FLS INTAKE

Financial Lifestyle Strategy Assessment

Complete this comprehensive assessment to help us understand your financial goals and create a personalized strategy for your wealth journey.

Client Information

Full Name *

Email Address *

Phone Number *

Date of Birth *

Home Address

Spouse Full Name

Spouse Date of Birth

Anniversary Date

PHP Associate / Agent Name

Dependent Children

Financial Goals

Rate each goal from 1 (Least important) to 10 (Most important)

Make a major purchase (car, boat, vacation)

Build savings for unexpected expenses

Help support aging parents

Finance college for children

Pay off credit cards

Buy a new home

Build retirement wealth

Alternate income in case of disability/death

Other goals (describe)

Income Information

Current Annual Income (Household)

Monthly Income (Take-home)

Other Income (rental, bonuses, commissions, etc.)

Emergency Fund

Emergency Fund Balance

Monthly Contribution to Emergency Fund

Current Savings Types

Monthly Expense Breakdown

Mortgage / Rent

Food

Tithe / Charity

Gifts / Holidays

Memberships / Subscriptions

Entertainment

Phone / Cell Phone

Cable / Internet

Utilities (Gas, Electric, Water)

Auto Gas & Maintenance

Auto Insurance

Property Insurance / Taxes

Discretionary Income (other spending)

Debt Management

List your outstanding debts (credit cards, loans, etc.)

Retirement & Investments

Do you expect Social Security income?

Do you have a pension?

Education Funds

Life Insurance Details

Annuities

Top 3 Financial Priorities

Priority #1

Priority #2

Priority #3

Retirement Planning

Do you feel you are saving enough for retirement?

Ideal Retirement Age

Desired Monthly Retirement Income (in today's dollars)

Comfortable Monthly Saving Amount (Minimum)

Comfortable Monthly Saving Amount (Maximum)

Tax Information

Federal Tax Refund Last Year

State Tax Refund Last Year

Number of Exemptions

Next Appointment

Preferred Date

Preferred Time