CONFIDENTIAL PERSONAL DATA
PERSONAL & RELATIONSHIPS
Name (1) ______________________________ Date of Birth _________ Where raised
________________
Name (2) ______________________________ Date of Birth _________ Where raised
________________
Date ________ Home Phone (____)________ Home Fax (____)________ E-Mail ____________________
Home Address ___________________________________________________ Own/Rent _____________
Cell phones, Pagers _____________________ Education level & where ___________________________
How important are your relationships with these Schools? _______________________________________
Marital Status (formal & informal) ____ Chance of change ___% Date of Marriage / Last Divorce ________
How did you come to me? ______________ Main motivation to do planning ________________________
What is the desired outcome of our work together? ____________________________________________
What were your best & worst experiences with advisors like me? __________________________________
What are your worst financial fears? ________________________________________________________
What’s important about money to you? (1) ___________________________________________________
What’s important about money to you? (2) ___________________________________________________
Is there anything more important than these? _________________________________________________
Short-term Goals (next 2 years) ___________________________________________________________
What is your most painful money memory? ___________________________________________________
What is your happiest money memory? ______________________________________________________
How have these experiences shaped your relationship with money? _______________________________
What 3 things did your parents teach you about money? ________________________________________
What values did your family have around money? _____________________________________________
How have you applied these and others? ____________________________________________________
What are your top accomplishments? What would you like them to be? _____________________________
_____________________________________________________________________________________
Your vision for the life you want____________________________________________________________
_____________________________________________________________________________________
How are you spending your discretionary money? _____________________________________________
Name all the people you financially care about, and their relationship to you. (Anyone not on this list need
not inherit from you, nor be planned for at all.) ________________________________________________
What do you want to do for the World at large? _______________________________________________
Office of Selwyn Miller, CFP®, ChFC®. 805-494-4868. [email protected]
Advisory services offered through Capital Analysts or Lincoln Investment, Registered Investment Advisors. Securities offered through Lincoln
Investment, Broker/Dealer, Member FINRA/SIPC. www.lincolninvestment.com. Miller Financial Planning and the above firms are independent
and non-affiliated.
Career & Work Plans, ideal job, happy now? _________________________________________________
How true? “In spite of doing financial planning, I/we still don’t feel like we will get where we want to be.”
___
Why do you want to change to us? _________________________________________________________
How do you believe you will get enough money for all your goals? _________________________________
_____________________________________________________________________________________
Child (1) ___________________ DOB _________ Child (2) ________________________ DOB ________
Child (3) ___________________ DOB _________ Child (4) ________________________ DOB ________
Other children; Prior marriage children; More future children (when)? ______________________________
Exceptions from Perfect Health; Special Needs; Anyone smoke? Drink? Use narcotics? Been hospitalized?
_____________________________________________________________________________________
In view of your personal & family health histories and genetics, what future ill health should we prepare for?
_____________________________________________________________________________________
Extended Family (1): Parents, siblings, etc.: Health & Financial status ______________________________
Extended Family (2): Parents, siblings, etc.: Health & Financial status ______________________________
What are some areas of financial disagreement in the nuclear / extended family, etc.? _________________
_____________________________________________________________________________________
When & where do you want to retire? What will you do in retirement? ______________________________
_____________________________________________________________________________________
What would you like to achieve with your money?
______________________________________________
How did you make your money? ___________________________________________________________
When you think about your money, what concerns or feelings come to mind? ________________________
_____________________________________________________________________________________
Describe a great day for you! ______________________________________________________________
What decision do you most regret? _________________________________________________________
Ideally, where would you like to be at 45? 55? 65? 75? 85? ______________________________________
_____________________________________________________________________________________
What relationships do you most care about (family members; at work; friends;…)? ____________________
__________________________________________________________________________________
What is your religious orientation? How devout are you? How important are your relationships with people
associated with your religion? _____________________________________________________________
Office of Selwyn Miller, CFP®, ChFC®. 805-494-4868. [email protected]
Advisory services offered through Capital Analysts or Lincoln Investment, Registered Investment Advisors. Securities offered through Lincoln
Investment, Broker/Dealer, Member FINRA/SIPC. www.lincolninvestment.com. Miller Financial Planning and the above firms are independent
and non-affiliated.
