Type of Plan

REGISTERED INVESTMENT ADVISER

Confidential Data
of
__________________________________
Investment Adviser Representative
_____________________________
Date
_________________
(REVISED 03-2008)
Comprehensive
Financial Plan
1
Budget
Analysis/Construction
2
Tax
Analysis
3
Investment
Analysis
4
Educational
Funding Analysis
5
Income Funding
Analysis
6
Accumulation
Funding Analysis
7
Retirement
Analysis
8
Medicaid
Plan
9
Estate
Analysis
10
Business
Financial Plan
11
.
In the course of doing business with cfd Investments, Inc. or CREATIVE
FINANCIAL DESIGNS, Inc., you share personal and financial information
with us. We treat this information as confidential and recognize the
importance of protecting access to it.
You may provide information when communicating with us in writing,
electronically, or by phone. For instance, information may come from your
applications, your requests for forms or literature or your transactions with
us. On occasion, such information may come from consumer reporting
agencies and those providing services to us.
We do not sell information about our clients (whether current or former) to
third parties. We do not disclose this information to third parties unless it is
necessary to process a transaction or service an account. We may also
disclose this information if otherwise legally permitted or required.
We may share information between the two companies in the course of
providing or offering products and services to best meet your investing needs.
We may also share that information with companies performing
administrative or marketing services for either company or with a business
partner with whom we are developing or offering investment products.
However, use of information about our clients in such cases is severely
restricted the other party is prohibited from sharing or using it for any
other purpose.
Finally, we may share your information with another broker/dealer in order to
assist in the timely transition of your account in the event that your financial
adviser leaves us and becomes associated with another securities firm. If you
would prefer that we not disclose your information in that circumstance, you
must let us know, in writing, addressed to cfd Investments, Inc., 2704 South
Goyer Road, Kokomo, IN 46902, Attn: Chief Compliance Officer.
POLICY ON CONFIDENTIALITY OF OUR CLIENT'S INFORMATION
PERSONAL INFORMATION
Last First MI
Birthdate
Yes or No
Last First MI
Yes or No
Street
City State Zip
Telephone Fax E-Mail
Residence
Spouse
Client
CLIENT
Occupation
Employer Date of Employment
Business
Address
Street
City State Zip
Telephone Fax E-Mail
SPOUSE
Business
Address
Occupation
Employer
Date of Employment
Street
City State Zip
Telephone Fax E-Mail
Great Good Average Fair Poor
Great Good Average Fair Poor
General Health (Circle) Tobacco User (Circle)
Tobacco User (Circle) General Health (Circle)
( ) - ( ) -
( ) - ( ) -
- -
( ) - ( ) -
Birthdate Birthplace Social Security#
City_________________ State_____Country_________ / /
Birthplace: Social Security#
- -
City_________________ State_____Country_________
/ /
1 2 3 4 5 6 7 8 9 10 11
MARITALAND CITIZENSHIP DATA 1 9 10
DATE OF MARRIAGE__________________________ PLACE____________________________
Occupation at date of marriage ________________________ _______________________
Husband Wife
Net Worth at date of marriage ________________________ ________________________
If you have changed your state of residence during the marriage, show:
State Year of Arrival Approximate net worth upon arrival
PRIOR MARRIAGES
CITIZENSHIP
If any members of your family are not U.S. Citizens, please indicate:
NAME AGE RELATIONSHIP CIRCUMSTANCE
HUSB./WIFE SPOUSE NAME DATE (e.g. by death) OF MARRIAGE
CURRENT MARRIAGE
TERMINATION HOWTERMINATED CHILDREN
ADVISERS 1 9 10
PROFESSION NAME STREETADDRESS CITY,ST., ZIP TELEPHONE
Attorney
Attorney
Accountant
Accountant
Life Insurance
Life Insurance
Casualty Insurance
First
First
First
First
First
First
First
First
First
Last
Last
Last
Last
Last
Last
Last
Last
Last
M.I.
M.I.
M.I.
M.I.
M.I.
M.I.
M.I.
M.I.
Ci t y
Ci t y
Ci t y
Ci t y
Ci t y
Ci t y
Ci t y
Ci t y
Ci t y
ST., ZIP
ST., ZIP
ST., ZIP
ST., ZIP
ST., ZIP
ST., ZIP
ST., ZIP
ST., ZIP
ST., ZIP
Fax
Fax
Fax
Fax
Fax
Fax
Fax
Fax
M.I.
( ) -
( ) -
( ) -
Fax
( ) -
( ) -
( ) -
( ) -
( ) -
( ) -
( ) -
( ) -
( ) -
( ) -
( ) -
( ) -
( ) -
( ) -
( ) -
Financial Planner
Casualty Insurance
PROVERBS 15:22
CHILDREN AND EDUCATION 1 5 9 10
CHILDREN'S DATA
Current Number of
/ / - -
/ / - -
Child's Name Date of Birth Social Security# Grade Married Grandchildren
1
2
3
4
5
6
/ / - -
/ / - -
/ / - -
EDUCATIONAL DATA
Available Year Private Public Private Graduate
Assets Range School College College School
Child 6 $
Child 5 $
Child 4 $
Child 3 $
Child 2 $
Child 1 $
From
From
Until
Until
From
Until
From
From
From
Until
Until
Until
/ / - -
PROVERBS 22:6
PARENTS AND SPECIAL NEEDS
CLIENT'S OTHER FAMILY MEMBERS
Relation Name Age Spouse Name Age City, ST. Net Worth
Father
Mother
*
*
*
*
*
Indicate brother, sister, half brother/sister, step brother sister
Relation Name Age Spouse Name Age City, ST. Net Worth
Father
Mother
*
*
*
*
*
*
*
Indicate brother, sister, half brother/sister, step brother sister
SPOUSE'S OTHER FAMILY MEMBERS
SPECIAL NEEDS DATA (PLEASE DETAIL)
Estimated
Estimated
1 8 9 10
The following information is completly confidential. The people listed will not be contacted at anytime. The information
is for the sole purpose to determine possible inheritance(s) and/or dependent need(s) of parents or relatives.
EXODUS 20:12 EPHESIANS 6:2
1 2 3 4 5 6 7 8 9 10 11
WHAT TO DO
Start with the "bottom step" and answer the question: "What is important to you the (client, spouse, couple) about money? Take
as much time as you need and use a one word answer. Move to the next "step" and ask: "What is important to you the (client,
spouse, couple) about the (last answer). Continue all the way up the staircase until you feel you have reached your "top".
Client Spouse
Couple
PRIORITIZING YOUR VALUES
HAGGAI 1:5-7 LUKE 6:34
GOAL PRIORITIES 1 2 3 4 5 6 7 8 9 10 11
OF NO OF LITTLE FAIRLY VERY EXTREMELY
IMPORTANCE IMPORTANCE IMPORTANT IMPORTANT IMPORTANT
1 2 3 4 5 6 7 8 9
Reduce Debt
Build an
Emergency Fund
Increase Insurance
Coverage
Buy a House
Make Home
Improvement
Buy a Car
Make Some Other
Big Purchase
Have Children
Finance Children's
Education
Improve Stewardship
Take an Expensive
Vacation
Take an Unpaid
Leave FromWork
Start a Business
Take Early Retirement
Live Well After
Retirement
Reduce Tax Liability
Provide for Yourself
in Event of Disability
Medicaid
Spending Down
Preserving Assets
Provide for Family
in Event of Death
DETAIL
PRIORITY MONEY DATE INCOME DATE
OBJECTIVE BY NUMBER NEEDED RANGE NEEDED RANGE

