New Client Questionnaire - Shepherd Wealth Advisors

First, let’s get to know you and those important to you.

Your Name*

First

Last

Your Age

Please list any important relationships we should know about. This can include family members, business partners, beneficiaries, etc.*

What are your goals? When would you like to retire? What are your wishes and concerns? New car, vacation home, education funding, becoming debt free, financial independence, etc?

In what year would you like to retire?*

What are your personal financial goals and wishes? This could include large purchases, becoming debt free, early retirement, etc.*

What financial concerns do you have?*

List each source of income and the amounts that get deposited into your bank account.

Income Sources

Monthly Amount

Salary 1

Salary 2 (if applicable)

Additional Income 1 (if applicable)

Additional Income 2 (if applicable)

Additional Income 3 (if applicable)

Additional Income 4 (if applicable)

Any additional sources of income we should know about? (optional)

What are your average monthly expenses in each category below?

Expenses

Monthly Amount

Average Essential Expenses

Average Non-essential Expenses

Average Debt Payments

What are you saving each month?

Employer Retirement Plan(s)

Type (401(k), 403(b), SEP, etc.)

Monthly Contribution Amount

Employer Match

Additional Savings

Additional Savings

Monthly Contribution Amount

IRA/Roth IRA contributions

Brokerage Account (s)

Cash value life insurance

Education or Trust Funding

Savings/Checking Account

Other

Now let’s zoom out to see your investment assets, real estate and debts.

What are the balances in your investment and bank accounts?

Investment/bank balances

Balance

Employer Retirement Plan

IRA/Roth IRA Balances

Brokerage Account Balances

Cash Value Life Insurance

Education or Trust Fund

Savings/Checking Accounts

Other

% in Equity:

% in Bond:

% in Cash:

Please include information on credit cards, mortgages, Home equity loans, student loans and other loans.

Credit Cards

Mortgages:

Home Equity Loans

Student Loans

Other Loans

If you own any real estate property, please provide details below.

Primary Home

Second Home (if applicable)

Rental Home(s)

Finally, let’s check your level of protection.

Include insurance policies such as life insurance, disability insurance or long term care

Life insurance funded through employer

Life insurance funded personally

Disability Insurance

Long-term care insurance

Please include any other information that could be helpful or that you want to make sure we discuss

Questionnaire

First, let’s get to know you and those important to you.

Next, let’s get a snapshot of your monthly income, expenses and savings.

Now let’s zoom out to see your investment assets, real estate and debts.

Finally, let’s check your level of protection.