Personal-financial-planning & Tax Planning Data Organizer

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personal financial planning / tax planning data organizerClient name:Client name:Advisor’s name: Tony Novak, CPA, MBA, MT, 610-572-1724, www.tonynovak.comDate:Documents reviewed: Tax returns Liability insurance policies Medical insurance policies Life insurance policies Disability insurance policies Other insurance Pension statement from employer 401(k) statement IRA statement Latest statements from trust companies, brokers, investment companies and banks pertaining toinvestments Budget of personal and living expenses Latest mortgage and other loan statements Latest will, power of attorney OtherPage 1 of 22

personal financial planning / tax planning data organizerCLIENT INFORMATIONPersonal InformationClientSpouseClientSpouseLast Name:Marital Status: (married, divorced, single)Number of Dependents:Gender:Date of Birth:Employment:Occupation:Contact InformationHome Phone Number:Office Phone Number:Cell Phone Number:Fax Number:Email Address:Address:City:State:Country:Zip Code:Name of Child(ren) or Dependent(s)GenderAdditional NotesOverall financial condition:What is the current level of financial stress within your household?What are your biggest and most immediate concerns?Page 2 of 22Date of Birth

personal financial planning / tax planning data organizerKey AdvisorsAdvisorAccountantTax AdviserLawyerLawyerInsurance AgentInsurance AgentPhysicianPage 3 of 22NameAddressTelephone #

personal financial planning / tax planning data organizerFAMILY SECURITYDisability Income sUntil AgeMedical Expense eficiaryPremiums*DeathBenefit*CashSurrenderValue** If the death benefits, premiums or CSVs are not level, attach the appropriate schedule.Life Insurance CoverageTypeInsuredMemberPage 4 of onthlyPremiumCoverageAppliesUntil Age

personal financial planning / tax planning data organizerWill InformationClientCo-clientIs there a Will? (yes or no):What date was the Will last updated on?Where is the Will located? (Safety deposit box, etc.):Power of Attorney:Executor :Estate Beneficiaries (Dependents are automatically included as potential heirs.)Beneficiary r ClientGSTTApplicablefor Co-Client(yes / no)(yes / no)50% Charity(applies tocharitablebeneficiaryonly) (yes / no)CASH FLOW PLANNINGCASH t Salary:Employment Salary:Employment Bonus:Self-employed Earned:Tax-Free Income:Royalty Income:Alimony:Child Support:IndexRateApplicable Period% Whilein LTCClientCo-ClientDebt Repayment PlanRegularAny payments made directly toward the principal of an existing loan. These are over and above therequired payments that are automatically defined for the loan.Repayment PeriodLiability NameAmountIndexFrequency(e.g. monthly,Rateweekly)Page 5 of 22

personal financial planning / tax planning data organizerLump SumPayments made in one or more lump sums toward the principal of an existing loan. These are over andabove the required payments that are automatically defined for the loan.Repayment DateLiability NameAmountIndexed to(upon retirement, uponInflation(yes / no)disability, other - e.g. Jan. 152003)Living ExpensesItemPerMonthPerAnnumItemLOANS & LIABILITIESOTHER LIVING COSTSMortgageChildcareOther Mortgage LoansChildren/DependantsClothingPersonal LoansSchool/University FeesAuto LeaseAllowanceAuto LoanClothes/Shoes – for WorkInvestment LoansClothes/Shoes – PersonalCredit CardsEntertainment/RestaurantsHome/Property InsuranceClub Membership/HobbiesLife InsuranceSports & FitnessIncome ProtectionFurniture/AppliancesOtherBooksPet CostsSubscriptions/NewspapersHOME, UTILITY, ElectricityOtherGasPage 6 of 22PerMonthPerAnnum

personal financial planning / tax planning data organizerCable TVTRANSPORTATIONHome PhoneCar InsuranceMobile PhoneCar FuelInternetCar Repairs & MaintenanceGroceriesTransport Costs (Bus, etc.)Medical/Dental ConsultationsOtherPrivate Health InsurancePharmacy/PrescriptionsHousehold HelpOtherAccountantSolicitorInvestment Real Estate Details:Primary homeSecond residenceBusiness / Investment propertyPage 7 of 22