HAGGAI 1:5-7 PROVERBS 14:15

Asset Allocation Questionnaire Asset Allocation Questionnaire
Different investors have different risk tolerances. Much of the difference stems from time horizon. That is,
someone with a short investment time horizon is less able to withstand losses. The remainder of the difference
is attributable to the individuals appetite for risk. Volatility can be nerve-wracking for many people and they
are more comfortable when they can avoid it. Risk and return are related, however, and investors need to
recognize the trade-off. The following risk tolerance questionnaire is designed to measure time horizon and
tolerance for risk. The total score recommends which of the five portfolios is most appropriate for the investor.
Time Horizon Time Horizon
1. When do you expect to begin withdrawing money from your investment account?

a. Less than 1 year
b. 1 to 2 years
c. 3 to 4 years
d. 5 to 7 years
e. 8 to 10 years
f. 11 years or more


2. Once you begin withdrawing money from your investment account, how long do you expect the
withdrawals to last?
a. I plan to take a lump sum distribution
b. 1 to 4 years
c. 5 to 7 years
d. 8 to 10 years
e. 11 years or more
Risk Tolerance Risk Tolerance
3. Inflation is the rise in prices over time. Long-term investors should be aware that, if portfolio returns are
less than inflation, the ability to purchase goods and services in the future might actually decline.
Portfolios with long-term returns that significantly exceed inflation, however, are associated with a
higher degree of risk.

Which of the following portfolios is most consistent with your investment philosophy?

a. Portfolio 1 will most likely exceed long-term inflation by a significant margin and has a high
degree of risk.
b. Portfolio 2 will most likely exceed long-term inflation by a moderate margin and has a high to
moderate degree of risk.
c. Portfolio 3 will most likely exceed long-term inflation by a small margin and has a moderate
degree of risk.
d. Portfolio 4 will most likely match long-term inflation and has a low to moderate degree of risk.
4. Portfolios with the highest average returns also tend to have the highest chance of losing money. The
table below provides the average dollar return for an investment of $100,000 and possibility of losing
money (ending value of less than $100,000) over a one-year holding periods in four different portfolios.
Please select the portfolio with which you are most comfortable.

Probabilities After 1 Year
Possible Average Dollar Return Chance of Losing Money
a. Portfolio A $105,000 17%
b. Portfolio B $107,000 23%
c. Portfolio C $108,000 29%
d. Portfolio D $109,000 31%
(Rev. 10/03)
INVESTMENT PHILOSOPHY AND OBJECTIVES
ECCLESIASTES 11:2
R
e
t
u
r
n

(
%
)

Which of these portfolios would you
prefer to hold?

a. Portfolio A
b. Portfolio B
c. Portfolio C
d. Portfolio D
5. Investing involves a trade-off between risk and return. Historically, investors who have received high
long-term average returns have experienced greater price fluctuations and higher potential for loss than
investors in more conservative investments. Considering the above, which statement best describes
your investment goals?

a. Protect the value of my account. In order to minimize the chance for loss, I am willing to
accept the lower long-term returns provided by conservative investment.
b. Keep risk to a minimum while trying to achieve slightly higher returns than the returns
provided by more conservative investments.
c. Balance moderate levels of risk with moderate levels of returns.
d. Maximize long-term investment returns. Therefore, I am willing to accept large and
sometimes dramatic fluctuations in the value of my investment.


