FNA

Financial Needs Analysis

Name

DOB

Age

Occupation

How Long?

Spouse Name

DOB

Age

Occupation

How Long?

Home Address

401K

Monthly Contribution

Match

Spouse 401K

Spouse Monthly Contribution

Spouse Match

Mutual Fund

Bank Savings

Annuity

Rent or Own

Interest Rate

Monthly Car Payments

Total Owed on Credit Cards

Total Payment on Credit Cards

Life Insurance: Face Amount

Monthly Premiums

Cash Value

Health Issues – Last 5 Years

Spouse Health Issues – Last 5 Years

Do you use tobacco?

Type of tobacco

Does Spouse use tobacco?

Spouse type of tobacco

How many months would your assets last if you were to suffer a critical illness or disability tomorrow?

Are you expecting a windfall or inheritance

Are you expecting a Tax refund

Are you a W-2 employee?

Exemptions claimed on your W-4

Are you paying extra on your mortgage each month?

How Much?

Do you have an existing IRA?

Contribution?

Balance?

Do you have Auto Insurance?

Auto insurance Payments

Auto Deductible

Do you have Home owners insurance?

Home insurance payment?

Home owners deductible?

Do you have health insurance?

Health insurance payment?

Do you have long term insurance

Long term insurance payment?

Cell phone monthly payment?

Monthly Subscriptions?

How much do you spend each month on Starbuck, movies, premium cable, eating out, etc?

Do you have a Financial Planner

Monthly Amount needed to comfortably retire?

How much can you comfortably afford to save toward reaching your Dreams & goals?

Other amount