TFA LLC Client Questionnaire Form 2013_01

The Financial Advisors, LLC 15 Railroad St. Andover, MA 01810 127 Water St. Newburyport, MA 01950 the-financial-advisors.com

Client Questionnaire

15 Railroad Street Andover, MA 01810 Phone 978-475-3242 Fax 978-475-3489

J anuary 2013

the-financial-advisors.com

Lincoln Financial Securities Corporation is not affiliated with The Financial Advisors, LLC. Investments are offered through registered representatives of Lincoln Financial Securities Corporation, SIPC

Member FINRA & SIPC.

Email: Ngoc Cormier

[email protected]

127 Water Street Newburyport, MA 01950 Phone 978-463-6660 Fax 978-463-8777

Email: Sue Woodhouse

[email protected]

The Financial Advisors, LLC Client Questionnaire - January 2013 2

Financial Informat ion: To effectively advise you on financial decisions and make the best use of meeting time, your advi-sor needs complete information about your financial life. The first step in the financial planning pro-cess is data collection. To facilitate the data collection, we use this questionnaire. Before you start, please review the list of documents shown below and gather the documents that apply to you. Do your best to fill in the questionnaire. If you are uncertain of the answer to a question, write your best estimate and include a note about the circumstances in the "Notes to Your Advisor" section at the end of the questionnaire. We also ask to receive copies of your documents before we meet. Please send your documents to us by mail, fax, or Secure Send on our web site. Call or email if you have any questions.

Confide nt iality:

Confidentiality and protection of your personal information is of the highest importance to your advi-sor and all of the associates and staff. We will not disclose any information about you to anyone -- including your employer, accountant, attorney, or family -- without your permission.

Important Documents for Introductory Meeting We ask that you provide these documents before our initial meeting.

Most recent US and State Income Tax Returns Recent Payroll statements for each employed person Recent account statements (Bank accounts, Retirement Plan accounts, Brokerage accounts, etc.) Employer Stock Plan Documents and Statements (Employee Stock Purchase Plan, Non-Qualified

Stock Options, Incentive Stock Options, Restricted Stock Units, etc.) Retirement Plans (401k, 403b, etc.) - Documents that show plan terms and investment choices Mortgage and other loan statements

Important Documents for Planning Meetings - We will request these and related documents for subsequent planning and review meetings.

Social Security benefit statements Employer Group Benefits statement or booklet Property & Casualty Insurance (Homeowner/Condo/Renter & Auto policy declaration pages) Life Insurance (Policy documents and annual statements) Long-term Care Insurance (Policy documents and statements) Annuity policy documents and statements Pension documents and statements Estate Documents (Will, Durable Power of Attorney, Health Care Proxy, Revocable Trust, etc.) Any other material financial documents (Ex. Business arrangements, Family Trusts, etc.)


Referred by: Date completed:

Clients Personal and Contact Info

Family Data Client 1 Client 2 Full Name Nickname

Home Street Address City, State, Zip

Home / Mobile Telephone Fax

Email Work Telephone

Fax Email

Preferred Contact (e.g. home email, work telephone, etc.)

Date of Birth Social Security Number U.S. Citizen (Yes / No)

Gender Marital Status [Single, Married, Di-

vorced, Widow(er)]

Employment Occupation / Job Title

Self-Employed (Yes/No) Employer Name

Employer Address Years w/ Current Employer

Parents Mothers Name

Mothers Date of Birth Marital Status

Fathers Name Fathers Date of Birth

Marital Status


Clients Children & Dependents Info Please list additional names or details on a separate page

Children / Dependents Client 1 Client 2

Child / Dependent

Full Name Relationship Date of Birth

SSN Marital Status

Spouse / Partner Name Spouse / Partner DOB

Children names & DOBs

Child / Dependent


SSN Marital Status


Children names & DOB

Child / Dependent


SSN Marital Status


Children names & DOB


Goals and Objectives

What are your areas of financial concern (check all that apply)

Cash Flow and Budgeting

Investment Review

Tax Planning

College Planning

Retirement Planning

Estate Planning

Insurance Review

Home Purchase Other (Please describe)

What is your picture for financial security five years from now?


Please list your major financial obligations and planned expenditures. Present (within the next 2 years)

Future

How comfortable are you managing your finances? (very, somewhat, not at all)

How satisfied are you with the performance of your investments?

Please note any health or other family circumstances that may impact your financial planning.


Income

Client 1 Client 2 What is your gross annual income?

How often are you paid? Are you considering a career change?

*Do you expect any major changes in income during the next 3 years?

* If yes, please describe the expected changes.

