FACT FINDER

Asset-Map®

Household Name

Fact Finder Date

Supporting Household Information

6Ls Financial Professional:

Financial Professional:

What is the household’s plan to deal with the following events? The following is a list of 6 events that commonly change the course of financial well-being. Plan No Plan Modify

Primary Entity Legal Name: Date of Birth: State of Birth: Gender: Resident State: Citizenship: Work Phone: Cell: E-mail:

______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________

Spouse/Partner Legal Name: Relationship to Primary: Date of Birth: State of Birth: Gender: Resident State: Citizenship: Work Phone: Cell: E-mail:

______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________ ______________________

A. Current Monthly Expenses (after-tax) 3-6 months (i.e. Core Living Expenses)

B. Comfort Liquidity Reserve (i.e. Amount desired to “sleep at night”)

2. Long-Term Disability A. Monthly Expense Needed to Live (after-tax) (i.e. Living Expenses, Lost Retirement

Investment Experience: Cash/Checking:____________ Savings/CDs:____________ Mutual Funds/Stocks:____________ Annuities:____________ 401(k):____________ Real Estate:____________

1. Liquidity Needs

Savings)

Bonds/Funds:____________ IRA/SEP:____________ Other:____________

B. Planned Capital Expenses (i.e. Education Funding, Home Modification)

3. Loss of Life Financial Summary: Total Assets:____________

Net Worth:____________

Total Income:____________

Liquid Net Worth:____________

A. Debt Repayment Obligations

Tax Bracket:____________

(i.e. Mortgage, Credit Card, Loans)

B. Planned Capital Expenses (i.e. Final Expenses, Education, Emergency Res. Legacy)

Financial Priorities/Investment Objectives:

Investment Risk Preference:

Investment Time Horizon:

C. Required Income Replacement

Please check ALL that apply

Please check ONE

Please check ONE

(i.e. Lifetime Income, Transitional Income)

Managing Risk Accumulating for Future Financial Independence Wealth Preservation Tax Relief

1. Conservative 2. Conservative/Moderate 3. Moderate 4. Moderate/Aggressive 5. Aggressive

Short (0-3 yrs.)

4. Long-term Care A. Daily Expense Needed

Medium (3-7 yrs.)

(i.e. Facility Expenses, In-home care)

B. Expected Capital Expenses

Long (> 7 yrs.)

(i.e. Home Modification, Training, Coordination)

5. Longevity Next Meeting/Discussion

A. Annual Expense Needed to Live (after-tax) (i.e. Living Expenses, Education Funding, Medical Expenses)

Date:

B. Desired Capital Expenses

Place: Time:

(i.e. Vacation Home)

6. Legal, Liability, & Legacies

All Rights Reserved © 2014 – Asset-Map®, LLC

Wills Trusts Creditors Predators Asset-Protection Concerns Liability Coverages Special Needs Dependents All Rights Reserved © 2014 – Asset-Map®, LLC

Details

Asset-Map® Platform Date

Legal Entities: Dependents, Supporters, Other Significant People

Name DOB Relationship

_____________ _____________ _____________

_____________ _____________ _____________

Businesses

_____________ _____________ _____________

INCOME SOURCES

Trusts Name Purpose Inception Date

Name Purpose Inception Date

Name Legal Structure Inception Date

Name Purpose Inception Date

Name Purpose Inception Date

_________________________ Legal Advisor _________________________ Tax Advisor _________________________ Investment Advisor _________________________ Insurance Advisor

INCOME SOURCES NOTES:

Reference Name Insurance Carrier Benefit Amount

Reference Name Income Source Annual Amount

Reference Name Income Source Annual Amount

Contribution Match

Contribution Match

Reference Name Asset Location Value

Reference Name Asset Location Value

Name DOB Relationship

Reference Name Asset Location Value

Name DOB Relationship

Reference Name Asset Location Value

TANGIBLE and JOINT ASSETS and LIABILITIES All Rights Reserved © 2014 – Asset-Map®, LLC

Reference Name Asset Location Value

Non-RETIREMENT ASSETS

Reference Name Asset Location Value

Advisors

RETIREMENT ASSETS

RETIREMENT ASSETS

Reference Name Insurance Carrier Benefit Amount

Non-RETIREMENT ASSETS

Charitable Organizations

Name Legal Structure Inception Date

INSURANCE POLICIES: Life, Long-term Disability Income, Long-term Care

NOTES:

Household