Q1: Full Name
(Required)
Date
(Required)
MM slash DD slash YYYY
Email
(Required)
Phone
(Required)
Will this proposal also cover your spouse/significant other?
(Required)
No
Yes
Person 2 (if applicable)
Full Name
(Required)
Email
(Required)
Phone
(Required)
Q2: Citizenship
(Required)
U.S.
U.S. Visa
Non-U.S., U.S. Ex-patriot
Q3: Current Marital Status
(Required)
Single
Married
Domestic Partnership
Widowed
Divorced
Q4: Dependents (Select all that apply)
(Required)
None
Biological / Foster / Adopted Children (ages 0 - 18)
Blended families (Your spouse has children ages 0-18)
Caregiver for elderly, disabled, special needs, handicapped, or dysfunctional (any age)
Q5: Total Household Income
(Required)
$100k or less
$101k to $250k
$251k or greater
Q6: Income Sources (Select all that apply)
(Required)
W-2 Wages and/or 1099 Wages ONLY
Plus passive income (rental, interest, dividend income)
Plus retirement income (social security, required minimum distributions, pension)
Q7: Debt (exclude mortgage and car loan)
(Required)
None
Credit cards, Student Loans, other debt
Tax Liens, Foreclosure, Bankruptcy
Q8: Total Debt (exclude mortgage and car loan)
(Required)
$100k or less
$101k to $250k
$251k to $500k
$501k - $1M
$1M+
Q9: Asset Value (exclude home value)
(Required)
Less than $250k
$251k - $500k
$501k +
Q10: Type of Accounts (Select all that apply)
(Required)
Checking/Savings, Brokerage, IRA, 401k or other retirement plan
Individual Securities, Savings Bonds, Direct Mutual Funds
Closely held business, real estate, Trusts, REIT, or other
Q11: Asset Ownership (Select all that apply)
(Required)
Direct Ownership or Custodial Ownership
Owned jointly by 2 or more people
Indirect ownership: Company, trust, or other
Q12: Locations
(Required)
All in state of domicile
2 states or more
Some or all assets are outside the U.S.
Q13: Number of Investment Accts
(Required)
0-3
4-9
10+
Q14: Estate
(Required)
Legal Documents/Business Agreements are complete.
Legal Documents/Business Agreements Need Revision
No Legal Documents/Business Agreements in place
Q15: Health
(Required)
No Major Issues
High Blood Pressure, High Cholesterol, Diabetes, Other
Terminal illness, Permanent disability
Q16: Life changes (Select all that apply)
(Required)
None
Pending Marriage, Birth or Adoption of a Child
Relocation, Re-marriage, Inheritance, Pre/Post-marital or domestic agreements
Pending Divorce, recent death, pending retirement, transition out of corp.
Q17: Special Circumstances (Select all that apply)
(Required)
None
Child Support, Alimony, Disability, Early retirement buyout
Stock Options, Structured Settlement, Trust Fund, Inheritance
Windfall Settlement, Personal Injury Settlement, Lottery Winnings
This field is hidden when viewing the form
Q18: Services Sought (Select all that apply)
Insurance Planning (Life/Long-Term Care/Annuities)
Investment Planning (Active Portfolio Management/Alternative Investments)
Retirement Income Planning (Mapping out income strategies for life after work)
Tax & Estate Planning (Tax Minimization/Wealth Transfer)
Business Planning (Buy/Sell, Benefits, Executive Compensation, Succession Planning)
Q18: Primary Goal(s) - Choose as many as you wish
(Required)
Prepare for the transition from working to retirement
Determine the most efficient order to spend down assets in retirement
Make sure I won’t outlive my money
Optimize my investments for inflation, market risk, and changing economic conditions
Prepare for healthcare and long-term care costs in retirement
Create a legacy and reduce taxes
Create or update my estate plan (will, power of attorney for finances, medical directive) for one person
Create or update my estate plan (will, power of attorney for finances, medical directive) for two people
Other
Select All
InvestHER Fiduciary Solutions, LLC © 2006 - 2024. All Rights Reserved.
Success message!
Warning message!
Error message!