Retirement Planning

Client 1 Client 2

At what age do you expect to retire? What are your expected annual income needs in retirement?

How much do you contribute each year to your retirement plan(s)? How much does your employer contribute each year to your retire-

ment plan(s)?

During retirement how much monthly income do you expect to receive from: Social Security

Employer Pension(s) Please describe any special considerations regarding your retirement plans:


Employer Stock Plans

Client 1 Client 2 Do you participate in an employer stock option plan (non-qualified

or incentive)?

Do you participate in an employer stock grant plan (restricted stock)?

Do you participate in an employee stock purchase plan (ESPP)?

Insurance

Client 1 Client 2 Do you have any life insurance?

Do you have medical insurance? Is the medical insurance through your employer?

Do you have homeowner or renter insurance? Do you have umbrella liability insurance?

Do you have auto insurance? Do you have short-term disability insurance? Do you have long-term disability insurance?

Estate Planning

Client 1 Client 2 Have you been previously married?

Do you have a Will? Do you have a Durable Power of Attorney?

Do you have a Health Care Proxy? Have you established any Trusts?

Are you the beneficiary of any trust?


Statement of Net Worth

Item Client 1 Client 2 Joint Total ASSETS

Cash Checking and Savings

Money Market funds CDs

US Savings Bonds Other

Total Cash

Taxable Investments Stocks, Bonds, Mutual Funds

Investment Real Estate Other Taxable Accounts or Assets

Total Taxable Investments

Retirement (Tax-deferred) Investments IRAs (Traditional, Rollover, SEP)

Roth IRAs Employer Plans - 401(k), 403(b), 457

Pension or other retirement plans Total Retirement Investments

Education Investments

529 / Tuition Savings Plans UTMA / UGMA Custodial Accounts

Total Education Investments

Personal Property Primary Residence Vacation Property

Vehicles / Boats Jewelry / Art / Antiques

Household and Other property Total Personal Property

TOTAL ASSETS


Item Client 1 Client 2 Joint Total

DEBTS / LIABILITIES

Debts / Liabilities Primary Residence Mortgage

Second Mortgage, Equity Loan, or Line of Credit (HELOC)

Education Loans Auto Loans

Credit Card Balances 401k or Retirement Plan Loans

Any other loans or debts

TOTAL DEBTS / LIABILITIES

NET WORTH

(TOTAL ASSETS TOTAL DEBTS / LIABILITIES)

DETAILS OF DEBTS / LIABILITIES

Creditor Original Amount

Current Balance

Interest Rate

Term of Loan

Monthly Payment

1. 2. 3. 4. 5.

