L I V E T H E L I F E T H AT YO U I M A G I N E

ENVISION
®
 PERSONAL INFORMATION

Name Name

Address Address

State of Primary Residency State of Primary Residency

Date of Birth (mm/dd/yyyy) Date of Birth (mm/dd/yyyy)

Email Address Email Address

Occupation Occupation

Total Annual Earned Income Total Annual Earned Income

Tax Filing Status: ☐Single  ☐Married Filing Jointly  ☐Partner/Other Tax Filing Status: ☐Single  ☐Married Filing Jointly  ☐Partner/Other

Attorney CPA

Primary Bank

Children/Grandchildren
Name Relationship Age or Date of Birth Address

Additional Information:

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LIFE GOALS
Please help us understand your goals and what you would ideally like to achieve.

1. I would like to plan for retirement at age _____ (acceptable), but I would be willing to take action, such as saving more or reducing my retirement
spending goal, if it would mean I could retire at age _____ (ideal).
If already retired, check here and skip to question 3: ☐
2. My spouse/partner will retire at the same time I do: ☐Yes  ☐No
If no, my spouse/partner would like to target retirement at age _____ (acceptable), but if he or she could retire at age _____(ideal), we would
like our plans to include that possibility.

3. We would like you to estimate our retirement spending needs as indicated below (check one) with an inflation rate of ________% (default = 3%)
☐ We would like to plan for after-tax, annual retirement spending of $________ (acceptable), but if we could increase our spending to $________
(ideal) a year, we would like to consider that possibility.
☐ We would like you to estimate retirement spending based on current after-tax income and what is normally needed to maintain our lifestyle.
Note: Generally, the bulk of your retirement spending should begin with the retirement of the primary earner. How do you plan to begin?
• When you retire, you plan on spending ________% of your annual retirement spending need
• When your spouse retires, you plan on spending ________% of your annual retirement spending need

4. We would like to leave an estate worth at least $________ (acceptable), but if we could increase that to $________ (ideal) with minimal impact
on our other goals, we would like to consider that possibility. (Please use present value dollars and account for ________% inflation (default = 3%).

EDUCATION GOALS
Please complete the following information for whom you wish to fund education goals. We will assume public, in-state college expenses unless you
indicate that you would like to target a private college or specific institution.

Name Name

Date of Birth Start Age Years in School Date of Birth Start Age Years in School

School Name ☐ Public  ☐ Private School Name ☐ Public  ☐ Private

Total Annual Cost Total Annual Cost

☐ Fund at least _____ % (acceptable), but if possible would like to ☐ Fund at least _____ % (acceptable), but if possible would like to fund
fund as much as _____ % (ideal). as much as _____ % (ideal).

Name Name

Date of Birth Start Age Years in School Date of Birth Start Age Years in School

School Name ☐ Public  ☐ Private School Name ☐ Public  ☐ Private

Total Annual Cost Total Annual Cost

☐ Fund at least _____ % (acceptable), but if possible would like to ☐ Fund at least _____ % (acceptable), but if possible would like to fund
fund as much as _____ % (ideal). as much as _____ % (ideal).
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 OTHER GOALS
Please indicate specific spending goals*, in addition to your retirement spending goal, that you would like to include in your plan (e.g. weddings,
vacation homes, charitable or intrafamily giving, travel, etc.). Note: All “Other Goals” reached prior to retirement are assumed to have been funded by
your investment portfolio.

DESCRIPTION IDEAL ACCEPTABLE

(Travel, New Car, Boat, Annual Whose Start End Annual Annual Whose Start End Annual
Net/Gross Net/Gross
Vacation Home, etc.) Amount Age Age Age Increase Amount Age Age Age Increase

$ ☐/☐ % $ ☐/☐ %

$ ☐/☐ % $ ☐/☐ %

$ ☐/☐ % $ ☐/☐ %

$ ☐/☐ % $ ☐/☐ %

$ ☐/☐ % $ ☐/☐ %

*Do not include basic retirement income goals, estate, or education goals. If you do not enter an annual increase, the goal will grow at the assumed rate of inflation.

