Green Financial Client Update Form

*Required Fields

*First Name:

*Last Name:

Address:

Date:

Home Phone Number:

Best Contact Number:

*Email Address:

1. Have there been any material changes to your financial situation? If yes, please indicate the changes below:

Yes No

Annual Household Income:

Liquid Net Worth:

Major Life Changes:

Net Worth:

Tax Bracket:

Other:

2. DO YOU ANTICIPATE NEEDING TO MAKE ANY WITHDRAWALS, OUTSIDE OF ANY YOU ARE ALREADY TAKING REGULARLY, FROM YOUR INVESTMENT ACCOUNTS OVER THE NEXT 3-5 YEARS?
If yes, please specify.

Yes No

3. IF NOT ALREADY IN RETIREMENT, WHEN DO YOU PLAN TO RETIRE?

4. HAVE YOU HAD ANY, OR DO YOU EXPECT ANY, MAJOR LIFE CHANGES THAT COULD IMPACT YOUR INVESTMENT PLANNING OVER THE NEXT 3-5 YEARS? (EMPLOYMENT, COLLEGE, MARITAL STATUS, CHILDREN, MAJOR PURCHASE, ETC)?

5a. HAVE YOU PLANNED FOR UNEXPECTED LOSS OF INCOME DUE TO ILLNESS OR INJURY?

Yes No

5b. DO YOU HAVE DISABILITY INSURANCE COVERAGE?

Yes No

5c. IF MARRIED, AND BOTH ARE WORKING, DO YOU BOTH HAVE COVERAGE?

Yes No

6a. HAVE YOU PLANNED FOR UNEXPECTED NURSING HOME OR IN-HOME CARE NEEDS?

Yes No

6b. DO YOU HAVE LONG TERM CARE INSURANCE COVERAGE?

Yes No

6c. IF MARRIED, DO YOU BOTH HAVE COVERAGE?

Yes No

7a. WILL YOUR DEPENDENTS BE TAKEN CARE OF FINANCIALLY IF YOU WERE TO DIE?

Yes No

7b. DO YOU HAVE LIFE INSURANCE COVERAGE?

Yes No

7c. IF MARRIED, DO YOU BOTH HAVE COVERAGE?

Yes No

TO HELP YOU GET THE MOST FROM OUR MEETING, PLEASE CHECK THE BOXES FOR ANY ADDITIONAL SPECIFIC ITEMS YOU MAY WISH TO DISCUSS OR LIST ANY OTHER TOPICS IN THE SPACE BELOW:

Investment Allocation

Financial Protection for Dependents

Planning for Potential Incapacity

Figuring out when I can Retire

My Existing 401(k)

College Planning

Timing of Social Security

Saving More

Harvesting Assets for/in Retirement

Consolidation of Investment/401(k) Accounts

Impact of Changing Jobs

Dependents with Special Needs

Elderly Parents

Pensions

Mortgages

Retirement Plan for my Small Business

Income Protection

Charitable Giving

Tax Deferral or Reduction

Estate Planning

Other - Please list here:

Click Here to Print the Completed Form for Your Records

Reminder note: Please make sure you have designated beneficiaries for all of your assets and review them periodically. Also it is important to have a valid will and directives in place and to ensure someone knows where to find your important documents.