision out-of-pocket Vitamins Insurance Premiums Auto Insurance Boat Insurance Dental Insurance Disability Income Insurance Health Insurance Homeowners Insurance Life Insurance Umbrella Insurance Vision Insurance Expenses Adult Education Bank Charges ATM Withdrawals Club Dues & Expenses Entertainment Financial Planning Fee Gifts Family/Friends Christmas Wedding/Anniversary Birthday Grooming & Salon Gym Membership Legal Fees Tax Preparation Fee Pet Expenses Postage Recreation Sports & Hobbies Subscriptions Vacation Divorce Obligations Alimony Payments Legal Fees Temporary Support Total Lifestyle Expenses 4

5 ASSETS/LIABILITIES: LIFESTYLE AND BUSINESSES* Fair Market Value Cost Basis Asset Growth Rate Current Liability Balance Liability Interest Rate Payoff Date/ # of Years Remaining Principal and Interest Payment Owner (Joint, Community, Client 1, Client 2) Rental Income Primary Residence Secondary Residence Rental House Rental House Rental House Business Business Business Personal Property Personal Property Personal Property Vehicles Vehicles Vehicles Mortgage Mortgage Line of Credit Line of Credit Credit Card Credit Card Investment Loans Investment Loans School Loans School Loans *This page is not necessary if statements are being provided. 5

6 LIQUID, INVESTMENT AND RETIREMENT ASSETS* Retirement Plan Contributions Current Market Value Cost Basis Return Rate Maturity Date Owner (Joint, Community, Client 1, Client 2) Intended Use (Retirement, Education, Emergency, ) Principal and Interest Payment Owner (Joint, Community, Client 1, Client 2) Cash/Checking Account Savings Account/Credit Union Money Market U.S. Government Bonds Tax Exempt Bonds CD CD CD Mutual Funds Mutual Funds Mutual Funds Stocks Annuity Annuity Retirement (Roth IRA) Retirement (Roth IRA) Retirement (401(k) plan) Retirement (401(k) plan) Retirement (IRA) Retirement (IRA) *This page is not necessary if statements are being provided. 6

7 FINANCIAL GOALS Rank in the order of importance (1-7) Achieve financial security for retirement Provide funds for education Achieve other goals please describe Maintain adequate life insurance Minimize estate taxes and provide for heirs Protect your resources in case of disability Create an overall asset allocation 1. Do you expect any inheritances, legal settlements or gifts that may affect your financial plan? 2. Are you aware of upcoming changes in your life (lifestyle), which will directly affect your present financial situation? If so, please explain: 3. Does Client 1 or Client 2 have any health problems or take any medications? If so, please list. 4. If Client 1 or Client 2 were to die, would the survivor want the mortgage on your personal residence paid off? If Client 1 died Yes No If Client 2 died Yes No 5. Should we include Social Security benefits when planning for retirement? Yes No Client 1 Client 2 Age at which payments begin % of total benefit expected 6. Age of Retirement? Client 1 Client 2 7. Life Expectancy? Client 1 Client 2 7