SURVIVOR NEEDS
If you will need to replace income in the event that you or your spouse/partner passes, please provide additional information; otherwise, skip this
section and continue to Estate Planning Needs.

Decedent Net-Annual Post-Retirement

Include Decedent Income Replacement Years of Need Spending Final Expenses

☐ $ $ $

☐ $ $ $

Insurance Policies
Company/ Death Annual Cash Loan Expiration
Policy Number Type Owner Insured Beneficiary Benefit Premium Value Value Date

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

$ $ $ $

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SURVIVOR NEEDS continued

Other Insurance
You Spouse/Partner Group-Owned

Do you have a disability policy? ☐Yes  ☐No ☐Yes  ☐No ☐Yes  ☐No
Do you have a long-term care policy? ☐Yes  ☐No ☐Yes  ☐No ☐Yes  ☐No

Concerning health insurance, are you and/or any of your family members covered by a group-owned policy that will need to be replaced at retirement? If
so, please indicate names, relationships, ages, and any special considerations.

Policy Notes:

ESTATE PLANNING NEEDS

You Spouse/Partner

Do you have a will? Revision date ___________ ☐Yes  ☐No ☐Yes  ☐No
Are there any amendments to the will? ☐Yes  ☐No ☐Yes  ☐No
Have you created a trust that is not part of your will? ☐Yes  ☐No ☐Yes  ☐No
Have you appointed an institution as your trustee? ☐Yes  ☐No ☐Yes  ☐No
Do you have a durable power of attorney? ☐Yes  ☐No ☐Yes  ☐No
Do you have a living will? ☐Yes  ☐No ☐Yes  ☐No
Do you have a health care directive? ☐Yes  ☐No ☐Yes  ☐No
Do you anticipate receiving an inheritance? ☐Yes  ☐No ☐Yes  ☐No
Do you have charitable provisions in your estate plan? ☐Yes  ☐No ☐Yes  ☐No

Additional Notes:

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 INCOME NEEDS
Please tell us which best describes your attitude toward income from the investment portfolio profiled in this report: (check one)

☐  Not expecting to need income from the portfolio for several years; investment strategy should emphasize growth.

☐  Interested in current income from the portfolio, but willing to accept a lower level of current income to have potential for
long-term growth.

☐  Primary investment goal is income; willing to accept less potential for long-term growth in order to seek more current income.

Please describe your attitude toward Social Security: (check one)

☐  I / We are not eligible for Social Security. Please explain: __________________________________________________________

☐  If possible, we would prefer not to be dependent on Social Security.

☐  We would like to include estimated Social Security benefits in our investment plan.

☐  I am currently collecting $________ in Social Security benefits yearly. My spouse/partner is receiving $________.

☐  I expect to receive $________ in Social Security benefits yearly. My spouse/partner will receive $________ when eligible.

PRIORITIES
For each goal below, please check ALL of the actions you would be willing to take, if necessary, to enhance your probability of achieving your basic
goals. You may check more than one box in each row. You can also rank goals in order of importance, with number one being the most important.

Reduce
Retirement Reduce Take More
Goal Retire Later Spending Estate Size Risk Save More Rank (#)

To achieve our early retirement age(s), we would be willing to: ☐ ☐ ☐ ☐ ☐ _____

To achieve our higher target spending ability for

retirement, we would prefer to: ☐ ☐ ☐ ☐ ☐ _____

To achieve our ideal estate goal, we would be willing to: ☐ ☐ ☐ ☐ ☐ _____

To reduce investment risk in our portfolio, we would be

willing to: ☐ ☐ ☐ ☐ ☐ _____

We would like to reduce our regular savings amount; to achieve

this, we would prefer to: ☐ ☐ ☐ ☐ ☐ _____

To meet our education funding goals, we would be

willing to: ☐ ☐ ☐ ☐ ☐ _____

To meet our other goals, we would be willing to: ☐ ☐ ☐ ☐ ☐ _____

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RISK TOLERANCE AND AVOIDANCE
We assume you would prefer to avoid risk if possible. However, it may be necessary to accept your maximum risk tolerance to meet critical financial
goals. Based on the table below, please identify both your ideal and acceptable strategic allocation based on risk. For a more detailed description of
these options, please see page 10.