6. Historically, markets have experienced periods of substantial short-term price swings (volatility) as
well as prolonged down markets. Suppose you owned a well-diversified portfolio that fell by 20%
over a short period. Assuming you still have 10 years until you begin withdrawals, how would you
react?

a. I would not change my portfolio.
b. I would wait at least one year before changing to more conservative options.
c. I would wait at least three months before changing to more conservative options.
d. I would immediately change to more conservative options.


7. The following graphs shows the hypothetical results of four sample portfolios over a one year holding
period. The best potential and worst potential gains and losses are presented. Note that the portfolio
with the best potential gain also has the largest potential loss
-27%
44%
33%
-20%
26%
-15%
15%
-7%
60%
50%
40%
30%
20%
10%
0%
-10%
-20%
-30%
Portfolio A Portfolio B Portfolio C Portfolio D
8. I am comfortable with investments that may frequently experience large declines in value if there is a
potential for higher returns.

a. Agree
b. Disagree
c. Strongly Disagree




_____________________________________ ________________________
Client Signature Date
R
e
t
u
r
n

(
%
)

INVESTMENT PHILOSOPHY AND OBJECTIVES (Cont.)
How much money do you feel you should maintain in cash, or its
equivalent? $_____________
Why? ____________________________________________________
Have you ever used an Investment Counselor? Yes No
Why?____________________________________________________
Do you feel it is important to take into account the effects of inflation
in your investment planning?________________________________
What rate of inflation do you feel will prevail over the next five
years? _____________
No Opinion? _____________
Yes No
Do you maintain a margin account with a brokerage firm? If 'yes'
what firm?______________________________________________.
$_____________
Are there any investments that you feel tied to. (for past
performance, family, or social reasons?) If 'yes', which ones and Yes No
why? ___________________________________________________
_______________________________________________________
What is your single most important financial objective at this time?
________________________________________________________
________________________________________________________
If feasible, our consultants may recommend additional leveraging.
How do you feel about borrowing money?_____________________
________________________________________________________
Do you consider tax consequences in making investments? ______
________________________________________________________
What methods are you now using to convert tax dollars into
capital? _________________________________________________
________________________________________________________
________________________________________________________
1 4 5 6 7 8 9 10
INVESTMENT PHILOSOPHY AND OBJECTIVES (Cont.)
INVESTMENT PHILOSOPHYAND OBJECTIVES (Cont.) 1 4 5 6 7 8 9 10
DoYou Know Where Your Money is Invested?
When you buy shares of a company, whether directly or through a mutual fund, you actually become
an owner of that company. Millions of Americans have invested large amounts of money in the
stock market through mutual funds as a method of growing money for future needs like retirement.
Many have little idea what their money does or where it is invested. Many companies that are
popular investments for mutual funds are involved in practices contrary to their beliefs while some actually
support those beliefs.
Yes No
* Are you concerned that your assets invest in companies that support abortion? ___ ___
* Are you concerned that your assets invest in companies that support pornography? ___ ___
* Are you concerned that your assets invest in companies that support anti-family
entertainment? ___ ___
* Are you concerned that your assets invest in companies that support non-married
lifestyles? ___ ___
* Are you concerned that your assets invest in companies that support alcohol? ___ ___
* Are you concerned that your assets invest in companies that support tobacco? ___ ___
* Are you concerned that your assets invest in companies that support gaming/
casinos? ___ ___
* Are you concerned that your assets invest in companies that support pharmaceuticals
and medical diagnostic services and products? ___ ___
* Are you concerned that your assets invest in companies that support interest-based
financial institutions? ___ ___
* Are you concerned that your assets invest in companies that support meat processing-
pork and poultry products? ___ ___
* Are you concerned that your assets invest in companies that support producers
of caffeinated beverages? ___ ___
* Are you concerned that your assets invest in companies with the goal of long-term
growth and stability and have no excessive debt? ___ ___
* Are you concerned that your assets invest in companies where management is seen
more as a helping hand rather than merely an authoritative source? ___ ___
* Are you concerned that your assets invest in companies where values training in
new-hire or recurring employee training program is in place? ___ ___
* Are you concerned that your assets invest in companies that have a stated, defined,
published mission statement and/or values statement and/or vision statement? ___ ___
* Are you concerned that your assets invest in companies that provide services for
employees such as day care and childhood developement services, generous
family leave programs, chaplain service, and other family-oriented programs
and resources? ___ ___
* Are you concerned that your assets invest in companies that are committed to a process
of continuous improvement. The company should solicit and encourage customer
