Estate Planning Fact Finder If you have any questions, please feel free to call BSMG Life Wholesaler at 1-800-343-7772. Agent: Date: BSMG Wholesaler: Client Information: First Name: Middle Int: Last Name: Date of Birth: Gender: Male Female U.S. Citizen: Yes No Spouse Name: Middle Int: Last Name: Date of Birth: Gender: Male Female U.S. Citizen: Yes No Resident Address: City: State: Zip Code: Home Phone: Business Phone: Name of Children: Estate Assets: Business Ownership: Legal Name(s): Type¹: Total Fair Market Value: Client Ownership (%) and Value: Title to Assets²: Cost Basis: 1. 2. 3. Real Estate: Purchase Price: Fair Market Value: Mortgages: Title to Assets²: Primary Residence: Second Residence: Commercial Property: Land: Other Real Estate: ¹ Business Type ² Title to Assets C= C-Corp CP= Community Property S= S-Corp TC= Tenant in Common P= Proprietor JT= Joint with Spouse PT= Partnership C= Client LLC= Ltd. Liability Co S= Spouse PSC= Personal Service Corp JO= Joint with Others FLP= Family Ltd. Partnership RT= Revocable Trust (C) (S) continued on next page Page 1 of 5
Estate Assets...continued Other: Asset Value: Title to Assets²: Miscellaneous Personal: (Jewelry, Autos, Boats, Collectibles) Other Non-Liquid: (Limited Partnership, Notes Receivable, Deferred Compensation, etc.) Liquid Assets: Current Value: Title to Assets²: Cash Equivalents (Savings, Money Markets, CDs) Securities and Mutual Funds (Stocks) (Bonds) (Tax Exempt Bonds) Deferred Annuities (Non-Qualified) Qualified Retirement Plans: Account Value(s): Participant Owner: Plan Beneficiary: Defined Benefit: Profit Sharing: 401(k): 457(b): TSA [403(b)]: SEP: IRA: Roth IRA: Life Insurance: Policy 1: Policy 2: Policy 3: Policy 4: Policy 5: Policy 6: Death Benefit Gross Cash Value Total Loans Cost Basis Issuing Company Insured Owner Beneficiary Annual Premium continued on next page Page 2 of 5
Estate Liabilities: Client: Spouse: Joint: Credit Card Debt: Auto Loans: Other Debt: Income: Client: Spouse: Joint: Gross Salary: Bonus: Income from Investments: Income from Qualified Plans: Current Estate Distribution Plan: Intestate (no will) Qualified Domestic Trust (Q-DOT) Simple Will (100% to Spouse) Bequests to Charity: Marital/Credit Shelter Will or Trust Specific Bequests to Others: Trusts: Revocable (client) Revocable (spouse) Irrevocable (client) Irrevocable (spouse) Date Established: Grantor: Living Deceased Trustee Name(s): Current Value of Assets: Income Beneficiaries: Trust Assets: Annual Income: Remainder Beneficiaries: Describe trust provisions for distribution of income or principal: Gift Planning: Type of Property Gifted: Donor(s): Donee(s): Date Value of Gifts: Annual Exclusion(s) Allowed: Donor(s) Unified Credit Used: Gift Taxes Paid by Donor(s): Page 3 of 5
Additional Financial Data: Assumptions - Retirement Planning: Growth rate for QRP/IRA assets: % Age of client at death Age of spouse at death At what age do you expect to retire? Amount of after-tax income needed for fixed expenses? $ (annual after-tax amount in today s dollars) Assumed inflation rate for fixed expenses % Annual defined benefit pension: $ Annual Social Security benefit: $ Assumptions - Stocks, Bonds, Mutual Funds, Annuities: Growth rate and dividend rate for equity assets: % / % Estimated total cost basis $ Growth rate for tax exempt income assets: % Growth rate for taxable interest/yield assets: % Growth rate for non-qualified annuities: % Estimated cost basis: $ Assumptions - Business, Real Estate, Land: Growth rate for non-liquid assets: % Net rental income from real estate: $ Will any non-liquid assets be sold? If yes, what year will asset(s) be sold? If yes, at what price will non-liquid asset(s) be sold? If yes, adjusted cost basis at time of sale $ Assumptions - Taxes: Assumed effective income tax rate % Assumed effective income tax rate of heirs % Assumed effective capital gains tax rate % Assumed effective estate tax rate % Gifting: Are you currently making regular, annual gifts to your children and/or grandchildren? Yes No If yes, annual amount is: $ Have you or your spouse purposely used any portion of your available unified credit exemption to make gifts in excess of the annual exclusion per person per year limit? Yes No If yes, how much of your exemption have you used? $ Page 4 of 5
Future Savings: Do you plan to make or continue to make annual contributions to a tax qualified retirement plan? Yes No (Pension, 401(k), IRA, Profit Sharing, 403(b), etc.) If yes, what is the total annual amount you plan to deposit to these plans: $ annually for years Regarding other annual savings, please complete the following: I estimate that I will make annual savings deposits from after-tax earned income or business profits to: taxable equity/income producing assets in the amount of $ annually for the next years tax exempt income producing assets in the amount of $ annually for the next years taxable interest/yield producing assets in the amount of $ annually for the next years Additional Information: Future Inheritances: Prior Marriages: Accountant: Phone: Long Term Care Plan: Special Medical Problems: Attorney: Phone: Other: Page 5 of 5