Welcome to Secura Financial Group!

Welcome to Secura Financial Group!

We look forward to working with you. Please complete this booklet and provide us with the following documents.

Life insurance policies including recent status notices showing any policy loans, premium amounts or dividends on deposit

Disability insurance policies you may have which provide income replacement in the event of an accident or sickness

Your company’s benefit statement from your employer. This should include a recent status of

• group insurance benefits,
• pension plans and
• other related information

Statements of Registered and Non-Registered Investments (RSP, Non-Reg, TFSA, RESP, etc)

Mortgage Statement (most recent)

Copies of the most recent Financial Statements of Businesses in which you own an interest and of any agreements in place (i.e. Shareholder agreement, buy/sell agreement), if applicable

If you are retiring in the next 2 years please obtain your CPP Statement of Contributions. Available at the Service Canada site or call 1-800-277-9914.

Please don’t hesitate to call if you have any questions.

A reminder to include statements...thanks!

Date: ______

ABOUT YOU

Press Tab to move between cells

PERSONAL INFORMATION

Client / Co-Client
Name
Date of Birth (m/d/y)
Gender
Marital Status
Home Phone
Address:
Cell Phone
Email:
Employer
Occupation

FAMILY INFORMATION

Name / Gender
M/F / DOB
(m/d/y) / Relationship
(child/parent/grandchild)

WHAT IS IMPORTANT TO YOU?

What Goals do you have?

Personal / Financial
Next Year
Next 3-5 Years
Long Term Goal

Are there charities that are important to you?

YOUR PROFESIONAL ADVISORS:

Name / City / Email
Lawyer
Accountant

IMPORTANT DOCUMENTS

Updated (m/d/y)
Will / Yes / No
Power of Attorney - Finances / Yes / No
Power of Attorney - Personal Care / Yes / No

CONTRIBUTION ROOM

Name / RRSP Room / TFSA Room
$ / $
$ / $

Please provide Notice of Assessment

TFSA room is availabe by contacting 1-800-267-6999

Additional Info:

NETWORTH

ASSETS

Asset / Value / Mortgage on Asset?
Primary Residence / $ / Yes / No
Cottage / $ / Yes / No
Other Real Estate / $ / Yes / No
$

LIABILITES

please include statements

Type / Outstanding Amount / Payment / How often? / Interest Rate / Renewal Date
m/d/y
$ / $ / %
$ / $ / %
$ / $ / %

INVESTMENTS

please include all statements

Value / Monthly Savings / Value / Monthly Savings
RRSP / $ / $ / $ / $
LIRA / $ / $ / $ / $
TFSA / $ / $ / $ / $
OPEN / $ / $ / $ / $
OTHER / $ / $ / $ / $
RESP / $ / PAC:

CASH FLOW

INCOMES

Salary / $ / $
Bonus / $ / $
Trust Income / $ / $
Current Pension Income / $ / $
Inheritance (in next 5 years) / $ / $
Rental Income / $ / $

EXPENSES

Expense / Monthly Expense
Housing (not including mortgage) / $
Food (groceries and restaurants) / $
Transportation / $
Tithing or charitable donations / $
Child Care / $
Recreation / $
Health Care / $
Memberships / $
Insurance / $
Other / $
Total / $

If you require clarification or a more detailed look of your expenses

we can provide you with a worksheet

RETIREMENT PENSIONS

please include statements - no need to fill this in if we have a statement.

Defined Benefit
(annual income) / Commuted Value
$ / $
$ / $
Defined Contribution
(details) / Current Value
$
$

Will you work during retirement?

To age / Gross Annual Expected Income
$
$

GOVERNMENT PENSION

please include CPP statements if retiring in the next 2 years

(Annual Gross)
CPP / $ / $
OAS / $ / $

Additional Information:

CURRENT INSURANCE PLANS

INSURANCE

** no need to fill this out if you supply us with your statements

Benefit / Premium / Benefit / Premium
Term Life / $ / $ / $ / $
Permanent Life / $ / $ / $ / $
Disability / $ / $ / $ / $
Critical Illness / $ / $ / $ / $
Long Term Care / $ / $ / $ / $

Please provide us with:

Group Benefits Booklet

SURVIVOR INCOME NEED:

Income Requirements if one person passes away:

Immediate Cash Requirements / At 's Death / At 's Death
Funeral / $ / $
Expenses / $ / $
Mortgage payout / $ / $
Education fund / $ / $
Debt elimination / $ / $
Special bequests / $ / $

Income Requirements if one person passes away:

$

RETIREMENT GOALS

MILESTONES

Name / Retirement Age / Life Expectancy Age

RETIREMENT INCOME GOALS

What are Your Retirement Goals? Please choose one.

percentage of current after-tax income - 60%, 70%, 80% or

percentage of current expenses - 70%, 80%, 90%, 100% or

specific amount - after tax

Timeline (age bands) / Net Amount (Annual)
$
$
$
$
$
$

CORPORATIONS

If you own a corporation or business please provide us with the following information:

Copies of the most recent Financial Statements

(ie. Shareholder agreement, buy/sell agreement

Corporate Structure

Investments Owned by Corporation

Life Insurance Owned by Corporation

Name of Accountant

Name of Lawyer

Additional Information on Corporation(s):

NOTES

To be completed by financial advisor:

RISK TOLERANCE

Name / Score / Profile

Adding value to the lives of our clients