Compass Plus QUESTIONNAIRE. Congratulations on taking the. Custom with Goal Development. first steps toward building your financial future!

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1 Custom with Goal Development Compass Plus QUESTIONNAIRE Congratulations on taking the first steps toward building your financial future! This questionnaire will help gather key information necessary to develop an appropriate financial strategy for you. Prudential, the Prudential logo and the Rock Symbol are service marks of Prudential Financial, Inc. and its related entities

2 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 1 FINANCIAL QUESTIONNAIRE Date Client Name(s) Financial Planner s Name Phone Number Office Code Contract Number Fax Number Other C L I E N T G O A L S & O B J E C T I V E S Rank the following goals in numerical order of importance to the client and/or select the areas of interest to the client for which you will be creating a report and making recommendations: _ Save for a major purchase _ Achieve financial security for retirement _ Provide funds for education _ Maintain adequate life insurance to protect your family from loss due to premature death _ Obtain the greatest return on investments, given your risk tolerance _ Create an overall asset allocation strategy to manage risk and reward _ Protect your resources in the event of disability _ Protect your assets in the event of an extended nursing home or home care stay _ Ensure that a surviving spouse will have adequate resources in the event of premature death _ Minimize estate taxes and provide for your heirs _ Complete risk management evaluation _ Create an overall tax strategy to minimize taxes _ Special needs (Please provide detail.) Prudential and its representatives do not give legal or tax advice. Please consult your own advisors regarding your particular situation. 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. Personal financial information obtained in the preparation of this document will not be automatically transferred to any product or service you may already own or purchase from Pruco Securities, LLC (Pruco) or an affiliate of Pruco, or your official records. ALL RIGHTS RESERVED. All information and forms contained herein are proprietary. The Prudential Insurance Company of America. It is unlawful to copy, reproduce, or distribute the information contained in this document without express written authorization of The Prudential Insurance Company of America. Any questions regarding these materials should be directed to The Prudential Insurance Company of America, 751 Broad Street, Newark, NJ

3 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 2 GENERAL GOAL DEVELOPMENT QUESTIONS Tell me what your shorter-term goals are (1-5 years horizon, prioritize if more than one goal). Do you currently have a specific plan in place to achieve these goals? If yes, how are you doing? Tell me what your longer-term goals are (6+ years, prioritize if more than one goal). Do you currently have a specific plan in place to achieve these goals? What concern(s) do you have which may impact your ability to achieve your short- or longer-term goals in the timeframe you would like? When it comes to making decisions about personal financial matters, do you make the final decision between yourselves or do you consult with someone else first before taking action? Tell me more about this person. What financial options do you want in the future that you don t have today? Would you like my help to make sure that you are on the right track with this?

4 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 3 CLIENT PROFILE Required fields are marked with an asterisk (*) throughout this questionnaire. CLIENT CO-CLIENT Title (select one) Mr. Mrs. Ms. Miss Dr. Mr. Mrs. Ms. Miss Dr. First name* Last name* Date of Birth* Gender* Male Female Male Female Tax Filing Status* Citizenship C O N T A C T I N F O R M A T I O N Home Phone Number Business Phone Number Cell Number Fax Number Pager Number Address H O M E A D D R E S S Street Address* City* State* Zip Code* Country F A M I LY M E M B E R S First Name* Last Name* Birth date* Relationship* Gender* Male Female Male Female Citizenship

5 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 4 CLIENT PROFILE (continued) CLIENT CO-CLIENT F A M I LY M E M B E R S ( c o n t i n u e d ) Street Address* City* State* Zip Code* Country E M P L O Y E R I N F O R M A T I O N Employer Name Title Occupation Business Phone Number Fax Number A D D R E S S Street Address City State Zip Code Country B E N E F I C I A R I E S Enter any potential beneficiaries for estate planning. Family members will automatically be included as potential beneficiaries. First Name/Description* Last Name* Beneficiary Type* Relationship GSTT Applicable for Client gifts? Yes No Applicable for Co-Client gifts? Yes No Beneficiary 1 Beneficiary 2

6 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 5 CLIENT PROFILE (continued) Enter information about the client s Financial Professionals, accountant and attorney. Do not enter the primary financial professional, as this information will be automatically captured. CO-FINANCIAL PROFESSIONAL OTHER PROFESSIONALS F I N A N C I A L P R O F E S S I O N A L S I N F O R M A T I O N Job Title First name Last name Profession Credentials C O N T A C T I N F O R M A T I O N Business Phone Number Cell Number Home Phone Number Fax Number Pager Number Address Office Name City State Zip Code Website

