Wealth Management Client Profile Template Page 2
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3HEIRS / BENEFICIARY INFORMATION (Children, grandchildren, friends, etc.)
Name (First, Middle, Last)
Social Security/Tax ID #
Relationship
Birthdate (mm/dd/yyyy)
PERSONAL FINANCIAL PROFILE (if available, please attach a copy of your documents for our review)
ASSETS
$
LIABILITIES
$
Bank Accounts
$
Mortgages
$
(CD, Savings)
Non-Retirement Accts
$
Loans
$
(Trust, Joint, Individual)
Retirement Accts
$
Autos
$
(IRA, 401k, Pension)
Real Estate (Home)
$
Credit Cards
$
Real Estate (Investment)
$
Other
$
Business Assets
$
EQUITY
$
Other
$
LIFE INSURANCE
INCOME
Term
Whole Life
Universal Life
Gross Annual Income
$
Amount of Coverage
$
Under Insured
Expenses (mo./yr)
$
How do you feel?
Fully Insured
Tax Bracket
%
Over insured
(State + Federal)
State of Taxation
Do you have:
How much income do you
need from your investment
$
/month
MEDICAL INSURANCE
Yes, $________
None
portfolio?
MEDICARE PART “B”
Yes, $________
None
TRUST
Yes
NONE
LONG TERM CARE INS.
Yes, $________
None
Trust date (mm/dd/yyyy)
Date Amended (mm/dd/yyyy)
ACCIDENTAL DEATH
& DISMEMBERMENT INS. Yes, $_______
None
ESTATE PLAN
Yes
NONE
DISABILITY INS.
Yes, $________
None
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