feedback and act on trends and issues as identified? ___ ___
* Are you concerned that your assets invest in companies whose products and/or
services provide superior value and possess life enhancing characteristics? ___ ___
* Are you concerned that your assets invest in companies that are a fun place to work
and provide highly competitive benefits to its employees, including but not limited
to, competitive wages, healthcare, retirement, education, and relocation? ___ ___
* Are you concerned that your assets invest in companies that use team processes
in core corporate divisions-corporate strategy, quality control, etc? ___ ___
* Are you concerned that your assets invest in companies that exhibit a commitment
to supporting causes with financial and tangible products and/or services? ___ ___
* Are you concerned that your assets invest in companies that are involved in and support
programs benefiting the local and extended community? ___ ___
* Are you concerned that your assets invest in companies that are cognizant of and take
steps to address any environmental concerns related to its industry? ___ ___
* Are you concerned that your assets invest in companies that have a fair
return/refund policy in effect and have a program to proactively address
customer complaints and concerns? ___ ___
* Are you concerned that your assets invest in companies whose awards and
recognitions provide confirmation of a company's dedication to its employees,
customers and communities? ___ ___
ECCLESIATES 12:13-14
PERSONAL SATISFACTION RATING
Little/No Some Moderate Significant Great
Area Satisfaction Satisfaction Satisfaction Satisfaction Satisfaction
Family 1 2 3 4 5
Professional 1 2 3 4 5
Physical 1 2 3 4 5
Community 1 2 3 4 5
Spiritual
OR 1 2 3 4 5
Faith
Recreational 1 2 3 4 5
Financial 1 2 3 4 5
1 2 3 4 5 6 7 8 9 10 11
1 2 3 4 5 6 7 8 9 10 11
1. Diligent Worker 1 2 3 4 5
Proverbs 10:4 Lazy hands make a man poor, but diligent hands bring wealth.
2. Grateful/Generous Giver 1 2 3 4 5
Proverbs 11:25 A generous man will prosper; he who refreshes others will himself be refreshed.
3. Committed Saver 1 2 3 4 5
Proverbs 21:5 The plans of the diligent lead to profit as surely as haste leads to poverty.
4. Disciplined Investor 1 2 3 4 5
Ecclesiastes 11:2 Give portions to seven, yes to eight, for you do not know what disaster may come upon the land.
5. Reluctant Debtor 1 2 3 4 5
Proverbs 22:7 The rich rule over the poor, and the borrower is servant to the lender.
6. Discerning Consumer 1 2 3 4 5
Philippians 4:12 ...I have learned the secret of being content in any and every situation.
7. Sacrificial Life 1 2 3 4 5
Romans 12:1-2 Therefore I exhort you, brothers and sisters, by the mercies of God, to present your bodies as a sacrifice -
alive, holy, and pleasing to God - which is your reasonable service. 2. Do not be conformed to this present world, but be
transformed by the renewing of your mind, so that you may test and approve what is the will of God - what is good and
well-pleasing
and perfect.
8. Cheerful Giver of Your Time 1 2 3 4 5
John 9:4 We must perform the deeds of the one who sent me as long as it is daytime. Night is coming when no one can work.
9. Willingly Give of Your Talents 1 2 3 4 5
1 Peter 4:10 Just as each one has received a gift, use it to serve one another as good stewards of the varied grace of God.
10. Steward of His Church 1 2 3 4 5
Romans 12:4-8 For just as in one body we have many members, and not all of the members serve the same function, so we
who are many are one body in Christ, and individually we are members who belong to one another. And we have different gifts
according to the grace given to us...
1 Corinthians 12:7-11 To each person the manifestation of the Spirit is given for the benefit of all. For one person is given
through the Spirit the message of wisdom, and another the message of knowledge according to the same Spirit,
TOTAL ________________
Possible Score of 50 = 100%, 45 = 90%, 40 = 80%, 35 = 70%, 30 = 60%, 25 = 50%
STEWARDSHIP EVALUATION
Circle the most appropriate response: #5 is high (or superior), #3 is acceptable, #1 low (or weak)
MONTHLY CASH FLOW 1 2 3 8
Income: Monthly Annually
Your Income ______________ ______________
Spouse Income ______________ ______________
Other ______________ ______________
Gross Income: ____________ ____________
Deductions For:
Federal Taxes ______________ ______________
State Taxes ______________ ______________
Social Security Taxes ______________ ______________
Group Employer Benefits ______________ ______________
401(k) Savings (all sources) ______________ ______________
Alimony/Child Support ______________ ______________
FAMILY EXPENDITURES
(Please indicate if paid other than monthly, otherwise we will assume the amount is per month)
1. Charitable Contributions:
Water _____________
Tithe ______________ Gas _____________
Missions ______________ Sanitation _____________
United Way ______________ Cable TV _____________
March of Dimes ______________ Telephone _____________
MDA ______________ Yard/Pool Service _____________
American Cancer Society ________________ Water Softener _____________
Universities ______________ Maintenance _____________
Other ______________ Other _____________
2. Savings: 4. Food & Beverage:
Bank ______________ Grocery _____________
Credit Union ______________ Convenience Store _____________
IRA's ______________ Other _____________
CD's ______________ 5. Automobiles:
Mutual Funds ______________ Car Payments _____________
Other ______________ Gasoline _____________
Lube/Oil _____________
3. Housing: Insurance _____________
Mortgage/Rent ______________ License Plates _____________
Property Taxes ______________ ExciseTax _____________
