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Retirement Priority Planning Review

Personal Information

Please complete only the information that may not be in our current records.

Name
Spouse Name

Personal Planning Profile

Please check the boxes that reflect your current planning.

I know how long my retirement income will last.
I am concerned about the risk of outliving my retirement income.
I am pleased with the returns on my retirement and investment programs.
I understand the impact of inflation on my retirement plan.
I pay taxes on my Social Security benefits.
I am fully covered for health care costs: Medicare A and B as well as “Med Sup.”
I am familiar with costs of long-term care and nursing home costs.
I have reviewed my life insurance program in the last two years.
I have a current will consistent with my estate distribution wishes.
I have advance directives (living will, medical power of attorney) consistent with my wishes.
I am concerned about estate taxes.
I am concerned about my final expenses.
I want to leave something to my: children, grandchildren, church, alma mater, charity.

Financial Statement

Please check the boxes of that best reflect you current situation.

Financial Statement

Please check the boxes that best reflect your current situation.

Your Annual Income
Your Spouse's Annual Income
Assets (excluding home)
Liabilities (excluding home mortgage)
Current Savings and Investments
Current Life Insurance
Your Spouse's Current Life Insurance

Financial Planning Priorities

Please check the boxes that most closely reflect your financial priorities.

Returns made on my retirement assets are a…
Effect of inflation on my assets is a…
Risk of outliving my retirement income is a…
Providing funds to pay my mortgage and debts in the event of death is a...
Protecting against the costs of long-term health care is a...
Investing money in tax-favored plans is a...
Low risk investments are a...
Investments that offer high growth potential are a...
An overall financial plan is a...
Review of all my insurance policies is a…
Availability of additional health care coverage is a…
Income from real estate including residence is a…
Involvement of my spouse in our financial planning is a...

Current Priorities

Please check all items you are interested in discussing:

Current Priorities

Future Plans

Please check all items that may apply within the next two years:

Future Plans