Confidential Client Questionnaire

1. Contact Information

Client

Spouse

2. Employment Income

Client

Spouse

3. Other Income

Client

Spouse

4. Retirement Income Needs

Client

Spouse

5. Goals and Objectives

Please summarize the other goals and objectives that you have f or your family. You may want to include things that you would like to accomplish before you retire, during your retirement and on the distribution of your estate.

6. Working in Retirement

Client

Spouse

7. Pension Income

Client

Spouse

8. Canadian Pension Plan

Client

Spouse

9. Old Age Security

10. Other Retirement Income

Client

Spouse

Retirement Investments (RRSP, RRIF, Locked-In Plans ...)

Client

Spouse

12. Cash Investments and TFSA (all investments not included in retirement investments)

Cash investments include any other investment accounts outside of RRSP’s and Pensions. This can include Savings Accounts, Cash Investments and Tax Free Savings Accounts (TFSA).

Do you currently have any Cash Investments and/or TFSA amounts?

• Yes
• No

If so, please enter the total value of all of your savings and cash investments (including any amounts in a TFSA) and any amounts you plan to save in the future.

Client

Total Value $

Savings $

• Indexed

Frequency

• Monthly
• Annual

Cost Base $

Spouse

Total Value $

Savings $

• Indexed

Frequency

• Monthly
• Annual

Cost Base $

Joint Accounts

Total Value $

Savings $

• Indexed

Frequency

• Monthly
• Annual

Cost Base $

13. Real Estate Holdings

For many people, their home represents the largest investment that they will ever make. In addition to your home, you may also own other real estate for investment or personal use, such as a cottage or another recreational property that will provide additional security in retirement.

Please enter the value of all your personal real estate holdings and any associated mortgage balance.

Principal Residence

Current Value $

Mortgage Balance $

Interest Rate %

Monthly Pmt. $

Recreational Property

Current Value $

Cost Base $

Mortgage Balance $

Interest Rate %

Monthly Pmt. $

Investment / Rental Property

Current Value $

Cost Base $

Mortgage Balance $

Interest Rate %

Monthly Pmt. $

14. Inheritance

Client

Spouse

15. Other Assets

16. Additional Notes

17. Additional Questions

18. Corporate Investments and Securities

19. Corporate Real Estate

20. Business Operations and Good Will

21. Share Value

22. Additional Notes