7 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 6 CLIENT PROFILE Continued A S S U M P T I O N S Inflation Base Inflation Rate (defaults to 3) Tax Rates Tax Bracket State Federal Average Federal Marginal Long Term Capital Gains Before Retirement During Retirement In the Year of Death Dependents Milestones Client Co-Client Retirement date (Year/Age)* Life Expectancy (Year/Age)* Capital Loss Carryovers Short-term regular tax Long-term regular tax Client Co-Client Dependent

8 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 7 ASSETS & LIABILITIES GOAL DEVELOPMENT How comfortable do you feel with your current level of debt? Is it going up or down? Do you expect to use debt to pay for any of your short or long term goals? Which goals? Do you expect your disposable income to increase, decrease or stay the same over the next year? How do you feel about that? How important is it to you to make sure that your assets are properly protected in the event of an unexpected liability (accident or lawsuit) on or off your property? Do you anticipate receiving a lump sum within the new few years (inheritance, sale of property/land/ business)? Would you like help with identifying possible ways in which you could conserve or grow your assets?

9 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 8 ASSETS (All columns are required fields.) L I F E S T Y L E Lifestyle assets are assets purchased for the owner s personal use and enjoyment and not for funding goals or producing income. Purchase date defaults to December 31 of the prior year. Valuation date defaults to plan date. Purchase Cost Market * Valuation Sale Depre./Growth Description* Type* Owner* + Date* Basis* Value Date* Date Rate Tax Purchase Cost Market * Valuation Sale Depre./Growth Property Deductable? Description* Type* Owner* + Date* Basis* Value Date* Date Rate Taxes Frequency (Y/N) R E A L E S T A T E Income Purchase Purchase Market Valuation Sale Growth Net Rental Income Growth Description* Owner* Date* Amount Value* Date* Date Rate Income Frequency Rate + For estate planning purposes only, indicate Community property assets as CP under Owner.

10 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 9 ASSETS Continued Information can be entered at Summary level, account level or detailed level. If details on individual holdings are available, attach statement information. I N V E S T M E N T A C C O U N T S Description* Plan Type* Owner* + Market Value* Cost Basis (Non-Qualified only)* Valuation Date Asset Class Weightings* Account 1 Account 2 Account 3 Account 4 Account 5 Account 6 Account 7 Saving Strategies Employee Contribution* ($ or ) Employer Contribution ($ or ) Contribution Frequency* Start Date* End Date* Index Rate Funding Strategies ++ Percent of Goal (For Funding Strategies) Retirement (Residual to Estate) Education Goal #1 Education Goal #2 Education Goal #3 Major Purchase Goal #1 Major Purchase Goal #2 Major Purchase Goal #3 Unallocated (Emergency Reserve) Total = K E Y S Plan Type: Owner: Asset Class: Non-Qualified; Qualified-IRA, IRA Spousal, Roth IRA, Roth IRA Spousal, 401(k), 403(b), 457, SARSEP, Keogh Other Plans Employer paid, Self-employed, Salary deferral, For estate planning purposes only, indicate Community Property assets as CP under Owner. ++ This information is entered in the Funding Strategies area. C = Client CC = Co-client J = Joint CP = Community Property + D= Dependent (enter name) Asset class options are available in the system drop-down menu.

11 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 10 ASSETS Continued A N N U I T Y A C C O U N T S Description* Plan Type* Owner* Annuitant* Beneficiary* Type of Annuitization* Market Value* Cost Basis* Asset Class Weightings* Account 1 Account 2 Account 3 Account 4 Account 5 Account 6 Account 7 Annuitization Issue Date Initial Premium Start Annuitization Frequency End/Beginning of Period Payment per $1,000 or #Years Saving Strategies Employee Contribution ($ or ) Employer Contribution ($ or ) Contribution Frequency Start Date End Date Index Rate Return Rate

12 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 11 LIABILITIES L I A B I L I T I E S Description* Owner* Interest Rate* Payment Type* Payment Frequency* Amortization (yrs)* or Loan End Date Compound Frequency* Liability Type Bring into Cash Flow? Y/N Refinanced? Y/N Tax Deductible Interest? Y/N Insured for Disability? Outstanding Principal as of (Date) Outstanding Principal Amount Loan 1 Loan 2 Loan 3 Loan 4 Loan 5 Loan 6 Loan 7 K E Y S Owner: Payment Type: Payment Frequency: Liability Type: Client Co-client Joint Interest Only Principal & Interest Last Period Payment Monthly Quarterly Semi-annually Annually Personal Business Credit Card Mortgage