Homeowners Insurance ____________ Maintenance _____________
Electric ______________
PROVERBS 3:9 LEVITICUS 27:30 MATTHEW 6:24
MONTHLY CASH FLOW (Continued)
FAMILY EXPENDITURES (CONTINUED)
6. Insurance: 11. Medical Expenses:
Life _____________ Doctor ______________
Medical _____________ Dentist ______________
Disability _____________ Prescriptions ______________
Umbrella _____________ Other ______________
Other _____________ 12. Education/Self-Improvement:
7. Debts: Newspaper ______________
Credit Cards Magazines ______________
Visa _____________ Special Education
Master Card _____________ Piano ______________
J.C. Penney _____________ Other Music ______________
Sears _____________ Gymnastics ______________
American Express _____________ Other ______________
Other _____________ Computer ______________
Other _____________ Other ______________
Other _____________ 13. Entertainment:
Notes/Loans Eating Out _____________
Banks _____________ Weekend Trips ______________
Finance Co. _____________ Baby-sitters ______________
Other _____________ Activities
Other _____________ Sports ______________
8. Clothing: ___________ Shows ______________
9. Furnishing: Theater ______________
Furniture _____________ Video Tapes ______________
Linens _____________ Memberships ______________
Kitchen _____________ Other ______________
Other _____________ 14. Vacations & Holidays:
10. Personal Care & Cash: Vacations ______________
Toiletries _____________ Gifts
Cosmetics _____________ Christmas ______________
Beauty Shop _____________ Birthdays ______________
Barber _____________ Showers ______________
Dry Cleaning/Laundry____________ Others ______________
Allowance _____________
Lunches _____________ 15. Miscellaneous:
Other _____________ Child Care ______________
Child Support ______________
Pet Supplies ______________
_______________ ______________
_______________ ______________
1 2 3 8
PROVERBS 3:9 LEVITICUS 27:30 MATTHEW 6:24
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INVESTMENT ASSETS
Market Growth Current
Fixed Assets: Value Rate Liability Ownership
Cash & Checking Accounts ____________ ___________ ____________ ____________
T-Bills, Gov't Bonds, Money Market ____________ ____________ ____________ ____________
Savings Accounts & CD's ____________ ____________ ____________ ____________
Municipal Bond Funds ____________ ____________ ____________ ____________
Corp. Bonds, Income Mutual Funds ____________ ____________ ____________ ____________
Notes & Mortgage Receivable ____________ ____________ ____________ ____________
Life Insurance Cash Value-Fixed ____________ ____________ ____________ ____________
Fixed Annuities ____________ ____________ ____________ ____________
IRA, Keogh, 401(k)-Fixed ____________ ____________ ____________ ____________
Corporate Qualified Plans-Fixed ____________ ____________ ____________ ____________
Other ____________ ____________ ____________ ____________
Variable Assets:
Residence ____________ ____________ ____________ ____________
Common or Preferred Stock ____________ ____________ ____________ ____________
Growth Mutual Funds ____________ ____________ ____________ ____________
Balanced Mutual Funds ____________ ____________ ____________ ____________
Life Insurance Cash Value--Variable ____________ ____________ ____________ ____________
Variable Annuities ____________ ____________ ____________ ____________
Income Real Property ____________ ____________ ____________ ____________
Undeveloped Land ____________ ____________ ____________ ____________
Real Estate Limited Partnerships ____________ ____________ ____________ ____________
Energy Exploration Partnerships ____________ ____________ ____________ ____________
Equipment Leasing Partnerships ____________ ____________ ____________ ____________
Business Interest ____________ ____________ ____________ ____________
Agriculture & Ranching ____________ ____________ ____________ ____________
Art, Antiques, Stamps, & Gems ____________ ____________ ____________ ____________
Gold, Silver, & Coins ____________ ____________ ____________ ____________
Commodities/Options ____________ ____________ ____________ ____________
IRA,Keogh, TSA, 401(k)--Variable ____________ ____________ ____________ ____________
Corporate Qualified Plans--Variable ____________ ____________ ____________ ____________
Other Variable Assets ____________ ____________ ____________ ____________
Personal Assets:
Personal Property ____________ ____________ ____________ ____________
Automobiles ____________ ____________ ____________ ____________
Recreational Property ____________ ____________ ____________ ____________
Other ____________ ____________ ____________ ____________
1 2 3 4 5 6 7 8 9 10 11
MATTHEW 25: 14-30; I TIMOTHY 6:17-19; ECCLESIATES 5:19-20; PROVERBS 11:4
If possible, it would be helpful to have a copy of the loan papers on any home mortgage
loans, so that we can accurately calculate payoff terms, dates and pre-payment options.
Secured Liabilites:
Type Lendor Original Outstanding Term Interest Date of Current
Amount Balance Of Loan Rate % 1st Pmt. Payment
Home Mortgage _________ _________ _________ ______ ______ _________ ______
SecondMortgage _________ _________ _________ ______ ______ _________ ______
Other Investments _________ _________ _________ ______ ______ _________ ______
_________ _________ _________ ______ ______ _________ ______
_________ _________ _________ ______ ______ _________ ______
_________ _________ _________ ______ ______ _________ ______
_________ _________ _________ ______ ______ _________ ______
_________ _________ _________ ______ ______ _________ ______
Automobile Loan _________ _________ _________ ______ ______ _________ ______
Automobile Loan _________ _________ _________ ______ ______ _________ ______
