Retirement Plan Analysis

As a service to both our current and prospective clients, we are pleased to offer a personalized retirement analysis. A copy of the final printed report and a telephone consultation with one of our professional advisors will be provided with this complimentary service.

Retirement Income Questionnaire

All spaces must be filled out for analysis to be run.

Contact Information	Individual 1	Individual 2
Name
Address
Phone
E-mail
Date of Birth
Retirement Age
Principal State of Residence

Insurance Information	Individual 1	Individual 2
Whole/Variable Life Insurance
Term Life Insurance
Cash Values (less loans)
Long-Term Care Insurance

Defined Pension Information

Include information on pensions that provide an annual income level (i.e.: military pension, state pension, etc.)

	Individual 1		Individual 2
	Pension 1	Pension 2	Pension 1	Pension 2
Anticipated Annual Amount	$	$	$	$
Starting Age
Increase Rate Before Retirement	%	%	%	%
Increase Rate After Retirement	%	%	%	%
Survivor benefit (%)	%	%	%	%

Earned Income	Individual 1	Individual 2
Earned Income now	$	$
Earned Income Post Retirement	$	$

Social Security	Individual 1	Individual 2
Age to Start Benefit
Estimated or Current Annual Benefit	$	$

Retirement Expenses

Estimate annual figures for expenses related to shelter, food, clothing, transportation, insurance, loans, etc. Do not .include taxes.

Monthly Living Expenses (today’s dollars)

Now	$
During Retirement	$
Current Surviving Household	$

Investment Assets

List capital assets including banking accounts, investment accounts, 401K or 403B plans, stocks, bonds, mutual funds, business interests and other financial assets.

No. Asset name	Current value*	Annual Additions	Account Description (i.e. stock, 401k, etc)	Owner
1.	$	$
2.	$	$
3.	$	$
4.	$	$
5.	$	$
6.	$	$

Rental Properties

	Value	Mortgage Amt	Mortg Intrest Rate	Rental Income
Property 1
Property 2

Additional Assets/Debts

Residence Value	$
Mortgage	$	Yrs left on mortgage		Interest Rate
Other Assets	$	Other Loans on Assets	$

Financial Events

(i.e. inheritance, home sale, sale of business, stock options)

Event Description
Date of Event
Value of Event

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