13 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 12 INCOME Required fields are marked with an asterisk (*) R E G U L A R / L U M P S U M I N C O M E S Description* Member* Income Type* Frequency* Amount* Start Date* End Date* Index Rate Key Member: Income Type: Start Date: End Date: Client Salary Jan 1, current year Retirement Co-client Bonus and Alimony Other Other Lump Sum Inheritance Other

14 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 13 INCOMES PENSIONS Required fields are marked with an asterisk (*). I N C O M E - B A S E D P E N S I O N E S T I M A T E Pension 1 Pension 2 Pension 3 Pension 4 Family member* Description* Method of payout* - Life Income - Lump Sum Transfer Payout IRA Asset Linked incomes Benefits start age* Benefit start date* of final salary Estimated Amount (today s dollars)* of Pension payable to survivor* Index Rate: () I N C O M E - B A S E D P E N S I O N F O R M U L A + Description* Family member* Participation start date* Benefit per year of service* to a max of Number of years for average salary* Benefit start date (age)* of Pension payable to survivor Index Rate: () Method of payout (Income stream or lump sum) + If client has multiple incomes, indicate on which income the pension is based.

15 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 14 INCOME SOCIAL SECURITY S O C I A L S E C U R I T Y B E N E F I T S F O R M U L A Monthly Retirement Benefits default 100 Percent of monthly benefit to include:* Client Co-client Benefits start at: Client Co-client (choose Retirement or provide a specific age) + Index Rate: Monthly Survivor Benefits default 100 Percent of monthly benefit to include:* Client Co-client Index Rate: Monthly Disability Benefits default 100 Percent of monthly benefit to include:* Client Co-client Revised for Benefits During Retirement Start Date: Client Co-client (choose Retirement or provide a specific age) + Index Rate: S O C I A L S E C U R I T Y E S T I M A T E B E N E F I T Retirement Benefits at full retirement age Disability Benefits + Survivor s Benefits at full retirement age + Should only be entered if benefits are currently being received. Client Co-Client

16 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 15 EXPENSES Required fields are marked with an asterisk (*) R E G U L A R / L U M P S U M E X P E N S E S Description* Member* Type* Frequency* Amount* Start Date* End Date* Index Rate E X P E N S E K E Y Description Member + : Type: Start/End Date: Housing Client Lifestyle Jan 1, current year Property tax Co-client Employment/Business Now Transportation Joint Retirement Food Death Clothing Other Medical/Dental Insurance Charitable Contribution Other Discretionary Alimony Probate Internet Access Cell Phone Cable/Satellite TV Gifts Daycare Lawn Service Publications Parent Care + Expenses transfer to survivor upon death

17 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 16 EXISTING POLICIES LIFE E X I S T I N G L I F E I N S U R A N C E P O L I C I E S ( D E T A I L S ) Description* Policy Type* Policy Owner* Insured* Beneficiary* Death Benefit* CSV CSV payable with death benefit? Coverage cease at age Coverage cease on date* Premium Payer* Premium Frequency* Premium Amount* Premiums cease at age Premiums cease on date* Premiums waived at disability Policy 1 Policy 2 Policy 3 Policy 4 EXISTING POLICIES DISABILITY E X I S T I N G D I S A B I L I T Y I N C O M E I N S U R A N C E P O L I C I E S + ( D E T A I L S ) Description* Policy Type* (short-term, long-term, individual) Insured* Policy Owner* Premium Payer* Premium Amount* Premium Frequency* Index Rate: () Benefit Amount* Benefit Frequency* Benefit Taxable? Y/N Index Rate: () Maximum Indexed Benefit Waiting Period* Benefit Period Offset by Social Security? Policy 1 Policy 2 Policy 3 Policy 4

18 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 17 EXISTING POLICIES LONG-TERM CARE E X I S T I N G L O N G - T E R M C A R E I N S U R A N C E P O L I C I E S + ( D E T A I L S ) Description* Policy Number Company Insured* Effective Date* Daily Amount* Benefit During LTC Period Indexed? Benefit Before LTC Period Indexed? Waiting Period* Benefit Paid Until (years)* Premium Amount* Frequency* Premium Indexed? Premium Payer* Premium Cease Date Client Co-Client