personal financial planning / tax planning data organizerSavingsRegular - Savings made on a regular basisAsset NameAmountIndexRateFrequencySavings Period(e.g. monthly,weekly)(while working, whileretired, both other- e.g.Start date – End dateLump Sum -Savings made in one or more lump sums.Asset NameAmountIndexed to InflationDate(yes / no)Surplus SavingsSavings put towards an asset using surplus cash at year-endAsset NameSavings Period(e.g. Jan. 1 2003 - Jan 1. 2013)Additional NotesPage 8 of 22Percentage ofSurplus

personal financial planning / tax planning data organizerNET WORTHAssets - Tax-qualifiedDescriptionOwnerType(name)(client, coclient)(e.g. IRA,401(k),529, other)PurchaseDate(if known)Market Value(as of the startof the Not Tax-qualifiedDescriptionTypeOwnerLinked To(abc mutualfund,UTMA, etc)(e.g.mutualfund ,stock,bond)(client, rchaseDateMarketValueCostBasis(if known)(as ofthe startoftheyear)(as ofthestart oftheyear)Rate terest I, dividend D, capital gains CG, deferred growth DG, tax free TF)LifestyleDescriptionPage 9 of 22TypeOwner(e.g. personalproperty, residence)(client, coclient,joint, ate(if known)(adj. costbase)(as of the startofthe year)(%)

personal financial planning / tax planning data organizerLiabilitiesDescriptionOwner(client, spouse, joint)Life Insured(yes / no)Disability Insured(yes / no)Interest TaxDeductible (yes / no)Start DateInt. RateAmortization(years or end date)Principal AmountPrincipal Date (as of)Pmt. Type(e.g. interest only, PI)Pmt. Freq.(e.g. weekly, monthly)NET WORTH SUMMARYClientAssetsLiabilitiesNet WorthAdditional NotesPage 10 of 22Co-client

personal financial planning / tax planning data organizerRETIREMENT PLANNINGRisk ProfileModel Portfolio (if applicable):Economic FactorsProjected Inflation: %MilestonesClientCo-clientRetirement Date (age / year):Life Expectancy (age / year):Retirement IncomeDesired Income (after tax): Savings Plan Start Date:Indexed to Inflation?Indexed to Inflation?YesYesNoNoMajor PurchaseDescription(e.g. Vacation)PurchaseAmountPurchaseIndexed RatePurchase DateGoal 1Goal 2Goal 3Goal 4Maximum Additional Monthly Savings you would consider for all major purchase goals.) Linked Assets: (Link the following assets to each goal as defined above.)Goal 1:Goal 2:Goal 3:Goal 4:Additional NotesPage 11 of 22Savings PlanStart Date

personal financial planning / tax planning data organizerDefined Benefit PlansAttach pension statements or obtain information from the client’s company pension administrator.GeneralPension 1Pension 2Pension 3Pension 1Pension 2Pension 3Benefits Basedon AverageAnnual SalaryEstimatedMonthlyBenefitOwner (client, spouse):Description:Linked Incomes(income to which the pension applies):Pension Participation Date(eligibility or enrolment date):Number of Years Average Salary:Pension Formula (percent per year of service):Accrue Pension Credits while Disabled (yes / no):Benefit CalculationBenefits Begin(age, date, at retirement or when disabled):Percent Payable to Survivor (If applicable):Benefit Reduction for Survivor Coverage(if applicable):Benefit Indexing(specify maximum indexing if applicable):Normal Retirement Age(as specified by the pension plan):Qualifying Factor(as specified by the pension plan):Percent Penalty for Early Retirement (per year);Minimum Retirement Age for Unreduced Benefit:IncomesSocial SecurityOwner(client, spouse)Eligible forBenefitsBenefitsStartAgeYearsWorkedto Date(if applicable)Applicable Benefits to be included in plan:Retirement Benefits:Survivor Benefits:Disability Benefits:Page 12 of 22YesYesYesNoNoNo

