AIN Services

PERSONAL FINANCIAL STRATEGY SUMMARY

This personal financial summary is designed to help you take inventory and assign realistic values to your personal assets and liabilities. It’s designed to be the first step in identifying potential savings.

Please bring the following documents:

  1. Last year’s tax returns3. All life insurance & annuity policies
  2. All Brokerage firm statements. 4. All IRA & retirement statements
  1. FAMILY INFORMATION

NAME: ______

ADDRESS:______

City ______STATE______ZIP______

DATE OF BIRTH:______STATE BORN:_____SOCIAL SECURITY NO.: ______

EMPLOYER:______SPOUSE’S EMPLOYER:______

SPOUSE’S NAME:______

DATE OF BIRTH:______STATE BORN:______SOCIAL SECURITY NO:______

DATE OF MARRIAGE:______Date of Death (spouse) ______

PHONE (home):______PHONE (work):______

PHONE (cell): ______PHONE (cell): ______

E-MAIL: ______

CHILDREN: AGE:STATE OF RESIDENCE:______

______

______

______

  1. PERSONAL INFORMATION

1. Do you have a financial professional? (Not stockbrokers)YN

If yes, who? ______

2 Do you have a living trust?YN

3. Do you have a will?YN

4. Do you have income from real estate?YN

5. Do you have an attorney?YN

6. Do you have an accountant?YN

7. Do you expect to care for a child or parent?YN

8. Do you expect an inheritance?YN

9. Any problems with previous financial professionals??YN

10. Do you have long term care protection?YN

  1. FINANCIAL OBJECTIVES

Rank these financial concerns/objectives in order of priority 1 through 5:

Spend It

High Risk

Low Risk

Pass It On

Accumulation / Preservation

  1. REAL ESTATE

Estimated value of your home$______

Remaining mortgage$______

Equity in your home (market value less mortgage)$______

  1. SOURCES OF INCOME

Social SecuritySurvivor Benefit

You$______You$______

Spouse$______Spouse$______

PENSION: RMD:

You$______You$______

Spouse$______Spouse$______

  1. BANKS & CREDIT UNION INVENTORY

(Checks, Savings, IRA’s, CD’s, Money Market Accounts, etc)

Name of institutionAverage Balance

______$______

______$______

______$______

______$______

  1. CDs

Name of Bank Rate of ReturnAmount of CDMaturity Date

______

______

______

______

______

  1. Individual Stocks & Bonds (please include EE Bonds, but not Mutual Funds or IRA”s)

Number Name Original MarketOwnership Date

Of Sharesof CompanyInvestmentValueAcquired

______$______$______

______$______$______

______$______$______

______$______$______

______$______$______

  1. Mutual Funds / Limited Partnerships

Number Name Original MarketOwnership Date

Of Sharesof CompanyInvestmentValueAcquired

______$______$______

______$______$______

______$______$______

______$______$______

______$______$______

  1. IRA & OTHER RETIREMENT ACCOUNT INFORMATION

(Please bring in the latest reports/statements)

OwnerName of organizationType of accountApprox. valueBeneficiary

______

______

______

______

______

______

______

  1. PRESENT LIFE INSURANCE(please bring in the latest reports/statements)

Name of insuredTypeFace AmountAnnual premium Name of Beneficiary

______

______

______

______

  1. ANNUITIES(please bring the latest reports/statements)

CompanyCost BasisAccount ValueSurr.DateDate purchased

______

______

______

______

  1. KNOWLEDGE

On a scale of 1 to 10 with 10 being “Warren Buffet”, where would you rank your knowledge in the following areas….

Taxes:

Stock Market:

Annuities:

What is your earliest memory about “money?”

Look into your crystal ball. How do you see yourself in 5 years? 10 years? 20 years?

What is your biggest financial concern?

  1. HEALTH

Please briefly tell us about any medical issues (heart attack, stroke, cancer, diabetes, high blood pressure etc.)

______

______

______

MR. - Medications______

______

Great, no medications!

MRS. - Medications ______

______

 Great, no medications!

  1. Action

What services are you looking for me to provide? ______

______

Note: Any transaction that involves a recommendation to liquidate funds held in a securities product, including those within an IRA, 401(k) or other retirement plan for the purchase of an annuity, can be conducted only by individuals currently affiliated with a properly registered broker/dealer or registered investment advisor.

  1. Market Risk Analysis

______

______

______

______

______

Approximate Total ______

% At Risk % Not At Risk

If your goal is asset preservation, do these numbers align with your goals?

CONFIDENTIAL. This material is for informational purposes only. It is not intended to provide any tax or legal advice or provide the basis for any financial decisions. You are encouraged to consult with a tax advisor or attorney before making decisions about your financial situation. 1305105