19 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 18 INVESTMENT ATTITUDE GOAL DEVELOPMENT Tell me about the best investment you ever made. Why? When was it? Tell me about the worst investment you ever made. Why? When was it? What other types of investments have you bought (mutual fund, annuity, stock, bond, real estate)? How did you come to acquire those investments? How are they performing? Do you feel your investment portfolios for education or retirement are properly diversified? If not, why not? Are you familiar with asset allocation? How do you feel about our current economic market conditions? Stock market? Interest rates? What is your biggest concern that could impact your ability to achieve your goals? Generally speaking, when it comes to investing do you consider yourselves as conservative, moderate or aggressive risk takers? Explain. Would an asset allocation analysis of your current portfolio be of value to you?

20 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 19 INVESTMENT RISK PROFILE R I S K T O L E R A N C E Q U E S T I O N N A I R E 1. The graph below shows the potential range of gains or losses of a $100,000 investment in each of seven hypothetical portfolios at the end of a 1-year period. The number to the right of each bar shows the best potential gain for that portfolio, while the number to the left of each bar shows the worst potential loss. Given that this is the only information that you have on these seven hypothetical portfolios, which one would you choose to invest in? Portfolio A Portfolio B Portfolio C Portfolio D Portfolio E -$5,000 -$8,250 -$11,500 -$14,750 -$18,000 A B C D E $10,000 $16,500 $23,500 $29,500 $36,000 Portfolio F -$21,250 F $42,500 Portfolio G -$24,000 G $49, Inflation (rising prices for goods and services) can have a significant effect on your investments by decreasing their potential purchasing power over time. Aggressive investments have historically outpaced inflation over the long run, but have had more instances of short-term losses than more conservative investments. How do you feel about inflation and its impact on your investments? You are satisfied with your investments keeping pace with inflation. Limiting the potential for short-term loss is your main goal, and you are willing to sacrifice the potential for higher returns. You would like your investments to outpace inflation. You are willing to assume some potential for short-term loss in order to achieve that goal. You prefer that your investments significantly outperform inflation. You are willing to assume a greater potential for short-term loss in order to achieve that goal. 3. Suppose that a substantial portion of your investment portfolio is invested in securities. If the stock market were to experience a prolonged down market, losing 50 percent of its value over a 3-year period, what would you do (assuming your stocks behaved in a similar fashion)? Sell all the stocks in your portfolio. You are afraid that the stock market is in a downturn and you cannot afford the decrease in value. Sell half of the stocks in your portfolio. You think that the market may rebound, but you are not willing to leave all of your investment exposed to further loss. Hold the securities in your portfolio. You understand that your investment may be subject to short-term price swings and are comfortable weathering the storm. Buy more securities for your portfolio to take advantage of their low price. You are comfortable with market fluctuations and assume that the stocks will regain their previous value or increase in value.

21 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 20 R I S K T O L E R A N C E Q U E S T I O N N A I R E 4. Once again, assume you have a substantial portion of your investment portfolio in stocks. If the stock market were to gradually decline at an average of 2 percent per month, eventually losing 24 of its value over a year, which of the following would you do? Sell the securities in your portfolio and realize the 24 loss. You wish to avoid the risk of further loss. Sell half of the securities in your portfolio. You are not willing to leave all of your investment at risk for further loss. Do nothing. You are comfortable waiting for the stocks to regain their previous value or to increase in value. Invest more now because stocks are selling for approximately 24 less than they were 12 months ago. You believe that the stocks will regain their value or possibly appreciate even higher over the long-term. 5. Aggressive investments have historically provided higher returns while exhibiting greater short-term price fluctuations and potential for loss. How do you feel about fluctuations in the value of your portfolio? You want to minimize the possibility of loss in the value of the portfolio. You understand that you are sacrificing higher long-term returns by holding investments that reduce the potential for short-term loss and price fluctuations. You can tolerate moderate losses in order to achieve potentially favorable returns. You can tolerate the risk of large losses in your portfolio in order to increase the potential of achieving high returns. 6. What is the investment time horizon on these investable assets? Less than 3 years 3 5 years 6 9 years 10+ years