Totals


Notes to Your Advisor (Please list any additional points of interest or concern)
Client 1Full Name: Client 2Full Name: Client 1Nickname: Client 2Nickname: Client 1Home Street Address: Client 2Home Street Address: Client 1City State Zip: Client 2City State Zip: Client 1Home Mobile Telephone: Client 2Home Mobile Telephone: Client 1Fax: Client 2Fax: Client 1Email: Client 2Email: Client 1Work Telephone: Client 2Work Telephone: Client 1Fax_2: Client 2Fax_2: Client 1Email_2: Client 2Email_2: Client 1Preferred Contact eg home email work telephone etc: Client 2Preferred Contact eg home email work telephone etc: Client 1Date of Birth: Client 2Date of Birth: Client 1Social Security Number: Client 2Social Security Number: Full Name: Relationship: Date of Birth: SSN: Spouse Partner Name: Spouse Partner DOB: Children names DOBs: Full Name_2: Relationship_2: Date of Birth_2: SSN_2: Spouse Partner Name_2: Spouse Partner DOB_2: Children names DOB: Cash Flow and Budgeting: OffInvestment Review: OffTax Planning: OffCollege Planning: OffRetirement Planning: OffEstate Planning: OffInsurance Review: OffHome Purchase: OffOther Please describe: What is your picture for financial security five years from now: Present within the next 2 years: Future: How comfortable are you managing your finances very somewhat not at all: How satisfied are you with the performance of your investments: Please note any health or other family circumstances that may impact your financial planning: If yes please describe the expected changes: Please describe any special considerations regarding your retirement plans: Creditor1: Original Amount1: Current Balance1: Interest Rate1: 0Term of Loan1: Monthly Payment1: Creditor2: Original Amount2: Current Balance2: Interest Rate2: Term of Loan2: Monthly Payment2: Creditor3: Original Amount3: Current Balance3: Interest Rate3: Term of Loan3: Monthly Payment3: Creditor4: Original Amount4: Current Balance4: Interest Rate4: Term of Loan4: Monthly Payment4: Creditor5: Original Amount5: Current Balance5: Interest Rate5: Term of Loan5: Monthly Payment5: Original AmountTotals: 0Current BalanceTotals: 0Monthly PaymentTotals: 0Notes to Your Advisor Please list any additional points of interest or concern: Client 2 Gender: [ ]Client 1 Gender: [ ]Client 2 Marital Status: [ ]Client 1 Occupation: Client 2 Occupation: Client 1 - Self-employed: [0]Client 2 - Self-employed: [0]Client 1 Employer Name: Client 2 Employer Name: Client 1 Employer Address: Client 2 Employer Address: Client 1 Years with current employer: Client 2 Years with current employer: Client 1 Mother's Name: Client 2 Mother's Name: Client 1 Mother's Date of Birth: Client 2 Mother's Date of Birth: Client 1 Marital Status: [ ]Client 2 Mother's Marital Status: [ ]Client 1 Father's Name: Client 2 Father's Name: Client 1 Father's Date of Birth: Client 2 Father's Date of Birth: Client 1 Mother's Marital Status: [ ]Client 2 Father's Marital Status: [ ]Referral name: Date completed: Client 1 Father's Marital Status: [ ]Child 2 Marital Status: [ ]Child 1 Marital Status: [ ]Full Name_3: Relationship_3: Date of Birth_3: SSN_3: Child 3 Marital Status: [ ]Spouse Partner Name_3: Spouse Partner DOB_3: Children names DOB_2: Full Name_5: Full Name_4: Full Name_6: Relationship_5: Relationship_4: Relationship_6: Date of Birth_5: Date of Birth_4: Date of Birth_6: SSN_5: SSN_4: SSN_6: Child 4 Marital Status: [ ]Child 5 Marital Status: [ ]Spouse Partner Name_4: Spouse Partner Name_5: Spouse Partner DOB_4: Spouse Partner DOB_5: Children names DOB_5: Children names DOB_4: Children names DOB_6: Spouse Partner DOB_6: Spouse Partner Name_6: Child 6 Marital Status: [ ]Client 1 Income: Client 2 Income: Client 1 pay frequency: Client 2 pay frequency: Client 2 Career Change: [ ]Client 1 Career Change: [ ]Client 2 Major Changes: [ ]Client 1 Social Security: Client 2 Social Security: Client 1 Employer Pensions: Client 2 Employer Pensions: Client 1 employer contributions: Client 2 employer contributions: Client 1 employee contributions: Client 2 employee contributions: Client 1 retirement income: Client 2 retirement income: Client 2 retirement age: Client 1 retirement age: Client 1 Major Changes: [ ]Client 2 Stock options: [ ]Client 1 Stock grants: [ ]Client 2 Stock grants: [ ]Client 1 Stock options: [ ]Client 2 ESPP: [ ]Client 1 ESPP: [ ]Client 2 Life Insurance: [ ]Client 1 Life Insurance: [ ]Client 2 Health Insurance: [ ]Client 1 Health Insurance: [ ]Client 2 Employer Health Insurance: [ ]Client 1 Employer Health Insurance: [ ]Client 2 Home or Renter Insurance: [ ]Client 1 Home or Renter Insurance: [ ]Client 2 Umbrella Liability Insurance: [ ]Client 1 Umbrella Liability Insurance: [ ]Client 2 Auto Insurance: [ ]Client 1 Auto Insurance: [ ]Client 2 Short-Term Disability Insurance: [ ]Client 1 Long-Term Disability Insurance: [ ]Client 2 Long-Term Disability Insurance: [ ]Client 1 Short-Term Disability Insurance: [ ]Client 2 Prior Marriages: [ ]Client 1 Prior Marriages: [ ]Client 2 Will: [ ]Client 1 Will: [ ]Client 2 POA: [ ]Client 1 POA: [ ]Client 2 HCP: [ ]Client 1 HCP: [ ]Client 2 Trusts: [ ]Client 1 Trusts: [ ]Client 1 Trust Beneficiary: [ ]Client 2 Trust Beneficiary: [ ]Client 1 US Citizen: [1]Client 2 US Citizen: [1]Client 1 Mortgage 1: Client 1 Mortgage 2: Client 1 Education Loans: Client 1 Auto Loans: Client 1 Credit Cards: Client 1 401k Loans: Client 1 Other Loans: Client 2 Mortgage 1: Client 2 Mortgage 2: Joint Mortgage 2: Client 2 Education Loans: Joint Education Loans: Client 2 Auto Loans: Joint Auto Loans: Client 2 Credit Cards: Joint Credit Cards: Client 2 401k Loans: Joint 401k Loans: Client 2 Other Loans: Joint Other Loans: Client 2 Total Debts: 0Joint Mortgage 1: Total Mortgage 1: 0Total Education Loans: 0Total Auto Loans: 0Total Credit Cards: 0Total 401k Loans: 0Total Other Loans: 0Joint Total Debts: 0Total Debts: 0Total Mortgage 2: 0Client 2 Net Worth: 0Joint Net Worth: 0Total Net Worth: 0Client 2 - Checking and Savings: Client 1 - Checking and Savings: Client 1 - Money Market: Joint - Money Market: Client 2 - CDs: Client 2 - Money Market: Client 1 - CDs: Joint - CDs: Client 2 - US Savings Bonds: Client 1 - US Savings Bonds: Joint - US Savings Bonds: Client 2 - Other Cash: Client 1 - Other Cash: Joint - Other Cash: Client 2 - Total Cash: 0Client 1 - Total Cash: 0Joint - Checking and Savings: Total - CDs: 0Total - US Savings Bonds: 0Total - Money Market: 0Total - Other Cash: 0Joint - Total Cash: 0Total - Total Cash: 0Client 2 - Brokerage: Client 1 - Brokerage: Joint - Brokerage: Client 2 - Real Estate: Client 1 - Real Estate: Joint - Real Estate: Client 2 - Other Investments: Client 1 - Other Investments: Joint - Other Investments: Client 2 - Total Investments: 0Client 1 - Total Investments: 0Total - Checking and Savings: 0Total - Real Estate: 0Total - Other Investments: 0Joint - Total Investments: 0Total - Total Investments: 0Client 2 - IRAs: Client 1 - IRAs: Joint - IRAs: Client 1 - Roth IRAs: Client 2 - Roth IRAs: Joint - Roth IRAs: Client 1 - Employer Plans: Client 2 - Employer Plans: Joint - Employer Plans: Client 2 - Pensions: Client 1 - Pensions: Joint - Pensions: Client 2 - Total Retirement: 0Client 1 - Total Retirement: 0Total - Brokerage: 0Total - Roth IRAs: 0Total - Employer Plans: 0Total - IRAs: 0Total - Pensions: 0Joint - Total Retirement: 0Client 2 - 529 Plans: Joint - 529 Plans: Client 1 - 529 Plans: Total - 529 Plans: 0Client 2 - UTMA/UGMA Accounts: Joint - UTMA/UGMA Accounts: Client 1 - UTMA/UGMA Accounts: Total - UTMA/UGMA Accounts: 0Client 2 - Total Education: 0Joint - Total Education: 0Client 1 - Total Education: 0Total - Total Education: 0Client 2 - Primary Residence: Joint - Primary Residence: Client 1 - Primary Residence: Total - Primary Residence: 0Client 2 - Vacation Property: Joint - Vacation Property: Client 1 - Vacation Property: Total - Vacation Property: 0Client 2 - Vehicles: Client 1 - Vehicles: Total - Vehicles: 0Client 2 - Jewelry: Joint - Jewelry: Client 1 - Jewelry: Total - Jewelry: 0Client 2 - Other Personal Property: Joint - Other Personal Property: Client 1 - Other Personal Property: Total - Other Personal Property: 0Client 2 - Total Personal Property: 0Joint - Total Personal Property: 0Client 1 - Total Personal Property: 0Total - Total Personal Property: 0Joint - Vehicles: Client 2 - TOTAL ASSETS: 0Joint - TOTAL ASSETS: 0Total - TOTAL ASSETS: 0Total - Total Retirement: 0Client 1TotalDebts: 0Client 1TotalAssets: 0Client 1NetWorth: 0Neg1: -1Client1DebtsNeg: 0Client2DebtsNeg: 0JointDebtsNeg: 0TotalDebtsNeg: 0Most recent US and State Income Tax Returns: OffRecent Payroll statements for each employed person: OffRecent account statements Bank accounts Retirement Plan accounts Brokerage accounts etc: OffEmployer Stock Plan Documents and Statements Employee Stock Purchase Plan NonQualified: OffRetirement Plans 401k 403b etc Documents that show plan terms and investment choices: OffMortgage and other loan statements: OffSocial Security benefit statements: OffEmployer Group Benefits statement or booklet: OffProperty Casualty Insurance HomeownerCondoRenter Auto policy declaration pages: OffLife Insurance Policy documents and annual statements: OffLongterm Care Insurance Policy documents and statements: OffAnnuity policy documents and statements: OffPension documents and statements: OffEstate Documents Will Durable Power of Attorney Health Care Proxy Revocable Trust etc: OffAny other material financial documents Ex Business arrangements Family Trusts etc: Off