Consultation Data Form

Confidential Client Data Form

This information is for use in providing recommendations only and will not be shared with other parties.

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So that we may provide the most thorough review of your situation, please provide in advance or have readily available during your meeting, statements for all financial/investment accounts including all 401k/403b accounts, insurance policies, Social Security statements, and anything else that might be relevant to our understanding of your complete financial situation.

*All recommendations made are based upon the information provided by you and other information disclosed in discussions. Any failure to provide complete information or to advise of material changes to retirement plans or financial situation may render such retirement planning recommendations invalid.

*Required Fields

Green Financial Consultation Data Form

Client A Information

Street address, P.O. box, company name, c/o

Apartment, suite , unit, building, floor, etc.

* If retired, provide prior occ and employer

Street address, P.O. box, company name, c/o

Client B Information

Street address, P.O. box, company name, c/o

Apartment, suite , unit, building, floor, etc.

* If retired, provide prior occ and employer

Street address, P.O. box, company name, c/o

Children
Expenses
Goals

In the next five years, how much of your investments or savings do you plan on spending?

Do you have a Financial Power of Attorney?



Do you have a Living Will/Healthcare Advance Directive?



Do you have a will?

Client A will

Client B will

Do you have any trusts?

Client A trusts

Client B trusts

Do you expect to support someone outside of normal dependent support (handicapped child, parent, etc)?

Is an inheritance part of your overall financial planning (giving or receiving)?

Investments

Type: PS = Passbook Savings; MM = Money Market; TB = Treasury Bills; I = IRA; R = Roth; 4T = Traditional 401K; 4R = Roth 401(k); SI = SEP-IRA; T = TSA or 403B; S = Stock; MF = Mutual Funds; RE = Real Estate Investment Trust; B = Bonds; CD = CDs; O = Other (explain)

*If your employer matches any contributions, please list amount along with your contribution

Insurance/Annuities

Type: T = Term*; U = Universal Life; V = Variable Life; VL = Variable Universal Life; W = Whole Life; VA = Variable Annuity; LT = Long-Term Car; DI = Disability; FA = Fixed Annuity

Pensions & Social Security
Real Estate

Type: PR = Primary Residence; SR = Secondary Residence; RR = Rental Residential; RC = Rental Commercial; O = Other
#: F = First Mortgage; S = Second Mortgage; T = Third Mortgage

Liabilities/Expenses

Item/Company: Auto, Credit Cards, Student Loans, Charitable Giving, etc.

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All recommendations are based upon the information provided by you and other information disclosed in discussions. Any failure to provide complete information or to advise of material changes to retirement plans or financial situation may render such retirement planning recommendations invalid