personal financial planning / tax planning data organizerDeferred AnnuitiesAnnuity #1Name:Type:(Amount Certain, Term Certain, Life Income)Co-ClientAnnuitant(s): ClientOwnership:JointFirst to DieLast to DiePercent to Survivor:Issue Date:Account type: GeneralSeparateBalance or Market Value :Type of Annuitization:Beneficiary:Initial Premium :Cost Basis :Annuitization Start Date:Payment Frequency:Guaranteed Number of Years:Annuity #2Name:Type:(Amount Certain, Term Certain, Life Income)Annuitant(s): ClientCo-ClientOwnership:JointFirst to DiePercent to Survivor:Issue Date:Account type: GeneralBalance or Market Value :Last to DieBeneficiary:Initial Premium :Cost Basis :SeparateAnnuitization Start Date:Type of Annuitization:Payment Frequency:Guaranteed Number of Years:Annuity #3Name:Type:(Amount Certain, Term Certain, Life Income)Annuitant(s): ClientCo-ClientOwnership:JointFirst to DieIssue Date:Account type: GeneralBalance or Market Value :Type of Annuitization:Last to DiePercent to Survivor:Beneficiary:Initial Premium :Cost Basis :SeparateAnnuitization Start Date:Payment Frequency:Guaranteed Number of Years:Additional NotesPage 13 of 22

personal financial planning / tax planning data organizerEDUCATION PLANNINGEducationDescriptionEducationIndex RateEducationStart AgeYearlyEducationCostsGoal 1Goal 2Goal 3Goal 4Maximum Additional Monthly Savings you would consider for all education goals. Linked Assets: (Link the following assets to each goal as defined above.)Goal 1:Goal 2:Goal 3:Goal 4:Additional NotesPage 14 of 22NumberOf YearsSavingsPlanStart Date

personal financial planning / tax planning data organizerTAX PLANNINGCapital Loss CarryoversSpouseClientShort-Term Capital Loss Carryovers:Long-Term Capital Loss Carryovers:Pre-retirementMemberFiling TypeIncome(e.g. married-joint, headof household, single)(annual amount)Average TaxRate(%)Marginal TaxRate(%)Average TaxRate(%)Marginal TaxRate(%)ClientCo-client (if applicable)Retirement (if different than pre-retirement)MemberFiling TypeIncome(e.g. married-joint, headof household, single)(annual amount)ClientCo-client (if applicable)DeathThis applies to potential taxes in the year of last member's death. This will include income from certainassets from the estate. Do not include estate taxes.MemberClientCo-client (if applicable)Additional NotesPage 15 of 22Filing TypeIncome(e.g. married-joint, headof household, single)(annual amount)Average TaxRate(%)Marginal TaxRate(%)

personal financial planning / tax planning data organizerESTATE PLANNING - PersonalEstate Expenses of DecedentExpense 1Expense 2Expense 3Expense 4Owner (client, spouse, firstto die, second to die):Expense Name (e.g. Burial):Amount:Index To Inflation (yes / no):GeneralAdditional Fees and TaxesUse this section to enter any additional fees that may be calculated on the estate at disposition.Use MaximumFederal CreditState DeathTax Rate(yes/no)State DeathTax duringRepealProbateFee RateAdministrationFee RateHistorical DataUse this section to enter information about historical transactions that affect estate taxes.SpouseClientTaxable Lifetime Gifts:Gift Taxes Already Paid:Lifetime GSTT Exemption Used:Gifting Growth & HistoryUse this section to enter estate gifting informationGift 1Beneficiary Name:Growth Rate (on propertygiven to beneficiary):Tax Rate on Growth:Prior Gifts From Client :Prior Gifts From Co-clientPrior Payments fromTrusts of ClientPrior Payments fromTrusts of Co-clientPage 16 of 22Gift 2Gift 3Gift 4