22 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 21 RETIREMENT GOAL DEVELOPMENT Describe the lifestyle you expect to have during your retirement years. Do you expect to relocate to a different area when you retire or stay where you are at today or possibly do both? What area? Do you currently have a plan in place to help you achieve your retirement goals? How are you doing? When was the last time you reviewed your plan? What is your biggest concern that could impact your ability to retire when you would like to or not being able to live the lifestyle you would like? Is working part-time an option for you during retirement? Why or why not? Does the possibility of outliving your money concern you? Why or why not? If, through our analysis, we find that what you currently have in place will not cover the initial costs to reach your goal, you have four options to consider: 4 Delaying your goal (e.g., retiring at a later age into the future)? Is this an option you would like me to explore? 4 Reducing your goal (e.g., reducing your required retirement income)? Is this a consideration? 4 Seeking to increase your rate of return by taking more risk? Is this an option you would like me to consider? 4 Increasing your level of savings? Should we consider this option? How would you feel if, at the time of your retirement, you had reached your financial goal and could (e.g., retire as you had imagined)? Would an analysis of your current retirement plans be of value to you?

23 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 22 GOALS ACCUMULATION R E T I R E M E N T Enter annual after tax retirement income. Different goals can be established for different time periods within retirement. Description* Member* Amount* Frequency* Start Age* End Age* (Note: Review Asset Allocation questionnaire to identify if investment preferences have changed for this goal.)

24 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 23 EDUCATION FUNDING GOAL DEVELOPMENT How do you feel about paying all or a portion of your child s education cost? If a portion, what percent? How do you feel about using an academic or athletic scholarship, grants or loans to help pay for education costs? Do you want your child to attend public or private school? In-state or out-of-state? Do you have a favorites list of schools for your child? What schools are they? Do you have a written education cost analysis showing the total projected expenses for tuition, room & board, fees and books for all four years? Would you like one for your child? Do you currently have a savings plan for your child s education? How are you doing? What is your biggest concern that could impact your ability to achieve your education goals? Do you expect your child s grandparent(s) to make a contribution to their grandchild s education fund? If so, when? What do you currently have in place that s earmarked for this purpose? If, through our analysis, we find that what you currently have in place will not cover the initial costs to reach your goal, you have four options to consider: 4 Delaying your goal (e.g., taking out loans to pay into the future)? Is this an option you would like me to explore? 4 Reducing your goal (e.g., public versus private school)? Is this a consideration? 4 Seeking to increase your rate of return by taking more risk? Is this an option you would like me to consider? 4 Increasing your level of savings? Should we consider this option? How would you feel if, at the time your child begins college, you had reached your financial goal and could send her/him off as you had imagined? Would an education funding analysis be helpful to you?

25 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 24 GOALS ACCUMULATION E D U C A T I O N Goal 1 Goal 2 Goal 3 Description* Name* Start Age* (year) Start Year* Annual Cost* Number of Years* Indexed at inflation +? (Note: Review Asset Allocation questionnaire to identify if investment preferences have changed for this goal.) E D U C A T I O N S E A R C H C R I T E R I A State School Name Goal 1 Goal 2 Goal 3

26 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 25 MAJOR PURCHASES GOAL DEVELOPMENT You indicated that you d like to build a new home in the next two years (or, buy a new car, save for a child s wedding, etc.). Can you tell me more about what you had hoped to purchase? What does it look like? Where would you build? What plans have you made to (for example) build the home? Have you determined the estimated cost of this goal? Could you change your mind about this goal or is it definite? Do you expect to use debt or existing funds to pay for this goal? What resources do you currently have in-place that are earmarked for this purpose? If, through our analysis, we find that what you currently have in place will not cover the initial costs to reach your goal, you have four options to consider: 4 Delaying your goal (e.g., taking out loans to pay into the future)? Is this an option you would like me to explore? 4 Reducing your goal (e.g., building a smaller/less elaborate home)? Is this a consideration? 4 Seeking to increase your rate of return by taking more risk? Is this an option you would like me to consider? 4 Increasing your level of savings? Should we consider this option? How would you feel if, in two years, you had reached your financial goal and could contract to build your home as you had imagined? Would an analysis be helpful to you?

27 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 26 GOALS ACCUMULATION M A J O R P U R C H A S E Goal 1 Goal 2 Goal 3 Description* Target Date* Amount* Index Rate (Note: Review Asset Allocation questionnaire to identify if investment preferences have changed for this goal.)