Ideal Portfolio Acceptable Portfolio Strategic Allocation

☐ ☐ Aggressive Growth

☐ ☐ Moderate Growth

☐ ☐ Aggressive Growth and Income

☐ ☐ Conservative Growth

☐ ☐ Moderate Growth and Income

☐ ☐ Aggressive Income

☐ ☐ Conservative Growth and Income

☐ ☐ Moderate Income

☐ ☐ Conservative Income

ACCOUNT SUMMARY
Please list the total value of each investment account in which you hold an interest, including IRAs, 401(k)s, CDs, etc. If you have copies of all account
statements available, please enclose those and skip this section.

ACCOUNT NAME NAME OF FIRM ACCOUNT NUMBER CURRENT VALUE TAX STATUS
Name of Account Holder Taxable | Deferred | Exempt | Education

$ ☐    ☐    ☐    ☐
$ ☐    ☐    ☐    ☐
$ ☐    ☐    ☐    ☐
$ ☐    ☐    ☐    ☐
$ ☐    ☐    ☐    ☐
$ ☐    ☐    ☐    ☐
$ ☐    ☐    ☐    ☐
$ ☐    ☐    ☐    ☐
$ ☐    ☐    ☐    ☐
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 ASSETS AND LIABILITIES
Personal Property (homes, rental properties, collectibles, etc.)
Include in Annual Appreciation/
Final Estate Description Owner Type Market Value Depreciation

☐ $ %

☐ $ %

☐ $ %

☐ $ %

Closely-Held Businesses
Include in Ownership Value of Annual Appreciation/
Final Estate Description Owner Type Ownership Business Value Interest Depreciation

☐ % $ $ %

☐ % $ $ %

Liabilities (mortgages and other debt)

Include in Estimated Monthly
Final Estate Borrower Type Lender Interest Rate Balance Payment Payoff Date

☐ % $ $ /   /

☐ % $ $ /   /

☐ % $ $ /   /

☐ % $ $ /   /

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ANNUAL CONTRIBUTIONS/SAVINGS
Please include contributions to your retirement plan(s), as well as any additional money being saved in your investment accounts. Remember to
include any employer matching contributions.

TAX STATUS CURRENT IDEAL ACCEPTABLE

Annual Annual Annual Start End Annual Annual Start End Annual
Owner Description Taxable | Deferred | Exempt | Education
Amount Increase Amount Age Age Increase Amount Age Age Increase

☐ ☐ ☐ ☐ $ % $ % $ %

☐ ☐ ☐ ☐ $ % $ % $ %

☐ ☐ ☐ ☐ $ % $ % $ %

☐ ☐ ☐ ☐ $ % $ % $ %

☐ ☐ ☐ ☐ $ % $ % $ %

☐ ☐ ☐ ☐ $ % $ % $ %

If you do not enter an annual increase, the savings stream will grow at the assumed rate of inflation.

OTHER SOURCES OF INCOME

How would you like to treat pre-retirement income sources? ☐Spending  ☐Savings
Note: Your selection for the treatment of pre-retirement income sources will apply to ALL income sources in your investment plan.
• Savings: All pre-retirement income sources are treated as savings into the investment portfolio. (Do not re-enter these in the Savings section.)
• Spending: All pre-retirement income sources are treated as income spent on normal living expenses and will not be added to the investment portfolio.

