Form. G _ R Fact Finder 2011

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Form. G _ R Fact Finder 2011 Powered By Docstoc
					       Gallo & Russell, Certified Financial Planner™ Professionals
                                      CONSULTATION FACT FINDER
Date: ___________

                              Name                          DOB / Age

Client A   _________________________                         ______
Client B   _________________________                         ______
Dependents _________________________                         ______
           _________________________                         ______
           _________________________                         ______

Home Address Information

Address ____________________________________________________________________
City ________________________________________ State________ Zip_____________
Mailing Address (if different) ____________________________________________________
Home Phone_______________________             Cell Phone    _________________________
Home Fax _______________________              E-Mail address_________________________

Employment Information (If retired or disabled, please indicate)

                   Client A                                                     Client B
Occupation _____________________________                             _______________________________
Employer   _____________________________                             _______________________________
Address    _____________________________                             _______________________________
Work Phone _____________________________                             _______________________________

Personal Financial Goals

Why did you contact Gallo & Russell? (mark all that apply)
□ retirement planning           □ asset management                           □   income protection
□ asset protection              □ asset diversification                      □   tax planning
□ financial planning            □ education savings                          □   estate planning
□ insurance planning            □ general consultation                       □   legacy for beneficiaries
□ other (explain):

What are you doing now to reach your financial goals?

Who has provided you with financial advice in the past?

 All data and information provided to Gallo & Russell is strictly confidential. Your information is absolutely not
  shared with any outside party. At the conclusion of our engagement, all information will be returned to you.

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                                       Current Income Information
                                      (Please provide prior year tax return)

               Client A                                                        Client B

        Earnings                       _________                       Earnings                      _________
        Social Security Income         _________                       Social Security Income        _________
        Pension Income                 _________                       Pension Income                _________
        Other sources of income                                        Other sources of income
        (dividends, interest, etc.)                                    (dividends, interest, etc.)
        ___________________            _________                       ___________________           _________
        ___________________            _________                       ___________________           _________
        ___________________            _________                       ___________________           _________

        Income All Sources:            _________                       Income All Sources:           _________

        Pension survivor benefit (%) _______                           Pension survivor benefit (%) _______

        Is any income after-tax?       _________                       Is any income after-tax?      _________

        Do you expect an inheritance?  Yes  No                    Do you expect an inheritance?  Yes  No
        Approximate amount?       _________                           Approximate amount?       _________

        If yes for either spouse, please describe the general situation:

                                  Risk Management (Insurance) Review
                              (Provide relevant policies and/or policy declarations)

                              Insured                          Provider                      Coverage





Long Term Care:

What general comments would you make regarding insurance protection?

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                                           Estate Planning

       Do you have a will?                                               Yes          No

       Do you have a Living Trust?                                       Yes          No

       Do you have Testamentary Trust Provision in your will?            Yes          No

       Do you have a “Living Will”?                                      Yes          No

       Do you have a Durable Power of Attorney?                          Yes          No

       Do you have a Health Care Surrogate?                              Yes          No

       Do you have joint account owners other than your spouse?  Yes                  No

              If yes, who?         ________________________
              Please explain:

       When was your estate plan last reviewed? _________________________________

       Who assisted you with your estate plan? __________________________________

       Do you gift?                        Beneficiaries                 Yes          No
                                           Charitable                    Yes          No

For Estate Planning purposes, please describe your personal marital situation (1st marriage, 2nd
marriage, children by each marriage, any other relevant information including the contemplation of

Please list your beneficiaries, their ages and their relationship to you:

           Please note: Gallo & Russell are not lawyers and do not practice law. However, the above
         information is necessary when considering comprehensive financial planning. Should a legal
                    matter arise, qualified legal representation will be strongly encouraged.
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                            Financial Information: Net Worth and Cash Flow
               (Provide the most recent financial statement for each account whenever possible)

                                                  Rate                                   Provider
    Asset                    Current               of               Monthly                 or
                             Value               Return             Funding             Institution
Vehicle 1
Vehicle 2
Money Market
401(k) A
401(k) B
Roth IRA A
Roth IRA B
Other Real Estate
Personal Property

      (Include information on all liabilities – including outstanding amounts and interest rates.)

                     Current            Financial      Monthly           Interest           Term
 Liabilities         Balance           Institution     Payment            Rate             Remaining
Vehicle Loan
Credit Cards

What is the amount of your net savings / (deficit) each month? Explain:

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Risk Tolerance: everyone needs cash in checking, savings, CDs, etc. for short-term needs and to
balance their overall financial goals.

For your longer-term financial goals, which of the following statements best describes your
GENERAL investment / risk attitude?

Client A     Client B

_____        _____ Concerned             “I want to avoid any chance of loss of principal, even if
                                         returns do not keep pace with inflation.”

_____         _____ Conservative         “Safety of principal is my primary concern but I want returns
                                         of 2% - 3%. I am open to minor account fluctuation to
                                         outpace inflation in order to achieve my goals.”

_____         _____ Moderate:            “I want balanced returns (4% - 6%). I am willing to accept
                                         fluctuations in my account to achieve my goals.”

_____         _____ Growth               “I hope to achieve long term stock market returns (>8%). I
                                         am willing to accept frequent account fluctuations to achieve
                                         my goals.”

_____         _____ Aggressive           “I seek the highest possible returns (>10%). I am willing to
                                         take large fluctuations in my account value to achieve my

What has been the best investment you have ever made and why?

Which investment have you been most unhappy with and why?

Retirement Planning (if not currently retired)
                                                                             Client      Spouse

At what age would you like to retire?                                        _____        _____

What percentage of your current income do you desire in retirement?          _____         _____

What is your Social Security benefit at retirement?                          _____         _____

If applicable, how much is your monthly pension at retirement?               _____         _____

What concerns you the most about your retirement? (Explain)

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                             SUMMARY OF FINANCIAL GOALS

Please provide a summary of your financial goals and how you expect Gallo & Russell to assist you in
accomplishing your goals:

To establish the relative importance of your goals and objectives, prioritize the following items:

_____ Retirement Security:          Provide enough retirement income to maintain your desired
                                    standard of living.

_____ Asset Management:             Provide prudent asset management to meet your investment goals
                                    and minimize the associated risks.

_____ Asset Accumulation:           Develop a systematic savings and investment program to meet current
                                    and future needs.

_____ Income Protection:            In the event of death or disability, provide enough income to maintain
                                    your family’s current and future standard of living.

_____ Children’s Education:         Provide adequate funds to meet scheduled educational expenses.

_____ Asset Protection:             Provide additional protection to preserve your principal from market
                                    declines and rising costs.

_____ Manage/Reduce Taxes:          Minimize current or future income tax liabilities.

____ Other                          Please Explain:

How did you hear about Gallo & Russell?

       Referred by Friend           Referred by Professional Advisor            Newspaper

       Yellow Pages                 Internet                     Other

 The success of our engagement is dependent upon the accuracy of the information you provide. We cannot be
    held liable for any solution or recommendation that is later determined to be unsuitable due to missing,
                                       inaccurate or misleading information.

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