Client update form : Roger Green, rogersgreen.com

First Name *

Last Name *

Date

Address Line 1

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

Address Line 2

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

City / Town

State / Province / Region

Zip / Postal Code

Home Phone Number

Best Contact Number

Email Address *

Preferred Contact Method

Phone Email Mail

1. Have there been, or do you expect, any material changes to your financial situation that could impact your investment planning over the next 3-5 years? (employment, college, marital status, children, major purchase, etc)?

If yes, please indicate the changes below

Yes No

Annual Household Income

Liquid Net Worth

Major Life Changes

Net Worth

Tax Bracket

Other

2. What are your average monthly expenses?

$1,000-2,999 $3,000-5,999 $6,000-8,999

Other

4. Do you anticipate needing to make any withdrawals from your investment accounts over the next 3-5 years, outside of any you already take regularly?

Yes No

If yes, please specify.

5. If not already in retirement, when do you plan to retire?

6a. Have you planned for unexpected loss of income via disability insurance?

Yes No

6b. If married and both are working, do you both have coverage?

Yes No

6c. Would you like to discuss disability coverage?

Yes No

7a. Have you planned for unexpected nursing home or in-home care needs via long term care insurance?

Yes No

7b. If married, do you both have long-term care coverage?

Yes No

7c. Would you like to discuss long-term care coverage?

Yes No

8a. Have you planned for the financial care of your dependents via life insurance?

Yes No

8b. If married, do you both have life insurance?

Yes No

8c. Would you like to discuss life coverage?

Yes No

9. Please check any topics you would like to discuss with an advisor:

10. Customer service is important to us. please provide any feedback you have on the service you have received from our staff over the past year:

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Leave this empty:

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.

Green Financial Resources

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Client update form

Click Here to Print the Completed Form for Your Records

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