Midwest Professional Planners

Free Consultation

A Free Consultation is designed to determine if a potential client is in need of financial planning or investment advisory services provided by MPPL or its business partners. Basic information about the client is collected, and reviewed by a financial planner in an effort to recommend a suitable starting point and provide a cost estimate.

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Personal Information

Name:

Address:

City:

State:

Zip:

Work Phone:

Home Phone:

Occupation:

Business Address:

Date of Birth:

Marital Status:

Spouse Name:

Date of Birth:

Spouse's Occupation:

Business Phone:

Number of Children:

Children's Age(s):

Retirement Strategies

Check the appropriate box
How concerned are you about:	High	Low
Knowing how much income, in today's dollars, you will need upon retirement?
Knowing how much income your current plan will provide upon retirement?
Having a systematic program for saving and investments?
Accumulating retirement funds without paying taxes on the growth?
Avoiding taxation on a portion of your retirement income?
Maintaining the buying power of your savings and investments?
	Yes	No
Does your company provide a retirement plan?
Does your spouse's company provide a retirement plan?
Are you satisfied with the amount of your current savings and investments?
Are you satisfied with your asset diversification?
Have you confirmed your Social Security earnings and benefits in the last 12 months?
At what age would you like to retire?
At what age would your spouse like to retire?
In current dollars, what amount will you need monthly?
In current dollars, what amount will your spouse need monthly:

Investment Strategies

Check the appropriate box
Are you saving for your children's college?		Yes No
Do you check on the balances in your savings and retirement account?
frequently rarely
What is your impression of the stock market? (Check all that apply)
	a pretty easy way to make money		a total mystery
	something I understand more than most		something I understand less than most
	a tedious place to make money		an exciting game
	money is made by luck		a dangerous game
	there are clear rules to follow		there are no patterns for investing
	money is made through knowledge and understanding		its manipulated by people on the inside

Investing in the stock market is most similar to: (one answer please)
	investing in real estate		playing a game of chance
	building up a savings account		playing a game of skill

Stocks are something which:
	you buy to sell when you have a profit		must be watched closely
	you hold for years while they grow in value		should be checked occasionally
	should be accumulated and added to over time.

My impressions regarding investing come from:
	opinions of friends and relatives		reading/TV
	professional advice I've sought out in the past		personal experience


	Yes	No
Do you invest with a full service, full commission broker?
Do you invest with a discount broker?
Do you invest with a bank broker?
Do you invest via the Internet?
Are you satisfied with the results of your investing thus far?

Income Protection Strategies

Check the appropriate box
How concerned are you about:	High	Low
Paying off the mortgage and other debts in the event of death or disability?
Providing adequate income for your family in the event of death or disability?
Providing long-term care for yourself, your spouse or your parents?

Check the appropriate box	Yes	No
Does your company provide group term life insurance?
Does your company provide survivor's benefits for you spouse?
Does your company provide a disability income program?
Would you like to review your current insurance coverage?

Wealth Preservation Strategies

How concerned are you about:	High	Low
Having an up-to-date will?
Reducing estate taxes you heirs may have to pay?
Providing for the efficient transfer of assets to your heirs?
Managing an inheritance or potential inheritance?

Check the appropriate box	Yes	No
Would you consider starting a gifting program to reduce the size of your estate?
Would you consider making charitable gifts to reduce the size of your estate?

Other Strategies

	Yes	No
Do you have written financial goals?
Have you implemented a plan for achieving your goals?
Do you have a current inventory of your major assets?
Do you have a current copy of your company's benefit program?
Would you like a review of existing financial arrangements?
Is it important for you to have access to a team of financial professionals?
Would you like a comprehensive financial analysis?
If not, is there one or several areas that you would like to focus on?

Anticipated Changes

Check all that are likely to occur in the next 12 months
Marriage		Make an investment
Have a child		inheritance
Graduation		Buy or sell a home
Divorce		Job change or promotion
Dependent Parent		Bonus or salary increase
Obtain a Loan		Buy a business or practice
Pay off a loan		Sell a business or practice
Increase savings		Retirement

Financial Overview

Household Income
Under $50,000		$100,000 - $200,000
$50,000 - $75,000		$200,000 - $ 500,000
$75,000 - $100,000		$500,000 or more

Types of assets or insurance
Home		Annuities
Second home		Whole/Variable life insurance
Other real estate		Business/Practice
Savings accounts/CDs		IRA
Money market accounts		Other retirement plans
Stocks/Bonds		Other
Mutual Funds

Total Assets		Total Liabilities
Under $100,000		Under $50,000
$100,000 - $200,000		$50,000 - $100,000
$200,000 - $300,000		$100,000 - $150,000
$300,000 - $500,000		$150,000 - $250,000
$500,000 - $1,000,000		$250,000 - $500,000
Over $1,000,000		Over $500,000

How Much of a Financial Risk Taker Are You?

Low						High
1	2	3	4	5	6	7