DESCRIPTION IDEAL ACCEPTABLE

Pension Plan, Annuity, Trust, Annual Whose Start End Annual Annual Whose Start End Annual
Net/Gross Net/Gross
Rental Income, etc. Amount Age Age Age Increase Amount Age Age Age Increase

$ ☐/☐ % $ ☐/☐ %

$ ☐/☐ % $ ☐/☐ %

$ ☐/☐ % $ ☐/☐ %

$ ☐/☐ % $ ☐/☐ %

$ ☐/☐ % $ ☐/☐ %

$ ☐/☐ % $ ☐/☐ %

Do not include income from stocks, bonds, mutual funds, or other investment accounts. If you do not enter an annual increase, the income stream will grow at the assumed inflation rate.

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 NOTES

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STRATEGIC ALLOCATION
Conservative Income
Income investors seek maximum income given their risk tolerance and are willing to forgo capital appreciation and growth of income. Conservative
Income investors seek maximum income consistent with a modest degree of risk. They are willing to accept a lower level of income in exchange for
lower risk. Higher-risk investments, such as high-yield bonds and some equities, are typically not a large percentage of their accounts.

Conservative Growth and Income

Growth and Income investors seek current income but also look for income and capital growth over time. These investors are willing to forgo a portion
of current income to seek potential future growth. Conservative Growth and Income investors seek the maximum growth and income consistent with
a relatively modest degree of risk. They are willing to accept lower potential returns in exchange for lower risk. Equities, particularly dividend-paying
equities, may make up some percentage of the account.

Conservative Growth
Growth investors do not seek account income, and their primary objective is capital appreciation. Conservative Growth investors seek maximum
growth consistent with a relatively modest degree of risk. They are willing to accept lower potential returns in exchange for lower risk. Equities may
make up a significant percentage of the account.

Moderate Income
Income investors seek maximum income given their risk tolerance and are willing to forgo capital appreciation and growth of income. Moderate Income
investors seek to balance the potential risk of capital loss with increased income potential. Higher-risk investments, such as high-yield bonds and some
equities, may make up a percentage of the account.

Moderate Growth and Income

Growth and Income investors seek current income but also look for income and capital growth over time. These investors are willing to forgo a portion of
current income in order to seek potential future growth. Moderate Growth and Income investors seek to balance the risk of capital loss with higher-potential
growth and income. High-yield bonds and equities, particularly dividend-paying equities, may be a significant percentage of the account.

Moderate Growth
Growth investors do not seek account income, and their primary objective is capital appreciation. Moderate Growth investors seek to balance potential
risk of capital loss with their goal of higher potential growth. Equities may be the primary assets in the account.

Aggressive Income
Income investors seek maximum income given their risk tolerance and are willing to forgo capital appreciation and growth of income. Aggressive Income
investors seek a significant level of income, are financially able and willing to risk losing a substantial portion of investment capital, and, due to their
long-term time horizon or other factors, employ higher-risk, aggressive strategies that may offer greater potential income. Higher-risk investments, such as
high-yield bonds and some equities, may make up a significant percentage of the account.

Aggressive Growth and Income

Growth and Income investors seek current income but also look for income and capital growth over time. These investors are willing to forgo a portion
of current income in order to seek potential future growth. Aggressive Growth and Income investors seek a significant level of growth and income, are
financially able and willing to risk losing a substantial portion of investment capital, and, due to their long-term horizon or other factors, pursue high-risk,
aggressive strategies that may offer higher potential returns. High-yield bonds and equities, particularly dividend-paying equities, may be the primary
assets in the account.

Aggressive Growth
Growth investors do not seek account income, and their primary objective is capital appreciation. Aggressive Growth investors seek a significant level
of growth, are financially able and willing to risk losing a substantial portion of investment capital, and, due to their long-term horizon or other factors,
employ higher-risk, aggressive strategies that may offer greater potential returns. Higher-risk investments, such as equities, may make up as much as
100% of the account.

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