Boat Loan _________ _________ _________ ______ ______ _________ ______
Other Loan _________ _________ _________ ______ ______ _________ ______
Unsecured Liabilities:
Type Lendor Outstanding Monthly Interest Credit
Balance Payment Rate % Limit
Bank Credit Line _________ _________ _________ ______ _________
Overdraft Checking _________ _________ _________ ______ _________
Personal Loans _________ _________ _________ ______ _________
_________ _________ _________ ______ _________
_________ _________ _________ ______ _________
Credit Cards _________ _________ _________ ______ _________
_________ _________ _________ ______ _________
_________ _________ _________ ______ _________
_________ _________ _________ ______ _________
DEBT INFORMATION 1 2 3 8 9 10 11
PROVERBS 22:7 PSALM 37:21 LUKE 12:15
LIFE INSURANCE
Policy Number
Company Name
Company Name
Company Name
Company Name
Company Name
Company Name
Company Name
Policy Number
Policy Number
Policy Number
Company Name
Policy Number
Policy Number
Policy Number
Policy Number
Current/Future
CV Loans
CashValue/
Growth Rate
Face
Amount
Ownership/
Beneficiary
Insured
Party
C S CP O
C S CP O
$ $
$
$
$
%
%
C S
O SD
C S
O SD
C S
O SD
C S
O SD
C S
O SD
C S
O SD
C S
O SD
C S
O SD
C S CP O
C S CP O
C S CP O
C S CP O
C S CP O
C S CP O
C S CP O
C S CP O
C S CP O
C S CP O
C S CP O
C S CP O
C S CP O
C S CP O
$
$ $ $
$
$
$
$ $
$
$
$ $
$ $
$
$
$
$
$
$
$
$
$
$ $
$
$ $ $
$
%
%
%
%
%
%
% %
% %
% %
C -- Client SD -- Second to Die
S -- Spouse CP -- Community Property
O -- Other
Growth Rate For Cash Value, the growth rate should be the annual percentage by
which the cash value is expected to grow. This should be a before-tax
rate of return. For Cash Value Loans, the rate should indicate the
annual percentage increase or decrease in the loan balance (negative
rates can be used).
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$
%
$
$
$
Annual
Premium/
Incr.
%
I TIMOTHY 5:3-8
OTHER INSURANCE
Company Name Policy Number
Insured
Party
Monthly
Benefit
Annual
Premium
C S
C S
C S
C S
C S
C S
$
$
$
$
$
$
$
$
$
$
$
$
Provide most recent annual statements.
Homeowner's
Automobile
Annual
Premium
CASUALTY:
Medical
$
$
$
DISABILITY:
C S
C S
C S
C S
C S
C S
$
$
$
$
$
$
Annual
Premium
Daily
Benefit
Insured
Party Policy Number
LONG TERM CARE:
Company Name
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I TIMOTHY 5:3-8
FINANCIAL INDEPENDENCE DATA
Retirement Age Desired:
Client: __________
Spouse:__________
Monthly Retirement Goal:
Client: $_________
Spouse:$_________
Pension Income Expected At Age Desired:
Client Life Only: $__________
Client Joint & Survivor: $__________
Survivor Income To Spouse: $__________
Spouse Life Only: $__________
Spouse Joint & Survivor: $__________
Survivor Income To Client: $__________
Are Pension Incomes Including Social Security Offset?:
Client : ____Yes____No
Spouse: ____Yes____No
How Much Continues When Social Security Begins?:
Client Life Only: $__________
Client Joint & Survivor: $__________
Survivor Income To Spouse: $__________
Spouse Life Only: $__________
Spouse Joint & Survivor: $__________
Survivor Income To Client: $__________
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LUKE 12:19-21
ESTATE PLANNING
WILLS -- MARITALAGREEMENT
Client Spouse
What kind of wills do you have?
Year Drawn?
Date it was last reviewed?
State in which it was drawn?
How do they leave your property?
(One-Trust, Two-Trust, etc.)
YES NO
Do these wills accomplish your desired current objective?
Details:______________________________________________________
Are you interested in preserving estate values to pass ultimately
to your children? Details:_______________________________________
____________________________________________________________
Have you named a guardian for your children? If yes, who_____________
____________________________________________________________
Who is the executor?___________________________________________
If a trust is involved, who is the trustee?____________________________
Do you have a pre or post nuptial agreement?
Have you executed a general or special power of appointment?
Details:______________________________________________________
Have you executed a directive to a physician?
Details:______________________________________________________
Are your beneficiaries good at managing money?
Details:______________________________________________________
Does your spouse share in investment decisions?
If you died first, could your spouse............
Carry on your business
Manage your investments
Are you planning any special bequests to any organizations (such as
churches, schools, civic groups, or charities)?
Details:______________________________________________________
Have you made any sizeable gifts to relatives or other non-charitable
beneficiaries?
Details:______________________________________________________
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PROVERBS 3:22 PROVERBS 22:9
ESTATE PLANNING (CONTINUED)
It takes a lifetime of work to accumulate enough savings for your retirement
and to take care of your family. It's sad, but anyone who has worked hard to
accumulate significant financial assets is now targeted for "extra taxes".
Under current tax law, if you accumulate too much money in certain assets, you
could pay taxes and legal fees as high as 70% of your entire estate. That's why
it is particularly important to take the time to protect your financial and family
assets from lawsuits, estate taxes and unnecessary probate fees.
Yes No
Do you have a written will?
Has it been reviewed and updated recently?
Do you have "Power of Attorney" to protect your assets
if you become ill?
Have you taken steps to protect your estate from the probate
process?
Do you have a " Living Trust " established?
