Financial Planning Questionnaire : Apriem

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PERSONAL INFORMATION

Today's Date *

Legal Name: *

First

Last

Marital Status *

Single
Married
Divorced
Widowed

Spouses Legal Name: *

First

Last

How many children do you have? *

0
1
2
3
4
Other

Your employment status: *

Employed
Self-Employed
Retired
Not Employed

Your spouses employment status:

Employed
Self-Employed
Retired
Not Employed

Date of Birth: *

Spouses Date of Birth: *

Phone Number: *

Spouses Phone Number: *

Email Address(es): *

Desired Retirement Age(s): *

What are your financial priorities? *

General Planning
Investment Planning
Retirement Planning
Charitable Planning
Estate Planning
Tax Planning
Insurance Planning

Do You Have Other Goals or Concerns?

INCOME

Salary(s): *

Do you and/or your spouse receive a yearly bonus(es)? *

Average Bonus(es): *

Example: John - Gross $10,000

Do you and/or your spouse receive social security benefits? *

Social Security Benefits: *

Example: Declared age and gross monthly benefit - John - 62 - $1,500

Other Income:

Example: Pension - monthly gross amount, annuity - monthly gross amount, rental property - monthly gross amount, or disability - monthly gross amount.

LIVING EXPENSES

Download the Apriem Expense Sheet

Please download the above form and reupload here upon completion.

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NON-RETIREMENT

Do you have any Non-Retirement accounts? *

Joint Brokerage Account
Trust Brokerage Account
Crypto Account
Individual Brokerage Account
CD
Other
None

Please share the current value of your Joint Brokerage Account: *

Please share the account owner & current value of your Trust Brokerage Account: *

Please share the account owner & current value of your Crypto Account(s): *

Please share the account owner & current value of your Individual Brokerage Account(s): *

Please share the account owner & current value of your CD(s): *

Please share the account owner & current value of your Other Non-Retirement Account(s): *

Do you have any Non-Retirement Savings (Ex: Savings or Checking account)? *

If so, please share account type and current values for each.

RETIREMENT

Please select all the Retirement Account types you have:

Traditional IRA
Roth IRA
Roth 401(k)
401(k)
403(b)
Roth 403(b)
SEP IRA
Simple IRA
457
Other

Please share the account owner & current value of your Traditional IRA(s): *

Please share the account owner & current value of your Roth IRA(s): *

Please share the account owner & current value of your 401(k)(s): *

Please share the account owner & current value of your Roth 401(k)(s): *

Please share the account owner & current value of your 403(b)(s): *

Please share the account owner & current value of your Roth 403(b)(s): *

Please share the account owner & current value of your 457(s): *

Please share the account owner & current value of your SEP IRA(s): *

Please share the account owner & current value of your Simple IRA(s): *

Please share the account owner & current value of your Other Retirement Account(s): *

Do you contribute to employee retirement account(s)? *

Please share the account owner, account type, and current value(s): *

Example: John - 401k - 10% of salary, Mary - Roth IRA - $7,000

Does your employer contribute to your employee retirement account(s)? *

Please share the account owner, account type, and current value(s): (copy) *

Example: John - 401k - 3% match

REAL ESTATE & LIFE INSURANCE

Do you own real estate? *

Please share address, current value, and property tax information: *

have any &

Do you and/or your spouse have life insurance? *

Please share policy type, purchase date, insured, beneficiary, term years, death benefit & any cash value, and monthly premium: *

LIABILITIES

Do you have a mortgage? *

Please share date of loan(s), original loan amount, current balance, interest rate, loan term (years), and monthly payment: *

Please share any other loan(s) you may have including their type (Ex: auto, credit card), date of loan, original loan amount, current balance, interest rate %, and monthly payment: *

How did you hear about Apriem Advisors? *

Client Referral
Employee Referral
Social Media
Our website
Other

Please use this to upload any account statements that may help our team get a complete picture of your financial portrait.

Drag & Drop Files, Choose Files to Upload

Ex: Life insurance policies, retirement accounts, social security benefits

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