Financial Review Summary

The following information is requested to determine your suitability for various insurance and investment products.

Client Info

Client Name*

Client Email*

D.O.B.*

Contact Phone Number*

Spouse Name*

D.O.B.*

Contact Phone Number*

Home Address*

City*

State*

Zip Code*

Child Name*

D.O.B.*

Child Name*

D.O.B.*

Child Name*

D.O.B.*

Child Name*

D.O.B.*

Child Name*

D.O.B.*

Questionaire

1. How did you hear about us and what do you know about our company?*

2. What are you currently doing in preparation for your financial future?*

3. What do you like most about what you are doing?*

4. What don’t you like about your current financial position?*

5. What would you like to see enhanced or improved?*

6. What has been your past experience with preparing for your financial future?*

7. What would you “ideally” like to accomplish with your financial strategy?*

8. Tell me about your decision making process.*

9. What keeps you up at night?*

10. Complete this sentence: “When it comes to my money and financial situation, the only thing I REALLY care about is _____________.”*

Employment

Client Employer*

Occupation*

Spouse Employer*

Occupation*

Current Income

Client Annual Salary*

Spouse Annual Salary*

Client Bonus*

Spouse Bonus*

Client Other Income*

Spouse Other Income*

Retirement Goal Age:*

Retirement Income*

Life Insurance

Does Client have life insurance?*

Insurance Company Name*

Type*

Premium*

Term*

Any health Conditions? (i.e. high blood pressure, diabetes, heart problems)*

Does Spouse have life insurance?*

Insurance Company Name*

Type*

Premium*

Term*

Any health Conditions? (i.e. high blood pressure, diabetes, heart problems)*

Current Assets

Mutual Funds: Company name*

Balance*

Monthly Contribution*

Stocks: Company name*

Balance*

Monthly Contribution*

Bank Checking: Company name*

Balance*

Monthly Contribution*

Bank Savings: Company name*

Balance*

Monthly Contribution*

Bonds/Treasures: Company name*

Balance*

Monthly Contribution*

Tax Deferred 401K: Company name*

Balance*

Monthly Contribution*

IRA/ SEP IRA: Company name*

Balance*

Monthly Contribution*

Annuities: Company name*

Balance*

Monthly Contribution*

Savings Bonds: Company name*

Balance*

Monthly Contribution*

Tax Exempt Roth IRA: Company name*

Balance*

Monthly Contribution*

IUL/VUL: Company name*

Balance*

Monthly Contribution*

Check all that are important to you and your money*

Liquidity

Taxation

Safety

Transferability

Any questions you have:

I hereby authorize Elite 8 Tax & Financial Service to use and disclose information provided herein to its affiliates, agents, third parties and any assigns for the purpose of providing me with various financial information for consideration pursuant to the purchase of such products aligned with my financial goals.