Do you have a " Living Will " established?
Do you have a Personal Health Care Representative
appointed?
Do you know what the taxes and settlement costs of your
estate will be?
What other trust arrangements have you established to protect
your assets form taxes, lawsuits and probates? ____________
__________________________________________________
__________________________________________________
__________________________________________________
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DOCUMENTS REQUIRED
EMPLOYMENT INFORMATION
_______ _______ Final Previous Year-End and as ManyCurrent Year Pay Stubs as Available
_______ _______ Summary Plan Descriptions for:
_______ _______ Group Life Insurance
_______ _______ Group Medical/Dental Insurance
_______ _______ Group Disability
_______ _______ Pension/Profit Sharing Plan (s)
_______ _______ ESOP/Stock Option Plan (s)
_______ _______ Thrift/401K Plan (s)
_______ _______ Deferred Compensation Plan(s)
_______ _______ Tax Sheltered Annuities/TSA's
_______ _______ Account Statements (for above plans)
_______ _______ Beneficiary Designations (for above plans)
_______ _______ Annual Benefits Summary Statements
INDIVIDUAL INSURANCE POLICIES
(Including Recent Premium, Loan and Dividend Statements)
_______ _______ Life
_______ _______ Annuities
_______ _______ Disability
_______ _______ Hospitalization/Major Medical
_______ _______ Homeowners/Renters
_______ _______ Automobile
_______ _______ Other Property
_______ _______ Liability Umbrella
INVESTMENT RECORDS
_______ _______ Personal Financial Statement
Account Statements for:
_______ _______ Banks, CD's (Include Yield & Maturity Date)
_______ _______ Brokerage Accounts, (Purchase prices, Date purchased, Splits, Etc.)
_______ _______ Mutual Fund/Dividend Reinvest Accounts
_______ _______ IRA/Keogh/Pension Accounts
_______ _______ Partnership Agreements
_______ _______ Loan & Mortgage Agreements (Balances, Original Amounts, Interest Rates,Term (s),
Payments.)
_______ _______ Saving Bonds
_______ _______ Prospectus/Offering Memoranda
_______ _______ Transaction Confirmations/Correspondences/K-1's
_______ _______ Personal Property Values (Furniture, Autos, Misc.)
_______ _______ IRA/Keogh Plan Description (5500's)
_______ _______ Real Estate Rental Properties (Such as above Plus rents, expenses & Insurance policies.)
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DOCUMENTS REQUIRED (CONTINUED)
TAX RETURNS
_______ _______ Federal & State Income Tax for the last 3 years
_______ _______ Federal Gift Tax Returns
_______ _______ Details on Quarterly Tax Estimates
_______ _______ Income & Deduction Estimated for current year tax preparation
MISCELLANEOUS
_______ _______ Wills, Trust Agreements, and Any Other Pertinent Legal Documents
_______ _______ Information on Present or Anticipated Inheritances
_______ _______ Completed Budget Worksheet
_______ _______ Checkbooks & Check Registers
BUSINESS OWNERS
_______ _______ Copies of Corporate Returns, Federal and State
_______ _______ Copies of Partnership Agreements or Articles of Incorporation
_______ _______ Copies of Latest Business Financial Statements
_______ _______ Copies of Buy & Sell, Stock Redemption, Split Dollar and Other Agreements
_______ _______ Value of Business and Stock or Ownership Percent
_______ _______ Qualified, Retirement Deferred Compensation Plans, Documents & Statements
_______ _______ Business Insurance Coverage
INVESTMENTADVISORY AGREEMENT 1 2 3 4 5 6 7 8 9 10 11
This agreement between Creative Financial Designs, Inc. (Advisers) and the
undersigned (Client) is dated ______________________, _______.
Services covered under this agreement include the following steps:
A. Data Collection --- The gathering of all information and documentation relative to the type of plan the
Client desires Advisers to prepare including the pertinent financial goals along with family income and
expenditures, assets, liabilities, tax records, insurance policies, employee benefits, estate documentation,
legal contracts, and business agreements. Client agrees to provide such information as well as accurate and
complete data related to attitude and opinions regarding investment philosophies and financial management
to permit Advisers to prepare a personal financial evaluation.
B. Plan Preparation --- Advisers will prepare for the Client a written document appropriate for the type of
plan selected which will include the following: (Please Check)
Comprehensive Financial Plan --- Advisers will calculate each of the following analyses except the
Business Financial Plan.
Budget Analysis/Construction --- Review family income and expenditures including the calculations
of the percentage of family income being spent in each of our fifteen (15) budget categories, compare
those percentages to Advisers recommended guidelines, suggest techniques to bring expenditures
within the guideline, and, if indicated, construct an appropriate budget based on a paycheck allocation
technique.
TaxAnalysis --- Review family income and current tax strategies Client is using including, but not
limited to, itemized deductions to calculate the projected Federal Income Tax (FIT) liability. Compare that
liability to the FIT withholdings and/or Estimates to determine the appropriateness of the withholdings
and estimates. Suggest additional strategies based on information provided that could be employed in
order to REDUCE the ultimate FIT liability.
Investment Analysis --- Review Client's investment objectives, risk tolerance, and specific time
horizons. Analyzing each asset to determine if it is Good or Bad and the appropriateness of its
investment characteristics relative to Client's objectives, Risk tolerance, and specific time horizons.