personal financial planning / tax planning data organizerLife InsuranceCalculated Life Insurance Requiredfor:Percentage of Retirement Goal toCover:Additional Annual Incomes/Survivor’sAnnual Income:Spouse Client SurvivorshipNeeds % Percentage of Expenses to Cover: %(rate of return applied to insurance proceeds)MemberLump Sum NeedsNeeds IndexedtoInflationAnnual IncomeNeedsExpensesIndexed toInflation(e.g. child care)(yes / no)(yes / no)ClientCo-clientProceeds Earn: %(typical return on asset)Premium per 1,000: Disability InsuranceCalculated Disability InsuranceRequired for:Percentage of Retirement Goal toCover %:MemberSpouse Client % Percentage of Expenses to Cover: %Lump Sum NeedsNeeds IndexedtoInflationAnnual IncomeNeeds(e.g. child care)ExpensesIndexed toInflation(yes / no)(yes / no)ClientCo-clientLong-Term Care InsuranceClientCalculated LTC Insurance for:LTC Analysis Period (start and end date):SpouseLong-Term Care ExpensesMemberClientCo-ClientPage 17 of 22ExpenseTypeDailyAmountFrequencyIndexed byInflationNumber ofYearsapplicableEnd Date

personal financial planning / tax planning data organizerPolicy 1Policy 2Policy 3Description:Insured Member:Effective Date:Daily Benefit:Frequency (daily, monthly, etc.):Index for Benefit Amount DuringLong-Term Care:Index for Benefit Amount BeforeLong-Term Care:Waiting Period:Benefit Paid Until (years or age):Monthly Premium:Premium Payer:Index Rate for Premium Amount:Premiums Cease (date or age):Funded TrustsCredit Shelter Trusts (funded trusts created as the result of a former spouse’s death)Trust Name (Credit Shelter Trust):Market Value (start of year):Crummey Trust (yes / no):Cost Basis:Return Rate:Percent Income to Spouse:Percent Income to Heirs:Percent Heirs Tax Rate:Beneficiaries (Income):Beneficiaries (Remainder):Credit Shelter Trust Planned (future trusts on first to die)Trust Name (Credit Shelter Trust):Amount (amount transferred or maximizeremaining exclusion):Percent Income to Spouse:Percent Income to Heirs:Percent Heirs Tax Rate:Return Rate:Beneficiaries (Income):Beneficiaries (Remainder):Page 18 of 22

personal financial planning / tax planning data organizerQualified Terminal Interest Property in TrustTrust 1Trust 2Trust 3Trust 2Trust 3Trust Name:Trust Tax Rate:Reverse QTIP Election (yes / no):GSTT Exemption(available at termination):Market Value:Cost Basis:Return Rates:Beneficiaries (Income):Beneficiaries (Remainder):Irrevocable Life Insurance Trust InformationTrust 1Trust Name(Irrevocable Life Insurance Trust):Insured:Premium Payer:Death Benefit:Current CSV:Return Rate:Beneficiaries (Income):Beneficiaries (Remainder):Additional NotesPage 19 of 22

personal financial planning / tax planning data organizerINVESTMENT STRATEGIESDetermining Your Investor Risk ProfileWhich of the following best describes your current stage of life?PointsSingle with few financial commitments. You are keen to accumulate wealth for the future. Somefunds must be kept available for enjoyment such as cars, clothes, travel and entertainment.50A couple without children. You may be preparing for the future by establishing and furnishing ahome. There are a lot of things you need to buy. You are probably better off financially now thanyou may be in the future.40Young family. This is the peak home purchasing stage. You have a mortgage and a very smallamount of savings. Probably dissatisfied with your financial position and the amount of moneysaved.30Mature family. You are in your peak earning years and have got the mortgage under control.Many partners also work and any children are growing up and have either left home or requireless supervision. You are starting to think about retirement, although it may be many years away.20Preparing for retirement. You probably own your own home and have few financial commitments;however you want to ensure that you can afford a comfortable retirement. Interested in travel,recreation and self-education.20Retired. No longer working you must rely on existing funds and investments to maintain yourlifestyle. You may be receiving the pension and are keen to enjoy life and maintain your health.10What return do you reasonably expect to achieve from your investments?A return without losing any capital.103 – 7% per annum.208 – 12% per annum.3013-15% per annum.40Over 15% per annum.50If you didn’t need your capital for more than 10 years, for how long would you be preparedto see your investment performing poorly before you cashed it in?You would cash it in if there were any loss in value.0Less than 1 year.10Up to 3 years.20Up to 5 years.30Up to 7 years.40Up to 10 years.50Page 20 of 22

