FINANCIAL PLANNING ORGANIZER
8401 Golden Valley Road, Suite 225
Golden Valley, MN 55427
Main: 763.762.3400 • Fax: 763.762.3409
www.sterlingretirement.com
Registered Representative of and securities and investment advisory services offered through Cetera Advisor Networks LLC, member
FINRA/SIPC. Some advisory services are offered through AdvisorNet Financial. Cetera Advisor Network, AdvisorNet Financial, and
Sterling Retirement Resources are not affiliated. This information will be used to prepare an individual report assessing your current
financial needs. Your responses will not be sold or shared with any unaffiliated parties.
Congratulations on your desire and commitment towards planning for a successful
financial future. Before we can begin our analysis, we ask you to complete the
following questionnaire and return it to our office, along with the following
documents listed below. All documents will be returned and all information will be
held in the strictest confidence.
Please furnish us with the following information:
Bank account statements (checking, savings, money markets)
Investment statements (Brokerage statement(s), Mutual Fund statement(s), Certificate of
Deposit statements, IRAs, 401K, 403B, Pension, Stock Option statement)
Most recent statement(s) for Annuity policy(s) AND copy of policy(s)
Last year’s tax return and W-2(s)
Last year’s property tax returns for ANY/ALL real estate
Will(s), Trust(s), Power(s) of Attorney, Living Will(s), or Health Care Directive(s)
Date Last Reviewed _____________________
Most recent statement(s) for life insurance policy/policies AND copy of policy/policies
Disability policy/policies. If group disability, “Summary Plan Description” is needed
Long Term Care policy/policies
Company benefits (most companies publish a benefits booklet/statement)
Pension statement(s)
Two consecutive months’ payroll stubs (to include explanation of deductions)
Social Security Benefit statement(s)
Copy of Mortgage(s) statement(s) AND Mortgage Note(s)
Homeowner and automobile insurance policy(s)
Loan and Liability statement(s)
Other: ___________________________________________________________________
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Confidential Personal Profile
Full Legal Name
Please include middle
initial
______________________________
_______________________________
Social Security Number ______________________________
_______________________________
Driver’s License ______________________________
_______________________________
Issuing State _____________ Exp ____________
_____________ Exp _____________
Date of Birth ______________________________
_______________________________
Home Address Line 1 ______________________________
_______________________________
OR
Same Address as Client
Home Address Line 2 ______________________________
_______________________________
City ______________________________
_______________________________
State _______ Zip Code ______________
_______ Zip Code _______________
Home Phone ______________________________
_______________________________
Cell Phone ______________________________
_______________________________
Work Phone ______________________________
_______________________________
Personal Email ______________________________
_______________________________
Professional Email ______________________________
_______________________________
Preferred Email?
Personal
Professional email
Personal
Professional email
I/we would like meeting notes
to be delivered via:
Email
Marital Status
Employment Status
Single
Divorced
Mail
Both
Married
Widowed
Employed
Homemaker
Retired
Not Currently Employed
Employed
Homemaker
Retired
Not Currently Employed
Employer Name ______________________________
Work Address ______________________________
______________________________
City, State, Zip Code ______________________________
Current Position/Title ______________________________
______________________________
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______________________________
______________________________
Family Information
Children and Grandchildren
Name: ________________________________
SS#:
Birth Date: _________________
Spouse Name: ____________________________________ State of Residency: _____________________________
(Your
Children:
Name ___________________ DOB ________
Name ___________________ DOB _________
Grandchildren)
Children:
Name ___________________ DOB ________
Name ___________________ DOB _________
Name: ________________________________
SS#:
Birth Date: _________________
Spouse Name: ____________________________________ State of Residency: _____________________________
(Your
Children:
Name ___________________ DOB ________
Name ___________________ DOB _________
Grandchildren)
Children:
Name ___________________ DOB ________
Name ___________________ DOB _________
Name: ________________________________
SS#:
Birth Date: _________________
Spouse Name: ____________________________________ State of Residency: _____________________________
(Your
Children:
Name ___________________ DOB ________
Name ___________________ DOB _________
Grandchildren)
Children:
Name ___________________ DOB ________
Name ___________________ DOB _________
Name: ________________________________
SS#:
Birth Date: _________________
Spouse Name: ____________________________________ State of Residency: _____________________________
(Your
Children:
Name ___________________ DOB ________
Name ___________________ DOB _________
Grandchildren)
Children:
Name ___________________ DOB ________
Name ___________________ DOB _________
Parents
Client 1’s Parents:
Name(s) and Age(s)
___________________________________________________________________
Health Concerns:
___________________________________________________________________
State of Residency:
_________________
Is their estate in order?
Comment:
Yes
No
___________________________________________________________________
Client 2’s Parents:
Name(s) and Age(s)
___________________________________________________________________
Health Concerns:
___________________________________________________________________
State of Residency:
__________________
Is their estate in order?
Comment:
Yes
No
___________________________________________________________________
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Family Background
1.
Hobbies/Interests/Organizations/Clubs:
Client 1: _____________________________________________________________________________
Client 2: _____________________________________________________________________________
2.
Health Concerns:
Client 1: _____________________________________________________________________________
Client 2: _____________________________________________________________________________
3.
Financial Commitments (Previous Marriage, Outstanding Loans, etc.):
Client 1: _____________________________________________________________________________
Client 2: _____________________________________________________________________________
4.
Is there a possibility that other people, such as a parent, might become financially dependent upon you?
Yes
5.
No
If yes, please explain: ____________________________________________________
Are there any special considerations that relate to your children and their future (e.g. Disabilities, Second
Marriages, or Financially Unskilled Children)?
Yes
No
If yes, please explain:____________________________________________________
Other Important Information:__________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Financial Counselors
Name
Phone Number
Satisfied?
Financial Planner
Yes
No
Stockbroker
Yes
No
Attorney
Yes
No
Accountant
Yes
No
Life Insurance Agent
Yes
No
Home/Auto Agent
Yes
No
Who would you consult first on an important financial decision? _______________________________________
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Financial Planning Objectives
At Sterling, we are committed to providing our clients with broad-based financial planning. To be the most
effective partner in helping you to achieve your goals, please select which goals and objectives are important to
you.
Client 1
Client 2
1. Establish a savings plan, accumulate wealth
2. Become financially able to retire
3. Taking care of self and family during a period of long-term disability/long-term care
4. Design an investment strategy for: ___________________________________________
5. Professional management of my investment portfolio
6. Reduce income taxes
7. Provide funds for college education for children/ grandchildren
8. Provide for my family's cash and income needs in the event of death
9. Prepare estate plan, protect estate for heirs, reduce taxation upon death
10. Provide for continuation/sale of business as a result of death or disability
11. Other: ________________________________________________________________
From the list above, please tell us which three are the most important to you now by indicating their number below:
1._________
2._________
3._________
Is there anything we haven’t asked you that we should discuss?_________________________________________
____________________________________________________________________________________________
What is the most important thing you hope to get from this process? ____________________________________
_____________________________________________________________________________________________
What do you like most/least about your present financial position? ______________________________________
_____________________________________________________________________________________________
If you were going to make improvements in your financial plan, what steps would you take?__________________
_____________________________________________________________________________________________
If we were meeting three years from today, and you were to look back over those three years, what has to have
happened during that period, both personally and professionally, for you to feel happy about your progress?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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Target Retirement Age
When would you like to retire? First enter your Target Retirement Age, then indicate how willing you are to delay
retirement beyond that age if it helps you reach your Lifestyle Goals.
Target Retirement Age
How willing are you to retire
later (if necessary) to attain
your goals?
Client 1
_______ OR
Retired Now
Not at all
Slightly Willing
Somewhat Willing
Very Willing
Client 2
_______ OR
Retired Now
Not at all
Slightly Willing
Somewhat Willing
Very Willing
Lifestyle Goals – Before & During Retirement
Lifestyle Goals are above and beyond what you need to pay for the basic expenses of day-to-day living. Dream a
little (or a lot), and create all the goals you would like, even if you’re not sure you can afford them. Only include
separate goals not accounted for in the Retirement and Education Goal sections.

Travel - Recurring Vacations

Wedding - Celebration


Cars - Transportation
Health Care for Yourself or Others


Gifts - Donations – Leave Bequest
New Home - Vacation Home - Renovations

Start a Business

Other Major Purchases
Importance
High Low
10
Description and Details
1
8
Target Amount
How
Often
How
Many
Times
$12,000
Yearly
20
Start
Year
At
Retirement
Example: Annual Travel Fund
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Portfolio Suitability Questionnaire
The following questionnaire will help us determine an investment strategy that best fits your needs.
If completing with a spouse or partner, please use the first column for Client 1 response and the second
column for Client 2 response. This questionnaire can be completed before or during your next meeting.
Client
1
Client
2
Client
1
Client
2
1) When do you expect to START withdrawing
money from your investment portfolio?
A. Currently or within 2 years
B. 2 to 4 years
C. 5 to 8 years
D. 8 to 12 years
E. 12 or more years
2) Once withdrawals start, how long will you
need the withdrawals to last?
A. Less than 2 years
B. 2 to 5 years
C. 6 to 10 years
D. 11 to 15 years
E. 15 or more years
3) If your investment portfolio worth $500,000
started losing value, at which point would you
START to become uncomfortable?
4) If the same investment portfolio continued to
lose value, at which point would you ask your
advisor to reduce your risk level?
A. $490,000
B. $475,000
C. $450,000
D. $400,000
E. $350,000
F. $300,000 or lower
A. $490,000
B. $475,000
C. $450,000
D. $400,000
E. $350,000
F. $300,000 or lower
5) If the choices below represented the best and worst possible outcomes for a
$500,000 portfolio invested for five years, which portfolio would you choose?
Worst Case Best Case
A. $550,000 $670,000
B. $500,000 $720,000
C. $450,000 $800,000
D. $400,000 $950,000
6) Which of the following statements best describes your attitude towards investment (market) risk?
A. I prefer taking a high level of risk in a portfolio that seeks significant growth.
B. I prefer taking a significant level of risk in a portfolio that seeks growth.
C. I prefer taking a moderate level of market risk in a portfolio that seeks growth and income.
D. I prefer taking a low level of market risk in an attempt to limit market losses.
E. I prefer taking no investment risk in an attempt to avoid losing any capital.
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