Financial Health Questionnaire

Please take 10 minutes to answer our quick review, as it will provide us with a brief overview of where you are currently. Thank you for your time.

Client Information

Date:

Full Name:

Mailing Address:

Home Phone:

Cell Phone:

Work Phone:

Date of Birth:

Occupation:

Email Address:

Employer:

Marital Status:

How did you hear about us?

Spouse Details

Spouse Full Name:

Spouse Date of Birth:

Spouse Occupation:

Spouse Employer:

Spouse Work Phone:

Spouse Email Address:

Children

Name and Date of Birth of Children:

Checklist

1. In the past two years, have you sat down to determine your lifestyle goals?

Yes No

2. Have you determined if your financial resources can meet those goals?

Yes No

3. Are you satisfied with the amount of money you are saving?

Yes No

Have you reviewed and updated these documents, in the past 2 years?

4a. Your will?:

Yes No

4b. Your networth statement?:

Yes No

4c. Your retirement plan?:

Yes No

5. Do you know if you have sufficient insurance coverage?

Yes No

6. Do you contribute the maximum to an RRSP each year?

Yes No

7. Do you make your maximum contribution within the first 3 months of the year?

Yes No

8. Are you aware of the performance of your investments, both inside & outside of your RRSP? ie. Annual Rate of Return achieved.

Yes No Don't Know

9. Have you determined your short and long-term investment strategies?

Yes No

10. If you have children, have you considered the cost or future education?

Yes No

11. Have you established an emergency fund or personal line of credit?

Yes No

12. Do you take advantage of all tax deductions/shelters available to you?

Yes No

13. Have you made the interest on your personal loans/mortgage tax deductible?

Yes No

14. Do you know your projected income tax before the year ends?

Yes No

15. Are you a member of a company pension plan?

Yes No

16. Are you aware of all the benefits/programs available to you through your company?

Yes No

17. Are you maintaining a retirement fund outside your company pension plan?

Yes No

18. Have you determined how much income you can expect on retirement?

Yes No

19. Have you determined what age you plan to retire?

Yes No

20. Do you know if your expected retirement income will meet your lifestyle needs?

Yes No

21. Do/will your parents require your financial support now/in the future?

Yes No

22. Do you feel in control of your financial future?

Yes No

23. Have you or your Spouse been named as an Executor or Executrix for someone?

Yes No Possibly

On a scale of 1 - 10, rank how confident you are that your financial plan is on track?

Know Your Advisor: IIROC Advisor Report