personal financial planning / tax planning data organizerHow familiar are you with investment markets?Very little understanding or interest.10Not very familiar.20Have had enough experience to understand the importance of diversification.30Understand that markets may fluctuate and that different market sectors offer different income,growth and taxation characteristics.40Experienced with all investment sectors and understand the various factors which may influenceperformance.50If you can only get greater tax efficiency from more volatile investments, which balancewould you be most comfortable with?Preferably guaranteed returns, before tax savings.10Stable, reliable returns, minimal tax savings.20Some variability in returns, some tax savings.30Moderate variability in returns, reasonable tax savings.40Unstable, but potentially higher returns, maximising tax savings.50Six months after placing your investment you discover that your portfolio has decreasedin value by 20%, what would be your reaction?Horror. Security of capital is critical and you did not intend to take risks.10You would cut your losses and transfer your money into more secure investment sectors.20You would be concerned, but would wait to see if the investments improve.30This was a calculated risk and you would leave the investments in place, expecting performanceto improve.40You would invest more funds to lower your average investment price, expecting future growth.50Which of the following best describes your purpose for investing?You want to invest for longer than 5 years, probably to the age of 55 – 60. You are mainlyinvesting for growth to accumulate long-term wealth.50You are not nearing retirement, have surplus funds to invest and you are aiming to accumulatelong term wealth from a balanced fund.40You have a lump sum, e.g. an inheritance or an eligible termination payment from your employer,and you are uncertain about what secure investment alternatives are available.30You are nearing retirement and you are investing to ensure that you have sufficient fundsavailable to enjoy retirement.20You have some specific objectives within the next 5 years for which you want to save enoughmoney.20You want a regular income and / or totally protect the value of your savings.10Investor Profile Total PointsPage 21 of 22

personal financial planning / tax planning data organizerInvestor Risk Profile Summary 0 –50DefensiveYou are a conservative investor. Risk must be very low and you are prepared to accept lower returns toprotect capital. The negative effects of tax and inflation will not concern you, provided that your initialinvestment is protected. 51 – 130ModerateYou are a cautious investor seeking better than basic returns, but risk must be low. Typically an olderinvestor seeking to protect the wealth that you have accumulated, you may be prepared to consider lessaggressive growth investments. 131 – 210 BalancedYou are a prudent investor who wants a balanced portfolio to work towards medium to long-term financialgoals. You require an investment strategy that will cope with the effects of tax and inflation. Calculated riskswill be acceptable to you to achieve good returns. 211 – 300 GrowthYou are an assertive investor, probably earning sufficient income to invest most funds for capital growth.Prepared to accept higher volatility and moderate risks, your primary concern is to accumulate assets overthe medium to long term. You require a balanced portfolio, but more aggressive investments may beincluded. 301 – 350 High GrowthYou are an aggressive investor prepared to compromise portfolio balance to pursue potentially greaterlong-term returns. Your investment choices are diverse, but carry with them a higher level of risk. Securityof capital is secondary to the potential for wealth accumulation.Client AcknowledgementI have reviewed the notations on this interview questionnaire and confirm that the details recorded arecorrect.SignatureSignatureNameNameSigned by Advisor:Page 22 of 22Date://

personal financial planning / tax planning data organizer . personal financial planning / tax planning data organizer. Page 6 of 22 Lump Sum Payments made in one or more lump sums toward the principal of an existing loan. These are over and

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