Confidential Client Profile Questionnaire - Advantage Retirement Group

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Refer a Friend

We recognize that a referral is the highest honor you can give us, and we thank you for your confidence in us. You can make a virtual introduction by filling out the form below. We will not contact your referral directly. We will wait for them to contact us.

"*" indicates required fields

Your Name*

First Last

Email Address*

Name of Your Referral*

First Last

Want to refer someone else?

Yes

No

Referral Name*

First Last

Email

This field is for validation purposes and should be left unchanged.

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Confidential Client Profile Questionnaire

Confidential Client Profile Questionnaire

Step 1 of 9

11%

Marital Status
- Single
- Married
- Divorced
- Widowed
Name*
First Middle Last
Date of Birth
MM slash DD slash YYYY
Home Phone
Cell Phone
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Spouse’s Name
First Middle Last
Spouse’s Date of Birth
MM slash DD slash YYYY
Spouse’s Home Phone
Spouse’s Cell Phone
Spouse’s Email
Spouse’s Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Professional Contact Information
Accountant Name
First Last
Accountant Email
Accountant Phone
Estate Planning Attorney Name
First Last
Estate Planning Attorney Email
Estate Planning Attorney Phone
Other Information
Do you have Long Term Care Insurance?
- Yes
- No
Insurer
Do you own Life Insurance?
- Yes
- No
Insurer
Do you own Health Insurance?
- Yes
- No
Insurer
Do you own Disability Insurance?
- Yes
- No
Insurer
Do you have a Will?
- Yes
- No
Last updated
Do you have a Trust?
- Yes
- No
Last updated

Beneficiary Information
Name
First Last
Relationship
Date of Birth
MM slash DD slash YYYY
Name
First Last
Relationship
Date of Birth
MM slash DD slash YYYY
Name
First Last
Relationship
Date of Birth
MM slash DD slash YYYY
Name
First Last
Relationship
Date of Birth
MM slash DD slash YYYY

Retirement Goals
Check all that apply
- Income
- Income + Growth
- Growth
- Aggressive Growth
Additional comments
Advisor(s)
Do you manage your own investments?
- Yes
- No
How would you rate your current advisor? 1 (lowest) to 10
What is your annual investment advisor fee?
How often do you have a review of your plan?
What do you want from your advisor?
Concerns or Fears
Check all that apply
- Inflation
- Pandemic
- Running Out of Money
Additional comments

Income
Employer
Spouse Employer
Spouse Current Gross Annual Salary
Current Gross Annual Salary
Projected Retirement Date
MM slash DD slash YYYY
Spouse Projected Retirement Date
MM slash DD slash YYYY
Social Security Benefits
Spouse Social Security Benefits
Pension
Spouse Pension
Survivor Pension
Spouse Survivor Pension
Real Estate
Spouse Real Estate
Investment Income
Spouse Investment Income

Annuities
1. Owner
1. Company
1. IRA/Non-IRA
1. Payout?
1. Account Value
2. Owner
2. Company
2. IRA/Non-IRA
2. Payout?
2. Account Value
3. Owner
3. Company
3. IRA/Non-IRA
3. Payout?
3. Account Value
Other
Gold, Silver, Cash, Coins, etc...

Real Estate
1. Owner
1. Company
1. Description
1. Value
2. Owner
2. Company
2. Description
2. Value
3. Owner
3. Company
3. Description
3. Value

Values
Below is a sample of values often expressed. This list is intended to inspire you, not limit your self expression:
Freedom, Energy, Generosity, Faith, Happiness, Honor, Security, Respect, Joy, Adventure, Independence, Comfort, Peace of Mind, Love, Recognition, Fulfillment, Creativity, Abundance, Dignity, Beauty
My top 3 value words
Spouse top 3 value words

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Phone: (239) 747-0552
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Naples, Florida

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