Embed Size (px)
Citation preview
Name (Last, First, MI)
Street address
City, state and zip code
Date of birth (mm/dd/yyyy)
Total annual earned income
The Envision® process
Description Ideal Acceptable
Client retirement age: _______________ ________________
Spouse/Partner retirement age: _______________ ________________
Retirement spending goal (after tax) $ ______________ $ _______________
Estate goal $ ______________ $ _______________
Annual savings $ ______________ $ _______________
Retirement goalsDescription Client Spouse/Partner
Estimate my benefit for me:
Currently collecting: $ ______________ $ _______________
Expect to collect: $ _____________ $ _______________
Do not include Social Security:
Please choose only one Social Security option per person
Social Security
Other goalsPlease indicate specific spending goals, in addition to your retirement spending goal, that you would like to include in this Envision investment plan. (i.e., weddings, education, travel)
Description Annual amount Net or Gross Whose age? Start age? End age? Annual increase (0%–14%)_______________________________ $ ______________ _______________ _______________ _______________ _______________ _____________ %
_______________________________ $ ______________ _______________ _______________ _______________ _______________ _____________ %
_______________________________ $ ______________ _______________ _______________ _______________ _______________ _____________ %
_______________________________ $ ______________ _______________ _______________ _______________ _______________ _____________ %
_______________________________ $ ______________ _______________ _______________ _______________ _______________ _____________ %
Other incomePlease list all other sources of income.
Description Annual amount Net or Gross Whose age? Start age? End age? Annual increase (0%–14%)_______________________________ $ ______________ _______________ _______________ _______________ _______________ _____________ %
_______________________________ $ ______________ _______________ _______________ _______________ _______________ _____________ %
_______________________________ $ ______________ _______________ _______________ _______________ _______________ _____________ %
_______________________________ $ ______________ _______________ _______________ _______________ _______________ _____________ %
_______________________________ $ ______________ _______________ _______________ _______________ _______________ _____________ %
Filing status: Single Married Partners/Other
Personal information
Spouse/Partner’s name (Last, First, MI)
Street address
City, state and zip code
Date of birth (mm/dd/yyyy)
Total annual earned income
Account summary and future savingsPlease list the total value and account details of each financial account in which you hold an interest.
Account name(Name of account holder)
Account number
Cost basis(Original pur-chase price) Current value
Annual contribution
Tax status Tax- Tax- Taxable deferred exempt
______________________ __________ $ _________ $ _________ $ _________
______________________ __________ $ _________ $ _________ $ _________
______________________ __________ $ _________ $ _________ $ _________
______________________ __________ $ _________ $ _________ $ _________
______________________ __________ $ _________ $ _________ $ _________
______________________ __________ $ _________ $ _________ $ _________
Insurance policiesPlease list all insurance policies. (i.e., life, long-term care)
Company Type Insured Owner BeneficiaryDeath benefit
Net cash value
Annual premium
____________ __________ __________ __________ __________ $ ________ $ ________ $ _______
____________ __________ __________ __________ __________ $ ________ $ ________ $ _______
____________ __________ __________ __________ __________ $ ________ $ ________ $ _______
____________ __________ __________ __________ __________ $ ________ $ ________ $ _______
____________ __________ __________ __________ __________ $ ________ $ ________ $ _______
____________ __________ __________ __________ __________ $ ________ $ ________ $ _______
Other assetsPlease list all additional assets. (i.e., home, business assets, rental property, automobiles)
Description Current value Owner Annual increase (0%–14%)
________________________________________ $ ___________ __________________________ ___________%________________________________________ $ ___________ __________________________ ___________%________________________________________ $ ___________ __________________________ ___________%________________________________________ $ ___________ __________________________ ___________%
Other liabilitiesPlease indicate debts, mortgages, loans, etc.
Description Liability type (Mortgage, loan, other)
Current amount
Owner Monthly payment
Interest rate
__________________________ _________________ $ ______ _________________ $ ______ ______ %__________________________ _________________ $ ______ _________________ $ ______ ______ %__________________________ _________________ $ ______ _________________ $ ______ ______ %__________________________ _________________ $ ______ _________________ $ ______ ______ %
Notes
Investment and Insurance Products: u NOT FDIC Insured u NO Bank Guarantee u MAY Lose Value Wells Fargo Advisors is the trade name used by two separate registered broker-dealers and non bank affiliates of Wells Fargo & Company providing certain retail securities brokerage services: Wells Fargo Advisors, LLC and Wells Fargo Advisors Financial Network, LLC, Members SIPC. ©2012, 2013 Wells Fargo Advisors, LLC. All rights reserved. 1013-02939 [84906-v3]
Envision® is a registered service mark of Wells Fargo & Company and used under license.