What
is
your
political
orientation?
How
important
is
it
to
you?
____________________________________
Any legal issues, potential, current, recent? __________________________________________________
Would you call yourself an extrovert or introvert?
Feeling?
_/_
Other
_/_ Detail-oriented or big picture? _/_ Thinking or
ways
to
describe
you
_________________________________________________________
Pets? How important are they to you? ____________________________________________________
PREVIOUS FINANCIAL PLANNING; FEARS ABOUT FINANCIAL PLANNING; ADVISORS
What financial planning so far? _________________ Liked; Disliked ______________________________
Major fears about using a financial planner: __________________________________________________
Check those Fears that apply a fair amount or more: Embarassed ___ Admitting failure ___
Lose Control? ___ Become Dependent ___ Lose Privacy ___ Lose Confidentiality ___
Opens can of worms ___ Feel judged? ___ Previous bad experience ___________________________
Expensive? ___ Waste of time & money ___ Might betray your trust ____ Might abandon you ____
What role should I play for you? _________________________________________________________
Accountant: (Who? does what? happy?) _____________________________________________________
Attorney: (Who? does what? happy?) _______________________________________________________
Investment Advisor: (Who? does what? happy?) ______________________________________________
P & C Insurance Agent (Who? does what? happy?)____________________________________________
Life Insurance Agent (Who? does what? happy?)______________________________________________
Private Banker / Trust Officer (Who? does what? happy?)_______________________________________
Any one person whose advice you really respect? _____________________________________________
YOUR INCOME & INCOME TAX, WORK, CASH FLOW
What are all your sources of income? ___________________________________________________
How do you Save or set aside money to Invest? _______________ Change in next 3 years? ________
Employer (1) __________________ Title ____________________ How long - Employer: __ Function: __
W2? __ Job Secure___% Work Phone (
) ___ ____ Fax (
) ___ ____ E-Mail _______________
Base pay $_____/y; Bonus, etc. $_____/y (when?_____) Bus.paid exps _______Pay Volatility ___%
Employer (2) __________________ Title ____________________ How long - Employer: __ Function: __
W2? __ Job Secure___% Work Phone ( ) ___ ____ Fax ( ) ___ ____ E-Mail ________________
Base pay $_____/y; Bonus, etc. $_____/y (when?_____) Bus.paid exps _______Pay Volatility ___%
Office of Selwyn Miller, CFP®, ChFC®. 805-494-4868. [email protected]
Advisory services offered through Capital Analysts or Lincoln Investment, Registered Investment Advisors. Securities offered through Lincoln
Investment, Broker/Dealer, Member FINRA/SIPC. www.lincolninvestment.com. Miller Financial Planning and the above firms are independent
and non-affiliated.
Other Jobs & Pay ______________________ Unearned Income $_____/y from _____________________
Last Year’s Federal AGI $___________ Federal Income Tax $________ State IncomeTax $________
Household Monthly Income (gross pay + unearned cash income)
$___________
LESS Deductions from Pay on your paystubs
___________
LESS 1/12 Annual Tax Owed (-Refund) on your 1040 + state return
___________
EQUALS Net Monthly Income
___________
LESS Living Expenses (including luxuries) per month
___________
EQUALS Monthly Savings (excluding what you saved through payroll)
___________
What Tax Strategies are you using, or contemplating? __________________________________________
Debts (who, type, balance, interest rate) _____________________________________________________
PORTFOLIO
Do you have an Investment Policy Statement(s)? ___ When was it last reviewed with you? _____________
What is your Investment Philosophy? ________________________ Investment Strategy? ____________
How are your Assets structured now? ______________________________________________________
Please supply most recent statements, etc. and cost basis and other information for the following:
How many do you have of each of:
IRA accounts? ____________ 401k, 403b, 457, other Defined Contribution accounts? ________________
Defined Benefit plans?_____ Non-Qualified (discriminatory) plans, e.g. Deferred Compensation? ________
Investment Properties? (Include net cashflow, mortgage balance & interest rate info:)__________________
_____________________________________________________________________________________
Closely-Held Businesses? ______________________________ Liquid accounts @ banks, money markets,
CDs?_______________ Stock & Bond accounts? ______ Mutual Funds? _____ Annuities? ______
Limited Partnerships? ______ 529, Minors’ accounts? _____ Other investments? ____________________
Anyone owe you money? _________ Large tax refunds? ________ Collectors’ Items for investment? _____
______________________________________________________________________ Insured? _______
Inheritances expected (by whom? From whom? Net $ amount? Approx. Timing) ______________________
INSURANCE
Life, Disability, Long-Term Care
Category
Sub Category On whom?
