Date:

Name Person 1:*

First

Last

Date of Birth Person 1:*

Phone Person 1:*

Area Code

Phone Number

E-mail Person 1:*

Profession Person 1:*

Employer Person 1:*

Name Person 2:

First

Last

Date of Birth Person 2:

Phone Person 2:

Area Code

Phone Number

E-mail Person 2:

Employer Person 2:

Profession Person 2:

Address:

Street Address Street Address Line 2 City State / Province / Region Postal / Zip Code

1/5

INCOME

**Please use whole numerical values only, not symbols, commas or decimals.

Salary/Wage Income (Before Taxes):*

Social Security/Pension Income (Before Taxes):*

Annual Savings/Retirement Plan Contributions:*

ASSETS

**Please use whole numerical values only, not symbols, commas or decimals.

Annuities:

Savings, Money Market, CDs

College Savings (529/Coverdell Plans)

Taxable Investments (Stocks, Bonds, Options, REITS, Mutual Funds

Employer Pensions Plans (Defined Benefit, MPPP, Profit Sharing)

Investment Real Estate (Office Buildings, Rental Properties)

IRAs, Roth IRAs, SEPs

401K, 403b, 457, TSP, Simple

Personal Property:

Closely Held Business Interests(Partnerships, Corporations, Limited Partnerships)

Home

Second, Vacation Homes

Total Assets:

LIABILITIES

**Please use whole numerical values only, not symbols, commas or decimals.

Home Mortgage (First, Seconds, HELOCs)

Consumer Loans (Credit Cards, Student Loans, Car Loans, Etc.)

Investment Real Estate or Business Loans

Total Liabilities:

NET WORTH

Total Net Worth (Assets less Liabilities)

3/5

Please prioritize the financial assistance you are seeking (1-Top Priority, 2-Second....6-lowest):

Asset & Income Protection

Investment Strategy Planning

Retirement Planning

Financial Coaching/Counseling

Cash Flow Management (i.e. Spending Plan, Budgeting)

Estate Planning

Total: 0/21

Tell us about your most important financial concerns and what you would like to accomplish through this engagement.

Tell us about your most important non-financial concerns right now?

Describe how you envision your lifestyle 5 years from now. (What are you doing or becoming, where, how, etc)

Describe previous experiences working with financial advisors. What was good/unsatisfactory?

Tell us how you make important investment decisions?

4/5

Tell us about future financial changes that you wish to plan for. (i.e.Family obligations /inheritances...)

During our review 3 years from now, what will need to have happened for you to be satisfied with your progress?

Tell us about past Litigation involvements. What happened?

Describe your ideal relationship with a financial planner.

Is there anything else we need to talk about? Any "special needs" situations you are responsible for?

Where did you hear about us?

5/5

Social

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Initial Interview Form

KFG Initial Interview Form

INCOME

ASSETS

LIABILITIES

NET WORTH