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

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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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