Company
Benefit
Annual Cost Riders, choices Beneficiary
Office of Selwyn Miller, CFP®, ChFC®. 805-494-4868. [email protected]
Advisory services offered through Capital Analysts or Lincoln Investment, Registered Investment Advisors. Securities offered through Lincoln
Investment, Broker/Dealer, Member FINRA/SIPC. www.lincolninvestment.com. Miller Financial Planning and the above firms are independent
and non-affiliated.
Medical & Dental ______________________________________________________________________
Property & Casualty (Personal, Business, Professional)
Category

On what?
Company
Benefits
Annual Costs
Are you on a Board? (which?) _________________ Do you have D&O insurance for this? ________
ESTATE PLANNING
Main Goals for your Estate _______________________________________________________________
_____________________________________________________________________________________
How are your non-retirement assets titled?___________________________________________________
Anyone not a US citizen? _________________________________________________________________
Residence: Owned/Rented. Value $________ Mortgage Balance $_______ Payment $_______until______
%rate_________ Cost Basis $________
Cars $______________ Boat(s) $_________Plane(s) $__________ Other Personal Assets $___________
Living Trust/Will? _____ Durable powers? ___ When last reviewed? ____ Main provisions ____________
__________________ Guardians for minors/disabled? __________________ Trustees _______________
Successors__________________________ Executors__________________________________________
Office of Selwyn Miller, CFP®, ChFC®. 805-494-4868. [email protected]
Advisory services offered through Capital Analysts or Lincoln Investment, Registered Investment Advisors. Securities offered through Lincoln
Investment, Broker/Dealer, Member FINRA/SIPC. www.lincolninvestment.com. Miller Financial Planning and the above firms are independent
and non-affiliated.
Other Trusts ___________________________________________________________________________
Other Asset Protection and Estate Planning Techniques used ____________________________________
_____________________________________________________________________________________
GOALS
What average rates of Inflation should we assume: generally? __%; college? __%; long-term care? __%;
your future standard-of-living increases? ___%. My real Expenses will change in future as follows:
_____________________________________________________________________________________
(1) Please project your earnings to Financial Independence (year: ____). Use either (a) annual increase
after inflation ____% per year; OR (b) average $_______ in today’s $; OR (c) ultimate $______ in today’s $
OR_______________________________________________________________________________
(2) Please project your earnings to Financial Independence (year: ____). Use either (a) annual increase
after inflation ____% per year; OR (b) average $_______ in today’s $; OR (c) ultimate $______ in today’s $
OR_______________________________________________________________________________
Until what age(s) would you expect to live? (allow longer to be more conservative) ____________________
On a scale of 1 (hardly) to 5 (extremely), how important are the following uses of your money?
Religious__ Charitable__ Financial Independence___Security __ Reducing Debt __ Long-Term Care __
LT Care for parents __ Child Education __ Renovate Home __ Buy bigger Home __ 2 nd Home __
Buy Business ___Building your Business __ Building Emergency Fund __ Help Family, etc. __
Accomplishments __ “Toys”__ More Travel __ Legacies for: Kids __ Grandkids ___ Community Needs __
Hobbies (what?_______)__ Asset Protection __ Worthy public purposes ____ Other _____________ ____
Education Goals
Student
Birth Year
Education Level Annual $
From Year …
To Year …
Large Expense Goals
Goal
Lump Sum
Purchase
Annual $
Until Year…
Finance
Remarks
Not if x dies?
Office of Selwyn Miller, CFP®, ChFC®. 805-494-4868. [email protected]
Advisory services offered through Capital Analysts or Lincoln Investment, Registered Investment Advisors. Securities offered through Lincoln
Investment, Broker/Dealer, Member FINRA/SIPC. www.lincolninvestment.com. Miller Financial Planning and the above firms are independent
and non-affiliated.
$
Year
from….