28 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 27 LIFE INSURANCE GOAL DEVELOPMENT How important is it for your family to be able to maintain their lifestyle if something happened to you? What would you want for your family in that event? Would your spouse continue to work, or go back to work? (CAN your spouse return to work?) Would you want your family to have the ability to stay in their present home? Do you want them to have the option of paying off the mortgage? What current financial goals would you want your family to achieve in the event of your premature death (e.g., spouse s retirement. children s education, wedding, etc.)? Would you like my assistance with this?

29 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 28 GOALS LIFE INSURANCE L I F E I N S U R A N C E Objectives: Analysis to include:* If Client dies If Co-client dies If both die Analysis Method: Cash Flow Analysis of Income Analysis Retirement Age of the Survivor: (If different from original input) Survivor s life expectancy: (If different from original input) Complete the following section only if selecting the of Income Analysis Option 1 S C E N A R I O S U R P L U S Percent Surplus Spent Percent Surplus Saved F U N D E D U C A T I O N G O A L S Education Goal #1 Education Goal #2 Education Goal #3 Percent of Goal to Include Percent of Goal to Include Percent of Goal to Include A N N U A L I N C O M E N E E D S Description* Member* Income Need* (pre-tax) Frequency* Start Date* End Date* Index Rate*

30 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 29 GOALS LIFE INSURANCE L U M P S U M N E E D S Pay Off Outstanding Liabilities (if applicable) Mortgage Yes No Other Loans Yes No Additional Lump Sum Needs Funeral Description* Amount* Expense Date Index Rate Major Purchase #1 Major Purchase #2 Percent of Goal to Include Percent of Goal to Include S U R V I V O R S I N C O M E Description* Member* Income Type* Frequency* Amount* Start Date* End Date* Index Rate*

31 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 30 GOALS LIFE INSURANCE A S S E T A V A I L A B I L I T Y The default for Nonqualified assets is Available at Death. The default for Qualified assets is Available at Retirement. Investment Assets Survivor Needs Estate Needs Asset Name Available Immediately Available at Retirement Not Available Not Available at Death The default for Lifestyle assets and Real Estate assets is Not Available. Lifestyle Assets Survivor Needs Estate Needs Asset Name Available Immediately Available at Retirement Not Available Not Available at Death Real Estate Assets Survivor Needs Estate Needs Asset Name Available Immediately Available at Retirement Not Available Not Available at Death

32 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 31 GOALS LIFE INSURANCE Complete the following section only if selecting the Cash Flow Analysis Option 2 E X I S T I N G A N N U A L E X P E N S E S Percentage of Pre-Retirement Lifestyle expenses to cover:* Percentage of Retirement Expenses to cover:* S U R P L U S S T R A T E G Y Percent Surplus Spent Percent Surplus Saved A D D I T I O N A L A N N U A L E X P E N S E S Description* Annual Amount* Number of Years* End Date* Index for Inflation (Y/N) A D D I T I O N A L A N N U A L I N C O M E Description* Income Type* Annual Amount* Start Date* End Date* Index for Inflation (Y/N) K E Y S Income Type: Salary Social Security Other

33 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 32 GOALS LIFE INSURANCE If income changes for the survivor, enter the details below. L U M P S U M N E E D S Pay Off Outstanding loans? Mortgage Yes No Other Loans Yes No Additional Lump Sum Needs Description* Amount* Expense Date Index Rate A S S E T A V A I L A B I L I T Y The default for Nonqualified assets is Available at Death. The default for Qualified assets is Available at Retirement. Investment Assets Survivor Needs Estate Needs Asset Name Available Immediately Available at Retirement Not Available Not Available at Death The default for Lifestyle assets and Real Estate assets is Not Available. Lifestyle Assets Survivor Needs Estate Needs Asset Name Available Immediately Available at Retirement Not Available Not Available at Death Real Estate Assets Survivor Needs Estate Needs Asset Name Available Immediately Available at Retirement Not Available Not Available at Death

34 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 33 GOALS LIFE INSURANCE (DEPENDENT SURVIVOR NEEDS ANALYSIS) ASSUMPTIONS Complete the following section if selecting If Both Die. Use this same section for single client situations with dependents or where only one client is participating in the planning process. S U P P O R T F O R D E P E N D E N T S Description* Owner* Annual Amount* End Age* Start Date* End Date* Index by Inflation (Y/N) A D D I T I O N A L L U M P S U M N E E D S Description* Amount* Index Rate

35 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 34 DISABILITY INCOME INSURANCE GOAL DEVELOPMENT How important is it for your family to be able to maintain their lifestyle if something happened to you? How would you replace your income if you were injured or ill and couldn t work? How comfortable would you feel with using your savings to maintain your lifestyle and the lifestyle of your family? What would you want for your family in that event? Would your spouse continue to work, or go back to work? (CAN your spouse return to work?) Would this analysis be of value to you?

