Fact Finder – Financial Assessment
Client Information
First Name
Family Structure
Date of Birth
Last Name
Gender
(mm/dd/yy)
Client
M
F
Co-client
M
F
Street
City
Home Phone Number
(Married-joint, Married-separate,
Head of household, Single)
Province
Business Phone Number
Postal Code
E-mail Address
Family Members
First Name
Last Name
Date of Birth
Relationship
(mm/dd/yy)
(Son, Daughter, Cousin, etc.)
Dependent of
Net Worth
Lifestyle Assets
Residence (i.e. home)
2nd Residence (i.e. vacation home)
Personal Use Property (i.e. car, boat)
Other Personal Assets
Current Value ($)
Liabilities
Mortgage
Outstanding Amount ($)
Interest Rate (%)
Monthly Payments ($)
Car Loans
Personal Loans
Other Debt
Cash Flow
Gross Annual Income ($)
Client
Co-client
Note: Expenses can be entered as one total amount to simplify data entry.
Monthly Expenses
Housing (i.e. utilities, repairs)
Amount ($)
Food
Transportation (i.e. gas, insurance)
Entertainment (i.e. restaurants, movies)
Personal (i.e. clothing, hobbies)
Other (i.e. child care, travel)
March 2009
Retirement Goal
Client
Desired Annual Retirement Income
(after tax in today’s $)
Co-client
Joint
Retirement Age
Life Expectancy
Estimated Annual Pension Income
(in today’s $)
CPP Eligibility
OAS Eligibility
Non-Registered Current Value ($)
 Monthly Savings ($)
Registered Current Value ($)
Indexed at (%)
Start Age
Start Age
%
%
Start Age
Start Age
%
%
 Monthly Savings ($)
Defined Contribution ($)
 Monthly Savings: Employee ($)
 Monthly Savings: Employer ($)
Assumed Rate of Return for all Accounts
Education Goal
Major Purchase Goal
Goal 1
Goal 2
(today’s $)
Index Costs by (%)
Education Start Age
Number of Years
Current Amount
Saved ($)
Current Monthly Savings
Assumed Return Rate
Goal 3
Disability Insurance
Client
Life Insurance
Client
Co-client
Existing Coverage ($)
Monthly Premium ($)
If Both Die
Number of Years
Goal 2
Description
Purchase Date
Cost (today’s $)
Index Costs by (%)
Current Amount
Saved ($)
Current Monthly Savings
Assumed Return Rate
Family Member
Annual Education Costs
Total Lump Sum Expenses on Death ($)
Annual Ongoing Expenses ($)
Goal 1
Goal 3
Co-client
Short-Term Coverage
Monthly Benefits ($)
Duration (months)
Monthly Premium ($)
Long-Term Coverage
Monthly Benefits ($)
Benefits End at Age
Monthly Premium ($)
March 2009