Estate Planning Fact Finder If you have any questions, please feel free to call BSMG Life Wholesaler at 1-800-343-7772. Agent:
Date:
BSMG Wholesaler: Client Information: First Name:
Middle Int:
Date of Birth:
Gender:
Spouse Name:
Last Name: Male
Middle Int:
Date of Birth:
Gender:
Female
U.S. Citizen:
Yes
No
U.S. Citizen:
Yes
No
Last Name: Male
Female
Resident Address: City:
State:
Home Phone:
Zip Code:
Business Phone:
Name of Children:
Age:
# of grandchildren:
Age:
# of grandchildren:
Age:
# of grandchildren:
Age:
# of grandchildren:
Estate Assets: Business Ownership: Legal Name(s):
Type¹:
Total Fair Market Value:
Client Ownership (%) and Value:
Title to Assets²:
Cost Basis:
1. 2. 3. Real Estate:
Purchase Price:
Fair Market Value:
Mortgages:
Title to Assets²:
Primary Residence: Second Residence: Commercial Property: Land: Other Real Estate: ¹ Business Type C=
C-Corp
CP=
Community Property
S=
S-Corp
TC=
Tenant in Common
P=
Proprietor
JT=
Joint with Spouse
Partnership
C=
Client
LLC=
Ltd. Liability Co
S=
Spouse
PSC=
Personal Service Corp
JO=
Joint with Others
FLP=
Family Ltd. Partnership
RT=
Revocable Trust (C) (S)
PT=
BSMG | 11/2013
² Title to Assets
continued on next page
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Estate Planning Fact Finder ...continued Estate Assets...continued Other:
Asset Value:
Title to Assets²:
Miscellaneous Personal: (Jewelry, Autos, Boats, Collectibles) Other Non-Liquid: (Limited Partnership, Notes Receivable, Deferred Compensation, etc.) Liquid Assets:
Current Value:
Title to Assets²:
Cash Equivalents (Savings, Money Markets, CDs) Securities and Mutual Funds (Stocks) (Bonds) (Tax Exempt Bonds) Deferred Annuities (Non-Qualified) Qualified Retirement Plans:
Account Value(s):
Participant Owner:
Plan Beneficiary:
Defined Benefit: Profit Sharing: 401(k): 457(b): TSA [403(b)]: SEP: IRA: Roth IRA: Life Insurance:
Policy 1:
Policy 2:
Policy 3:
Policy 4:
Policy 5:
Policy 6:
Death Benefit Gross Cash Value Total Loans Cost Basis Issuing Company Insured Owner Beneficiary Annual Premium BSMG | 11/2013
continued on next page
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Estate Planning Fact Finder ...continued Estate Liabilities:
Client:
Spouse:
Joint:
Credit Card Debt: Auto Loans: Other Debt: Income:
Client:
Spouse:
Joint:
Gross Salary: Bonus: Income from Investments: Income from Qualified Plans: Current Estate Distribution Plan: Intestate (no will)
Qualified Domestic Trust (Q-DOT)
Simple Will (100% to Spouse)
Bequests to Charity:
Marital/Credit Shelter Will or Trust
Specific Bequests to Others:
Trusts: Revocable (client)
Revocable (spouse)
Irrevocable (client)
Date Established:
Irrevocable (spouse)
Grantor:
Living
Trustee Name(s):
Trust Assets:
Current Value of Assets:
Annual Income:
Income Beneficiaries:
Remainder Beneficiaries:
Deceased
Describe trust provisions for distribution of income or principal:
Gift Planning: Type of Property Gifted:
BSMG | 11/2013
Donor(s):
Donee(s):
Date
Value of Gifts:
Annual Exclusion(s) Allowed:
Donor(s) Unified Credit Used:
Gift Taxes Paid by Donor(s):
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Estate Planning Fact Finder ...continued Additional Financial Data: Assumptions - Retirement Planning: Growth rate for QRP/IRA assets:
%
Age of client at death
Age of spouse at death
At what age do you expect to retire? Amount of after-tax income needed for fixed expenses?
$
Assumed inflation rate for fixed expenses
%
Annual defined benefit pension:
(annual after-tax amount in today’s dollars)
$
Annual Social Security benefit:
$
Assumptions - Stocks, Bonds, Mutual Funds, Annuities: Growth rate and dividend rate for equity assets:
%
Growth rate for tax exempt income assets:
%
Growth rate for non-qualified annuities:
%
/
%
Estimated total cost basis $
Growth rate for taxable interest/yield assets:
%
Estimated cost basis: $
Assumptions - Business, Real Estate, Land: Growth rate for non-liquid assets:
%
Net rental income from real estate: $
Will any non-liquid assets be sold?
If yes, what year will asset(s) be sold?
If yes, at what price will non-liquid asset(s) be sold?
If yes, adjusted cost basis at time of sale $
Assumptions - Taxes: Assumed effective income tax rate
%
Assumed effective income tax rate of heirs
%
Assumed effective capital gains tax rate
%
Assumed effective estate tax rate
%
Gifting: Are you currently making regular, annual gifts to your children and/or grandchildren? If yes, annual amount is:
Yes
No
$
Have you or your spouse purposely used any portion of your available unified credit exemption to make gifts in excess of the annual exclusion per person per year limit?
Yes
No
If yes, how much of your exemption have you used? $ BSMG | 11/2013
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Estate Planning Fact Finder ...continued Future Savings: Do you plan to make or continue to make annual contributions to a tax qualified retirement plan?
Yes No
(Pension, 401(k), IRA, Profit Sharing, 403(b), etc.) If yes, what is the total annual amount you plan to deposit to these plans: $
annually for
years
Regarding other annual savings, please complete the following: I estimate that I will make annual savings deposits from after-tax earned income or business profits to: taxable equity/income producing assets in the amount of $
annually for the next
years
tax exempt income producing assets in the amount of $
annually for the next
years
taxable interest/yield producing assets in the amount of $
annually for the next
years
Additional Information: Future Inheritances:
Long Term Care Plan:
Prior Marriages:
Special Medical Problems:
Accountant:
Attorney: Phone:
Phone:
Other:
BSMG | 11/2013
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