CONFIDENTIAL CLIENT PROFILE

COMPANY NAME	COMPLETED BY	DATE

BASIC INFORMATION

CLIENT A	PREFERRED CONTACT METHOD	BEST TIME TO CONTACT
OCCUPATION
ADDRESS
WORK PHONE	HOME PHONE	CELL PHONE
FAX	EMAIL ADDRESS

CLIENT B	PREFERRED CONTACT METHOD	BEST TIME TO CONTACT
OCCUPATION
ADDRESS
WORK PHONE	HOME PHONE	CELL PHONE
FAX	EMAIL ADDRESS

FAMILY INFORMATION

NAME	AGE	# OF CHILDREN	COMMENTS

ADVISORS

ROLE	NAME	FIRM NAME	PHONE
Attorney
Accountant

ASSETS

DESCRIPTIONS	A	JOINT	OTHER
Cash
Taxable Accounts
IRAs
Qualified Plans (401k, Pension)
Non-Qualified Plans (Deferred Compensation)
Primary Residence
Other Real Estate
Annuities
Business Interests
Marital Trusts
Personal Property (Autos, Jewelry, etc.)
Other (Beneficiary of GST Trust)
Other
TOTAL ASSETS	0	0	0

LIABILITIES

LOAN	TITLE (A/B/JT)	OUTSTANDING BALANCE	INTEREST	INSTITUTION
Mortgage
Home Equity
Personal Debt

LIFE INSURANCE

TYPE	ISSUER	INSURED (A/B/JT)	DEATH BENEFIT	CASH VALUE	BENEFICIARY
TOTAL INSURANCE	0	0

SUMMARY

A	B	JOINT	OTHER
Assets	0	0	0	0
Liabilities	0	0	0
Life Insurance	0	0	0
TOTAL NET WORTH	0	0	0	0

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