Guardian Wealth Advisory Group | Financial Advising Services in Elgin, IL 60123

Pre-Appointment Form

We are looking forward to getting together with you. If you have any questions or require special assistance prior to your visit, please call our office at 847.741.2284. *Please note that the form will not save if you leave this website.*

Step 1 of 8

The following items would be helpful to have at the time of our visit:
1. All brokerage firm statements
2. All life insurance & annuity policies
3. All IRA & retirement statements
4. 2 Years of Tax Returns
5. Social Security Statement (SSA.gov)
CONTACT INFORMATION
Name
First Last
Nickname
Date of Birth
MM slash DD slash YYYY
Working At/Retired From:
Current/Former Occupation:
Retired?
Spouse Name
First Last
Spouse Nickname
Spouse Date of Birth
MM slash DD slash YYYY
Spouse Working At/Retired From:
Spouse Current/Former Occupation:
Spouse Retired?
Home Phone:
Cell Phone:
Email Address:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Were you referred to us?
If so, by whom?

FAMILY
Number of Children
Number of Grandchildren
Do any of your children or grandchildren have special needs?
Are any of your children or grandchildren listed as joint owners on any of your accounts/assets?
Family Notes:

LEGAL ITEMS
Which of the following legal documents do you have in place?
Will
Power of Attorney (POA) Assets
Power of Attorney (POA) Health
Living Will
Living Trust
LEGAL ITEMS
Which of the following do you have in place?
Umbrella Policy
Long Term Care Insurance
Death Benefit Life Insurance
Life Insurance

CASH FLOW
Please list monthly income from each source.
Pension
You
Your Spouse
(Survivor Options)
You
Your Spouse
Social Security
You
Your Spouse
Wages
You
Your Spouse
Other Income
You
Source(s)
Total
Other Income
Spouse
Source(s)
Total
Are these amounts net or gross?
How much are your monthly expenses?
Here are some common expenses:
Mortgage, Food, Gas, Car Loan, Insurance, Utilities, Gifts/Donations, Medical, Taxes, Social Security, etc
Total
CASH FLOW
Is your current cash flow sufficient and comfortable?
Do you live off interest your investment dollars earn?
Do you anticipate any significant changes in cash flow?
Are you planning any major lifestyle changes?
Do you foresee any large purchases greater than $5,000 within the next 3 years?
Do you contribute to charity?

ASSETS
Property:
Home Value $
Autos and Personal Property $
Rental/Additional Properties $
ASSETS
Description
Balance Owed
Pay Off Date
MM slash DD slash YYYY
Description
Balance Owed
Pay Off Date
MM slash DD slash YYYY
Description
Balance Owed
Pay Off Date
MM slash DD slash YYYY

Additional Information
If you are not already retired, when do you want to retire?
How did you acquire your wealth?
How involved would you like to be with your investments?
What is most important about your money to you?
Are you more concerned about growing your assets or protecting what you already have?
Concerns
Which of the following are your top three concerns?
- Losing too much money in the stock market
- Avoid paying too much in taxes
- Considering retirement and not sure if I/we can afford to
- Not having a reliable income plan for retirement
- Concerned about giving away life savings due to a catastrophic illness
- Outliving nest egg
- Uncertainty about stock market
- Leaving a legacy to children and/or grandchildren
- Need direction with 401K and/or IRA accounts

Objectives
Which of the following describes your risk tolerance when it comes to retirement assets?
What are your Financial Objectives? (Check all that apply)
- Income Now
- Tax-Deferred Growth
- Guarantees Provided
- Pass Assets to Beneficiaries
- Growth Potential
- Other
By submitting your personal information, you consent to be contacted by a financial professional regarding your financial strategy for retirement.
Email
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Pre-Appointment Form

Step 1 of 8

The following items would be helpful to have at the time of our visit:

CONTACT INFORMATION

FAMILY

LEGAL ITEMS

LEGAL ITEMS

CASH FLOW

Pension

(Survivor Options)

Social Security

Wages

Other Income

You

Other Income

Spouse

How much are your monthly expenses?

CASH FLOW

LIFE EVENTS

ASSETS

ASSETS

ASSETS

Additional Information

Concerns

Objectives

Ready To Chat?

Contact Us