8 INVESTMENT RISK PROFILE This questionnaire will aid in defining your financial and investment objectives. By analyzing your investment objectives, time horizon and risk tolerance, we can determine a proposed asset allocation mix that can help you meet your financial goals. 1. Estimated Time Horizon years 2. What is your Asset Allocation preference?: An allocation among different styles of equity and fixed income portfolios An allocation among different styles of equity portfolios An allocation among different styles of fixed income portfolios 3. Over the next five years, do you expect your financial situation to: Dramatically improve Stay about the same Improve somewhat Worsen 4. When investing, there may be a natural trade-off between investment performance and the risk of a decline in portfolio value. Typically, the higher the return you pursue, the more willing you must be to suffer potential losses. Please review the following investment choices and their risk and return characteristics. Select the hypothetical investment that would most likely meet your expectations for returns in average and good years without making you uncomfortable during periods of declining values. Typical Return in a Bad Year Typical Return in an Average Year Typical Return in a Good Year Investment A -10% +4% +10% Investment B -15% +5% +13% Investment C -20% +6% +16% Investment D -28% +7% +20% Investment E -38% +8% +30% 5. On rare occasions the worst-case scenario may indeed occur. As a result, investors may suffer greater-than-normal interim portfolio losses. The table below shows the cumulative losses that might be expected for four hypothetical $100,000 portfolios, over worst-case scenarios lasting 12-, 24- and 36-month periods. Please select the hypothetical portfolio with maximum interim losses you may be able to tolerate. 12 months 24 months 36 months Portfolio A $ (39,000) $ (50,000) $ (56,000) Portfolio B $ (28,000) $ (35,000) $ (39,000) Portfolio C $ (15,000) $ (17,000) $ (18,000) Portfolio D $ (10,000) $ (11,000) $ (9,000) 6. When investing, you must consider several risks. The risk of a decline in value is the most common definition of risk and the one that many people think to avoid first. However, you cannot reduce this risk without assuming others, such as the risk of inflation. Please indicate which of the following risks most concerns (first choice) you and which is your next most important concern (second choice). 1st Choice 2nd Choice A B C D E F The possibility that my investment may not grow enough to meet my future needs. The risk of a sharp decline in value in a short period of time. (1-6 months) A decline in portfolio value over the course of 1-2 years. The risk that my portfolio may not grow enough to keep pace with inflation. The risk of not earning a rate of return greater than the general stock market. The risk that my portfolio will not generate enough current income. 8

9 7. Which statement most accurately describes your attitude and expectations when investing over a market cycle of 5-7 years? It is more important to do well in up markets than it is to limit losses in down markets. I am comfortable with average returns in both up and down markets. It is more important to limit losses in down markets than it is to do well in up markets. 8. The graph below shows the returns of a hypothetical investment over time. If you owned this investment, given its historical and current returns, what action would you take today (year 18)? 30% 25% 20% 15% 10% 5% 0% -5% -10% -15% -20% YEAR I would immediately sell all of the investment and cut my losses. I would sell some of the investment to protect myself from further loss. I would continue to hold the investment with the expectation of higher future returns. I would invest more now since the price is lower. Tell me about the best investments you have ever made. Why? When was it? Tell me about the worst investments you have ever made. Why? When was it? What other types of investments have you bought (mutual fund, annuity, stock, bond, real estate)? 9

10 EXISTING LIFE INSURANCE COVERAGE Insured: Client 1, Client 2 or Second to Die Owner: Client 1, Client 2, Joint, Community, or Trust Beneficiary: Client 1, Client 2 or Insured Face Amount Loan Cash Surrender Value Owner Beneficiary Type (Term, UL, VUL, etc.) Coverage Period (years) Monthly Premium Premium Payments (years) EXISTING DISABILITY INSURANCE COVERAGE Benefit Period Insured: Client 1 or Client 2 Monthly Benefit: Enter the amount that you will receive each month. Elimination Period: Enter the number of days you must wait before payments begin. Benefit Period: Enter the total number of months that you will receive payments before they stop or check if benefits are received until age 65. Insured Monthly Benefit COLA % Elimination Period # of Months Check if to Age 65 Monthly Premium Premiums Paid with Personal Funds (after tax)? 10

11 EXISTING LONG-TERM CARE INSURANCE COVERAGE Insured: Client 1 or Client 2 Benefit: Enter the amount that you will receive if you require qualified long-term care services. Maximum Benefit: Indicate if there is a daily or monthly limit of benefits payable. Benefit Period: Enter the total number of years that you could receive payments before they stop or check if the benefit period is unlimited. Lifetime Benefit Total: This is the dollar value of the maximum amount of benefits that may be received over the lifetime of the policy or indicate unlimited. This may be calculated by taking the maximum benefit multiplied by the benefit period. If an inflation rider is included in the policy, this amount may increase after the initial purchase. Cash Rider, Restoration or Benefit and Shared Care: Yes No Check if there is a Waiting Period Insured Benefit Maximum Benefit: Daily or Monthly Benefit Period Lifetime Benefit Total Inflation Rider Calendar Day or Service Day Monthly Premium Cash Rider Restoration of Benefit Shared Care Home Health Care Amount 11

Retirement Income Planning Worksheet

Retirement Income Planning Worksheet Build Preparations for Your Retirement A Straightforward Resource to Help Gather the Data You Need Use this simple worksheet to get started on your retirement income