Goals in Contingencies
If (1) Dies, living costs would decline by a gross $____ monthly, but increase $____ for extra childcare,
housekeeping and health insurance. Final Expenses at Death: say $30K each, or _______.
If (2) Dies, living costs would decline by a gross $____ monthly, but increase $____ for extra childcare,
housekeeping and health insurance. Final Expenses at Death: say $30K each, or _______.
If Both die, would children’s guardians need $ from your estate (a) initially? $______ (b) monthly? $______
Other large outlays at Death (e.g. mortgage payoff, estate tax court cases, bequests) _________________
_____________________________________________________________________________________
Your income goals in Disability ____________________________________________________________.
How much can the following suffer in Disability – (a) your lifelong standard of living? -___% (b) education
funds -___% (c) your retirement funds -____% (c) your estate -____%
Your goals for Long-Term care: Quality of facility, expressed in cost $_____/day. Stay at home as long as
possible, up to a cost of $____/day. (My default values: $250/day for each.)
Investment Goals
Please rank the following in order: Investing well __ allows me to take good care of my family; __ means Freedom; __ gives me Power; __ gets me Respect;
__ lets me accumulate more and more; __ is Exciting; __ is Scary; __ is My Own business; __ other ______
Risk Tolerance (1 conservative to 5 aggressive) _____ What single investment most resembles the
number(s) you chose? _________________________________________________________________
How much of your portfolio would you risk losing, if necessary to achieve your goals? _____% or $______
By when do you need your money back intact? During Retiremt __ At Death only __ Sooner __(when?
Will you need regular distributions from your investments? If yes, give details below:
a) Starting _________(date) through __________, will need $_____ per ____. Remarks ______________
Office of Selwyn Miller, CFP®, ChFC®. 805-494-4868. [email protected]
Advisory services offered through Capital Analysts or Lincoln Investment, Registered Investment Advisors. Securities offered through Lincoln
Investment, Broker/Dealer, Member FINRA/SIPC. www.lincolninvestment.com. Miller Financial Planning and the above firms are independent
and non-affiliated.
b) Starting _________(date) through __________, will need $_____ per ____. Remarks ______________
What’s the longest market decline you could stomach without losing heart and exiting? ________ years.
What Return do you want /need from your portfolio as a whole? __% specific parts? _________________%
How Volatile can your portfolio comfortably be? Any ____ > Market ____ = Market ____ < Market ____
Very Little ____ None _____.
How much must you set aside for Emergencies? $_____
Any types of investments you do not like? __________________________________________________
CONCLUDING
What is the most important thing to you in this world? __________________________________________
Any major changes soon (personal, work, …)? ________________________________________________
What were your Best and Worst financial moves? _____________________________________________
_____________________________________________________________________________________
What are you willing to do differently around money? _________________________________________
Questions I should have asked, but didn’t (and their answers) ____________________________________
_____________________________________________________________________________________
In personal financial planning, people typically have four main goals: (a) Accumulating money for
specific spending GOALS; (b) Saving for Financial INDEPENDENCE / retirement; (c) Protection in
DEATH; (d) Protection in Ill HEALTH and Frailty. Theory says to rank the Protection needs
foremost, with Ill-Health ranking ahead of Death because of the extra cost and probability and likely
sooner onset; as contingencies may happen before you can build up enough to self-insure. Then
comes Financial Independence, a core goal. Finally come the spending goals. But what’s your
ranking?
_____________________________________________________________________________________
Do you prefer a Comprehensive Financial Plan? A Plan for each Specific Issue? No plan, just examining
specific areas like investments or insurance? _________________________________________________
If the Plan does not work initially, I would most rather [rank these]: Retire later __ Work harder for more
money __ Change career (s)__ Spend less monthly __ Reduce/Eliminate the goal of ____________ __
Take more risk with portfolio, for more return __ Tie up investments for less liquidity but save tax __
TO DO
Office of Selwyn Miller, CFP®, ChFC®. 805-494-4868. [email protected]
Advisory services offered through Capital Analysts or Lincoln Investment, Registered Investment Advisors. Securities offered through Lincoln
Investment, Broker/Dealer, Member FINRA/SIPC. www.lincolninvestment.com. Miller Financial Planning and the above firms are independent
and non-affiliated.