36 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 35 GOALS DISABILITY INCOME D I S A B I L I T Y I N C O M E Assumptions Client Co-Client Analysis to include:* If Client becomes disabled If Co-Client becomes disabled Retirement age for analysis (if different from previous input) Life expectancy: (if different from previous input) Analyze Disability through age: Override tax rates? (yes/no) A N N U A L E X P E N S E S Percentage of Pre-Retirement expenses to cover:* Percentage of Retirement Expenses to cover:* S U R P L U S S T R A T E G Y Percent Surplus Spent Percent Surplus Saved A D D I T I O N A L E X P E N S E S Description* Annual Amount* Number of Years* End Date* Index for Inflation (Y/N)

37 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 36 GOALS DISABILITY INCOME L U M P S U M N E E D S Description* Amount* Index Rate A S S E T A V A I L A B I L I T Y The default for Nonqualified assets is Available at Disability. The default for Qualified assets is Available at Retirement. Investment Assets Asset Name Available at Disability Available at Retirement Not Available The default for Lifestyle assets and real estate assets is Not Available. Lifestyle Assets Asset Name Liquidate Immediately Liquidate Retirement Not Available

38 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 37 LONG-TERM CARE GOAL DEVELOPMENT Logic suggests that the longer you live, the greater the chance that you ll develop a long-term, chronic condition that requires long-term care. Is preparing for this possibility important to you? How do you feel about the possibility of caring for your parents some time in their future? How would you feel if your children needed to care for you because you were unable to care for yourself? Would you like my help with this?

39 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 38 GOALS LONG-TERM CARE L O N G - T E R M C A R E P R O T E C T I O N Objectives: If Client needs LTC If Co-client needs LTC Start (Age/Year) LTC Period (Years) ++ E X I S T I N G A N N U A L E X P E N S E S Of expense to cover Long-Term Care Survivorship A D D I T I O N A L LT C E X P E N S E S Description Expense Type* Daily Amount* Number of Years* Index Rate I N C O M E A D J U S T M E N T S D U R I N G LT C Existing Incomes Description Applicable on LTC A S S E T A V A I L A B I L I T Y Investment Assets (Non-qualified and Qualified assets default to Available during LTC. ) Asset Name Available During LTC Not Available Lifestyle assets and real estate assets default to Not Available. Asset Name Liquidate During LTC Not Available ++ The assumption is that client or co-client dies at the end of the LTC period.

40 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 39 ESTATE PLANNING GOAL DEVELOPMENT You have worked very hard to build your financial future and that of your family. How do you see the estate being distributed? What do you currently have in place to ensure this happens (e.g., trusts, wills, beneficiary designations, etc.)? Current estate taxes can erode your estate significantly. Is that a concern to you? How do you feel about your spouse s ability to manage assets after your death? Do you have or are you planning for any charitable gifting programs? Would you describe them for me? Would you consider various options (e.g., lifetime gifting, tax-free gifts to heirs like grandchildren, life insurance, etc.) that could help to minimize estate taxes at your death? Do you anticipate receiving an inheritance or windfall (bonus, life insurance payout, etc.) in the future? Can you tell me more about this? Should we explore these options together?

41 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 40 ESTATE PLANNING SET UP O B J E C T I V E S (Note: This information will not impact reporting.) W I L L D E T A I L S Client has a will Yes No N/A Last Update: Co-Client has a will Yes No N/A Last Update: Marital Trust Provisions in the will Yes No N/A Durable Power of Attorney Yes No N/A Revocable living trust Yes No N/A Living Will/Health Care Proxy Yes No N/A E S T A T E P L A N N I N G Q U E S T I O N S Current trustee or beneficiary of any trust Yes No N/A Joint property ownership with a non-spouse Yes No N/A Pre-nuptial agreements Yes No N/A Real property ownership in another state Yes No N/A Owns a Business Yes No N/A Post-nuptial agreements Yes No N/A Buy/Sell agreements Yes No N/A Employment contracts Yes No N/A Plan for children from a previous marriage Yes No N/A Plan for family with special needs Yes No N/A Plan gifts or bequests to charity Yes No N/A Plan for current gifts to heirs to reduce Yes No N/A potential estate taxes Plan Gifts to grandchildren Yes No N/A BEFORE MEETING WITH AN ATTORNEY, CONSIDER THE FOLLOWING: Attorney Name Guardian for minor children Estate Administrator Trust Administrator First Name Last Name Gifts and Bequests to children Gifts and Bequests to charity Other personal and financial goals important in your estate planning Target Amount Time Frame

