Forms

Family Information

Client

Date

Name (First/Last)
Date of Birth:		Male: Female:
Marital Status: (single, married, separated, divorced, domestic partnership, widow, widower)

Spouse

Name (First/Last)
Date of Birth:		Male: Female:

Contact Info

Address:
City:	State:	Zip:
Home Phone:
Cell Phone:
Spouse Cell Phone:
Fax:
Client Preferred E-mail:
Spouse Preferred E-mail:

Employment - Client

Employer Name:
Employer Address:
City:	State:	Zip:
Work Phone:
Work Fax:
Work Email Address:
Title/Position:
Years Employed:

Employment - Spouse

Employer Name:
Employer Address Line:
City:	State:	Zip:
Work Phone:
Work Fax:
Work Email Address:
Title/Position:
Years Employed:

Children

Investments

Real Estate

	Primary Residence	Secondary Residence	Investment Property	Investment Property
Property Name:
Address 1:
Address 2:
City:
State:
Zip:
Property Type: (Residence, Non-Residence)
Current Value:
Mortgage Balance:
Owner: (Client, Spouse, Joint, etc.)

Taxable Investments and 529 Plans

	(1)	(2)	(3)	(4)	(5)
Asset Name:
Current Value:
Owner: (Client, Spouse, Joint, etc.)
Beneficiary:

Qualified Retirement
(401(k), IRA, Money Purchase, Profit Sharing, 403(b), Pension, SEP, Other)

	(1)	(2)	(3)	(4)	(5)
Asset Name:
Type: (Traditional 401(k), Roth401(k), IRA, Money Purchase, ProfitSharing, Traditional 403(b), Roth403(b), Pension, SEP, Other)
Current Value:
Owner: (Client, Spouse)
Beneficiary:

Contributions to Retirement Plan

General Contribution Information

	Client	Spouse
Contributions Based On: (All Earned Income, Salary)

Employee Annual Contributions (For 401(k) or 403(b))

	Client	Spouse
Type: (Percent of Salary, Match Percent, Fixed Amount, Maximum)
Percent:
Dollar Amount:

Employer Annual Contributions (For 401(k), Money Purchase, 403(b), SEP, or Profit Sharing)

	Client	Spouse
Type: (Percent of Salary, Match Percent, Fixed Amount, Maximum)
Employer Percent Match of Employee Contribution:
Dollar Amount:

Annuities (Fixed/Variable)

	(1)	(2)	(3)	(4)	(5)
Asset Name:
Asset Type: (Fixed / Variable)
Type of Funds: (Qualified, NQ, Tax Free)
Current Value:
Owner: (Client, Spouse, Joint, etc.))
Beneficiary:

Insurance

Life Insurance

	(1)	(2)	(3)	(4)
Policy Name & Carrier:
Policy Type: (Whole Life, VWL, Term, UL, VUL, Group, Other)
Term Ends at Retirement: (Group Life Only) (Yes / No)
Insured: (Client, Spouse, Survivorship, etc.)
Owner: (Client, Spouse, Joint, etc.)
Beneficiary: (Client, Spouse, Survivor,etc)
Current Death Benefit:
Annual Premium:

Long Term Care

	(1)	(2)	(3)
Policy Name & Carrier:
Insured: (Client, Spouse, Joint)
Benefit Amount:
Period for Benefit Amount: (Annually, Quarterly, Monthly, Weekly, Daily):
Owner: (Client, Spouse, Joint)
Annual Premium:

Disability

	(1)	(2)	(3)
Policy Name & Carrier:
Policy Type: (Group Short Term, Group Long Term Personal Short Term, Personal Long Term, Other)
Insured: (Client, Spouse)
Benefit Type: (Fixed Amount, Percent Of Salary)
Benefit Amount:
Period for Benefit Amount: (Annually, Quarterly, Monthly, Weekly, Daily):
Owner: (Client, Spouse, Joint)
Annual Premium:

Income/Retirement

Salary & Bonus

	(1)	(2)	(3)	(4)
Salary / Bonus Name:
Annual Amount:
Owner: (Client, Spouse, Joint)
Self-Employment? (Yes / No)

Retirement Dates

	Semi-Retirement Date/Age w/Expected Income	Full Retirement Date/Age
Client:
Spouse:

Social Security (disregard if supplying Social Security statements)

	Client	Spouse
Retirement Benefit at Age 62:
Retirement Benefit at Full Retirement Age:

Living Expenses - All values are net after-tax in today's dollars

Current Monthly Standard of Living:
Semi-Retirement Monthly Standard of Living (if applicable):
Retirement Monthly Standard of Living:

Client's Monthly Standard of Living in Event of:

Spouse's Death Before Retirement:
Spouse's Death in Retirement:

Spouse's Monthly Standard of Living in Event of:

Client's Death Before Retirement:
Client's Death in Retirement:

Wills, Estate Documents and Gifting

Check All Documents That Are Currently In Place

Objectives

Retirement/ Investment

Estate

Risk Tolerance

Professional Contacts

Advisors

Advisor Type (Accountant, Attorney, etc.)	First/Last Name	Company	Address	Phone, Fax, Email

Notes:

Client Resources

Disclosure

Advisory Services offered through Capital Analysts or Lincoln Investment. Registered Investment Advisers Securities offered through Lincoln Investment. Broker Dealer, Member FINRA/SIPC www.lincolninvestment.com StoneCrest Wealth Management and the above firms are independent, not affiliated.

Contact Details

StoneCrest Wealth Management Inc
118 S Kyrene Road, Suite 4
Chandler, AZ 85226
Toll Free: 800-852-2860
Phone: 602-258-9400
Fax: 602-258-9300
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

First/Last Name	Address	DOB	M/F	Marital Status	Telephone/E-Mail	Special Needs?
			M: F:
			M: F:
			M: F:
			M: F:
			M: F:
			M: F:

	Will	Rev Trust	Irr Trust	ILIT	FLP	Planned Gifts	CLT	CRT	Buy/Sell	Other
Client
Spouse

Rate the importance of each item according to the following scale:	Low	Med	High
Your retirement goals
Directing a portion of your personal savings or investment portfolio to a tax advantaged vehicle
Having all of your portfolios consolidated and analyzed to make sure your overall plan is on track
Matching your risk tolerance to that of your investment portfolio
Reviewing your investment performance against that of an index
Reviewing your investment performance against your plan
Reviewing alternative retirement methods
Minimizing the taxes on your investment accounts
Reviewing techniques to save income tax and estate taxes on deferred money
Asset protection in the result of serious illness
Protecting assets in the event that you require long term care in the future
Receiving adequate income in the event of disability during your working years
Planning for income for your spouse in the event of your premature death
Generating a guaranteed retirement income stream
Planning for income for your children in the event of your premature death

Rate the importance of each item according to the following scale:	Low	Med	High
Distributing assets equally to your children
Protecting your assets transferred to your children from creditors, divorce, and bankruptcy
Reviewing your insurance portfolio
Reviewing different methods of meeting your estate tax liabilities
Minimizing estate taxes
Charitable planning to your estate's planning
Contributing annually to charity
Gifting to your children if it doesn't interfere with your financial independence
Planning for your grandchildren's education
Reviewing your current will structure to eliminate unnecessary taxes
Protecting your residence and/or vacation home from estate taxes
Having your estate in trust for your spouse in order to protect your children's inheritance

Do you have an Estate Planning Attorney?	Yes No	Would you like us to recommend someone?	Yes No
Do you have a CPA?	Yes No	Would you like us to recommend someone?	Yes No
Is your Attorney a key decision maker for you?	Yes No	Is your CPA a key decision maker for you?	Yes No