401k Participant Planner
401k Participant Planner
Name:_____________
Date:__________
Primary Financial Goals
My primary financial goals are:
1.____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
2.____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
3.____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Primary Financial Goals
Marriage Status: ____________
Marriage Stat s
DOB: ___________
Spouse DOB:
Spouse DOB:________________
Number of Children: ______ Male ______ Female
Please answer the following questions:
Please answer the following questions:
My spouse and I both have our wills completed. [ ] y [ ] n
, p p y [ ]y[ ]
If so, our wills have been updated in the past five years. [ ] y [ ] n
I have calculated the value of my life to my family. [ ] y [ ] n
I understand the value of my spouse to my family. [ ] y [ ] n
I know the amount of money necessary for me to be financially
independent. [ ] y [ ] n
Balance Sheet
Assets Liabilities
Investments (Non‐Retirement):
I t t (N R ti t) Short Term:
Sh t T
Stocks $_________________ Credit Card $_______________
Bonds $_________________ Long Term:
Mutual Funds $_________________ Mortgage $_________________
Other $_________________ Business $_________________
Investments (Retirement): Additional Property $_____________
IRA $_________________ Other:
__________________________________
401(k) $___________________ __________________________________
__________________________________
403(b) $___________________
403(b) $ __________________________________
__________________________________
Profit Sharing $_________________ __________________________________
__________________________________
Other $_________________ __________________________________
__________________________________
Other Assets: __________________________________
__________________________________
Business: $___________________
Real Estate: $_____________________
Insurance Information
Life Insurance:
Company:_____________________
Company:_____________________
Death Benefit:_________________
Death Benefit:_________________
Premium:_____________________
Premium:_____________________
Disability Insurance:
Company:_____________________ Company:_____________________
Monthly Benefit:_______________ Monthly Benefit:_______________
Premium:_____________________ Premium:_____________________
Long Term Care Insurance:
Company:_____________________ Company:_____________________
Daily Benefit:_________________ Daily Benefit:_________________
Premium:_____________________ Premium:_____________________
Total Household Income:________________
Total Household Income:
Current Expenditures Amount Now At Retirement
Federal and State Income Tax
FICA Taxes
Residence Mortgage
Investment Real Estate Loans
Life Insurance Premiums
Homeowners Insurance
Auto Insurance
Medical and LTC Insurance
Disability Insurance
Disability Insurance
Charitable Contributions
Misc Itemized Deductions
Property and other taxes
Medical Expenses
Groceries
Household Supplies
Eating Out
Gas/Electric
Water/Trash
Gas/Oil
Repair/Maintenance
Gifts/Birthday
Domestic Help
Clothing/Jewelry
Property Improvements/Upkeep
Home Furnishings
Vacations/Travel
V ti /T l
Hobbies
Membership, Dues ‐ Professional
Pet Expenses
Cable TV/Phone/Internet
Property Owner's Association
p y
Total Expenses
Your Next Steps
Now that you have spent some time thinking about your financial future, you
Now that you have spent some time thinking about your financial future you
should be much clearer on where you are and where you want to go in the
next three to five years. We encourage you to take action immediately either
with us or with your current advisors, team members and family.
As part of our commitment to you and your success, we are now offering
you the following support:
The Personal Financial Health Report: This is a simple assessment of your
current financial health. You will understand the necessary actions needed
to help you get closer to your goals and to take full advantage of all your
opportunities. This typically is a 30 minute phone call and there is no fee or
commitment, we are simply glad to help.
[ ] ld lik l h l i i l lh
[ ] Yes, I would like to complete the Personal Financial Health Report
The Inspired Goals Blueprint: This is a more detailed plan designed to help
you establish a written mission with specific goals and the actions steps
needed to achieve your personal mission and goals. It consists of a simple
p p , p p p,
preparation exercise, an in‐depth Blueprint Workshop, and the development p
of your Inspired Goals Blueprint. This generally requires a 2 – 3 hour time
commitment. The blueprint presents a detailed evaluation of your current
situation and performance in the areas we know are critical for your ultimate
success. It also provides a detailed, three year implementation calendar to
ensure you are always working on the most important goals. The blueprint
helps you focus your energy, rally your team and advisors, and fully leverage
O f f hi i i i ll $ 000
your resources. Our fee for this services is typically $1,000. But, we are
offering this to our 401k participants for $500 (50% discount).
[ ] Yes, I would like to register for the Inspired Goals Blueprint
Please fax this document back to 843‐873‐5313 or email it to
ben@waypointus.com
ben@waypointus com
Name:___________________
Company Name:________________
Best Way to Contact:______________
Phone Number:________________
Phone Number:
Email Address:______________________