Buy, Sell, and Hold recommendations will be provided based on the various analyses.
Suggested portfolios will be provided for monies requiring repositioning due to a "SELL"
recommendation.
Educational, Income, and other Accumulation Funding Analyses --- Advisers calculate the amount
of inflation-adjusted monies that is required to achieve the Client Educational, Income, or
Accumulation objective. A projection of the Client's current strategy is compared to the calculated
need. The Advisers are determining if a surplus or deficit is likely to exist. Recommendations are given
for existing investments which have been allocated toward the specific objective relative to their
appropriateness based on the investment's characteristics.
Retirement Analysis --- Review family income and expenditures to determine the appropriate monthly
income required in order to maintain the desired lifestyle. Compare the inflation-adjusted requirement
to the expected benefits form Social Security, qualified pension plan, and investment accumulation in
order to determine if the objective will be achieved in the most efficient, tax-wise manner consistent
with Client's investment temperament. Suggested portfolios will be provided for monies requiring
repositioning along with suggestions for any additional periodic investments that may be required.
INVESTMENT ADVISORY AGREEMENT (Continued)
Medicaid Plan --- Advisers will review the likelihood of assets being depleted and/or confiscated in
the event of a Long Term Care need. Asset protection strategies will be reviewed to determine the
appropriateness of various Trusts, Insurance Policies, and Gifting Techniques.*
Estate Analysis --- In addition to the Medicaid Plan analysis, the Client's assets will be analyzed
through a hypothetical probate based on current values, ownership, and current disposition
techniques with the present Will/Trust arrangement. Various estate tax strategies will be explored in
order to illustrate the trade off between control and tax liability. The Advisers will calculate
techniques to illustrate methods of minimizing taxes, maximizing inheritances, and providing
lifetime security for the client.*
Business Financial Plan --- Goals and objectives will be reviewed to determine appropriateness
based on current income and existing balance sheet. Accounting Ratios will be compared to Client's
industry classifications. Suitable changes will be recommended based on the analyses. A Business
Valuation will be performed along with a review of business continuation agreements. A tax analysis
will be completed along with a business form feasibility study. Appropriate recommendations will be
made.*
Other -- Specify ----
Advisers will make no recommendations which in their opinion are unsuitable, impractical, or
unattainable. Projections are designed to be conceptual and conservative in nature and do not
represent guarantees of future performance.
C. Plan Presentation --- Plan will be presented to the client in person and reviewed in
detail with whatever level of explanation the client may require to achieve understanding.
By entering into this contract, the Client is not bound to the implementation of the investment
and insurance recommendations made.
Compensation for the services listed requires a total payment of $___________.
The total payment for a Comprehensive Financial Plan and those services denoted with an * may,
upon approval, be paid for as follows: a downpayment of ( $ ) is due upon submis-
sion of the data; the balance of the downpayment is due within 30 days after completion of the
plan/service; and, a monthly payment of ($ ) is due for each of the next months.
NOTE: An additional fee may be required for estates of $500,000.
This agreement may be terminated by either party upon written notice.
If, before payment in full is received, the client is not satisfied and the plan/service cannot be modi
fied, then the lesser of one-half of the first year payments or the first year's payments prorated
monthly will be refunded. If, after payment in full, the client is not satisfied with the plan/service and
it cannot be modified, then 50 % of the total fees collected will be refunded.
Advisers agree that all information submitted by Client will not be released to any person
or entity outside CFD organization without the Client's prior consent unless such disclosure
is required by law.
This agreement shall only become effective after signed acceptance by an Officer of
Creative Financial Designs, Inc. Client shall have the right to terminate the agreement by
written notice within five business days of the date of signing by the Client.
This agreement entitles the Client to consultation regarding his financial situation for a period
of 12 months from the date of signing. The original plan may be updated as situations
or objectives change for an amount equal to 25% of the then current fee schedule for plan
preparation.
Client hereby agrees to the provisions of this agreement.
_______________________________ ___________________________
Client Signature Print Name
_______________________________ ___________________________
Spouse Signature Print Name
________________________________ ___________________________
Date Representative
Approved and accepted by Creative Financial Designs, Inc. on_____________________,
by:
INVESTMENT ADVISORY AGREEMENT (Continued)
Adviser is an Investment Adviser registered with the United States Securities & Exchange
Commission. Adviser has delivered information providing disclosures regarding the Advisers
background and business practices. The Client acknowledges receipt of such information.
The law governing this agreement shall be those of the State of Indiana.
NOTES
NOTES
.