42 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 41 ESTATE PLANNING SET UP (continued) A S S U M P T I O N S Life Expectancy Scenarios Client Co-Client Life Expectancy (for estate planning purposes only) Alternate Life Expectancy Simultaneous Death Year Assumed First Death Estate Distribution Selection Mirror Wills/Either Dies First (details entered apply regardless of order of death illustrated) Specify By Order of Death (separate data entry allowed to illustrate client or co-client dying first) State Death Taxes Add Maximum Federal Credit: Yes No Yes No State Death Tax Rate: Additional Fees Probate Fee or $ or $ Administration Fee or $ or $ F U N D E D T R U S T S Enter information on trusts that are currently funded. Trust Trust Tax Start of Yr. Start of Yr. Income Income to Income to GSTT Trust Name* Type Rate Market Value Cost Basis Member* Member Heirs Inclusion Ratio K E Y S Trust Type: Funded CST Funded Irrevocable Funded ILIT Funded QTIP Funded Marital Trust Funded Generic Testamentary Trust Funded CRT

43 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 42 ESTATE PLANNING SET UP (continued) G I F T I N G G R O W T H A N D H I S T O R Y Enter all future gifts below including regular (periodic, lump sum or asset gifts.) Any cash split gifts must be entered from each spouse to each beneficiary. Historical Data Member Taxable Lifetime Gifts Gift Taxes Already Paid Lifetime GSTT exemption used $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ E S T A T E E X P E N S E S Expense Name Amount Member

44 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 43 ESTATE PLANNING SCENARIOS A S S E T E S T A T E D E T A I L S Asset Name New Owner Probate Fees Admin. Fees Beneficiary When to Bequest Taxes G I F T I N G Regular Cash Gifts Max Annual or Description* Gifted By Gifted To* Gift Exclusion Annual Amount* Start Date* End Date* Index Rate Lump sum cash gifts Description* Gifted By* Gifted To* Amount* Gift Date* Index Rate Asset Gifts Max Annual Gift Exclusion/ Source Asset* Gifted To* Split Gift Yes/No (end of Year)* Value ($ or )* Gift Date*

45 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 44 ESTATE PLANNING SCENARIOS (continued) T R U S T S Enter all trusts that will be created in the future. Funded trusts that are a part of an existing trust should be entered in Funded Trusts. Trust Tax Crummey Trust Transfer to Trust Transfer Death Benefit Income to Income to Trust Type* Rate Yes or No (end of Year)* Policy Payable to Trust() Spouse Heirs K E Y S Trust Type: New Irrevocable New ILIT - Existing Insurance New ILIT - New Insurance New CRT

46 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 45 SAVINGS STRATEGY Enter regular and one-time saving strategies to help meet goals. Q U A L I F I E D S A V I N G S S T R A T E G Y Client Employer Accounts* Contributions* ($ or ) Contribution* ($ or ) Frequency* Start Date* End Date* Index Rate* N O N - Q U A L I F I E D S A V I N G S S T R A T E G Y Client Accounts* Contributions* ($ or ) Frequency* Start Date* End Date* Index Rate* SURPLUS SAVINGS STRATEGY Surplus strategies can illustrate saving funds in years there are positive cash flows at the end of the year. N O N - Q U A L I F I E D Accounts* Percent of Surplus* Start Date* End Date* Assumed expenses account for cash outflow items not specified by the client, in order to project a more accurate cash flow. Description* Percent of Surplus* Start Year* End Year* DEBT STRATEGY Enter additional payments over and above the regular payment schedule defined when the liability was originally created (entered). Liability* Amount* Frequency* Start Date* End Date* Index Rate*

47 C U S T O M W I T H G O A L D E V E L O P M E N T PA G E 46 DISCOVERY SUMMARY S U M M A R I Z E P R I O R I T I Z E A V A I L A B L E R E S O U R C E S O T H E R I S S U E S N E X T A P P O I N T M E N T Date: Location: