Page 14 - HGI Virtual Fast Start Kit
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 Step 3. Financial Needs Analysis
Date __________________________
Client Name ___________________________________________ DOB ______________ Non-Smoker Smoker Spouse Name __________________________________________ DOB ______________ Non-Smoker Smoker Address ____________________________________________________________________________________________ Home Phone ____________________________________ Work Phone _______________________________________ Cell Phone ______________________________________ E-mail ___________________________________________
Goals
Retirement _______________ Home _______________ LTC _______________ Retire Parents ___________________ Education ________________ Vacation ____________ Travel ____________________________________________
Monthly Income
Combined Gross ___________________ Combined Net ___________________ Discretionary ____________________
Monthly Expense
Mortgage/Rent
Car Payments
Utilities
Credit Cards
Food/Clothing
Property Insurance ____________________________
Assets
Market Value of Home _______________________ Mutual Funds/Stocks _______________________ Life Insurance-Cash Value _______________________
Savings Account _______________________ Checking Account _______________________ Retirement Plan _______________________ Previous Year Tax Return _______________________
Car Insurance _____________________________ Life/Health Insurance ___________________________ Other Loans _____________________________ Car Maintenance/Gas ___________________________ Personal Expenses _____________________________ Miscellaneous _____________________________ Total Expenses _____________________________
Liabilities
Mortgage ____________________________ 2nd Mortgage ____________________________ Car Loan ____________________________ Credit Cards ___________________________
Personal Loans ____________________________ Other Loans ____________________________
Purchase Price _____________ Years Due ________________ Monthly Payment ___________
Other Mortgage Information
Outstanding Low Balances ____________ Fixed ______ Variable ______ Term ____ Monthly Property Taxes ______________
Loan Rate _______________________ Estimated FICO ___________________ Monthly Hazard Insurance ___________
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How much could you comfortably afford to set aside in a lump sum each month to reach your goals? $200 $300 $400 Other: $__________
Follow-up Appointment Date ______________________________ Client Signature: _________________________
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