Financial Needs Assessment & Priorities Interview Sheet

Thank you so much for taking the time to review and complete this questionnaire. There are many different products and services available at our agency. We want to make sure that we are focusing on the things that are important to you. We have created this simple yet informative questionnaire to provide us with some insight into your goals and objectives. We hope you find this quick and effective as the first step to reaching your financial goals and risk assesment.

Personal To-Do List

What is on your “Personal To Do List” when it comes to financial planning and prioritizing your current financial position and risk management:
 
Please Check All items you are interested in discussing:

On The Horizon

Tell us a little bit about what is “On the Horizon” for you. Where do you foresee any of these events in the future years of your life:
 
Please check all items you are interested in discussing.
New Home
Bonus
Inheritance
Change Job
Salary Increase
Charitable Gifts
Start Business
Marriage
Sell Business
Retirement
Children
Sell Property
Pay Off Loans
Taking Care of Elderly Parents

Business Owner's Information

If you are a Business Owner, tell us if any of these topics are of interest to you:
Please check any items of interest or concern: *

Financial Priorities

Lastly let us knowwhich of these subjects are of the Highest to Lowest Priority in regards to your personal goals and objectives:
 
Please select those that most closely reflect your financial priorities.
 
H = High Priority          M = Medium Priority          L = Low Priority          N/A = Not Applicable
Protecting MYSELF and MY lifestyle and quality care during retirement and old age
Protecting MY FAMILY’s and THEIR lifestyle and quality care during retirement and old age
Saving and investing on a regular basis are a
Providing educational funds for my children is a
Protecting my income in the event of sickness or accident is a
Providing funds to pay my mortgage / debts in the event of my death is a
Investments that offer high growth potential are a:
An overall financial plan is a:
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