TriDelta Financial Planning Questionnaire TriDelta Financial Planning Questionnaire from Anton Tucker Step 1 of 5 20% TriDelta Financial is a comprehensive financial planning firm focused on you. Our goal is to help you meet your lifestyle goals and aspirations Our role is to provide you with financial advice on a broad range of issues including investments, insurance, cash/debt management, estate and retirement planning. We believe that to be happy you must have dreams. Success however generally requires a plan. It is with this in mind that we partner with you to develop, implement and monitor the plan to ensure your dreams become a reality. Please take the time to complete the attached questionnaire and attachments. The information gathered will remain confidential and is a vital first step in laying the framework for your personal financial plan. The attached questionnaire should be accompanied by copies of the following statements where applicable: 1. Investment statements 2. Mortgage & Loan / Line of credit statements 3. Summary page of insurance policies 4. Notice of Assessment (NOA) - provided after your last tax filingClient Personal InformationName First Last Address Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home PhoneBus. PhoneEmail Birth DateMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920SIN Citizenship Marital Status Single Married Common Law Separated Divorced Widowed Employment Employed Self employed Owner of incorporated business Retired Other (e.g. Homemaker) Occupation Company Health (Rate 1 as Excellent and 5 as Poor)12345 Co-Client Personal InformationName First Last Address Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home PhoneBus. PhoneEmail Birth DateMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920SIN Citizenship Marital Status Single Married Common Law Separated Divorced Widowed Employment Employed Self employed Owner of incorporated business Retired Other (e.g. Homemaker) Occupation Company Health (Rate 1 as Excellent and 5 as Poor)12345 Children / DependentsChildren / DependentsPlease list the names, genders and dates of birth of your children and grandchildren.RESP ($) Trust ($) WillDo you have a will?YesNoNot sureWhen was it last updated?MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Do you have a power of attorney for property and personal care?YesNoNot sure GoalsPlease identify the goals that are most important to you.Goals Ensure a comfortable retirement Reduce taxes payable Provide for a child’s education costs Reduce mortgage Reduce credit card and other personal debt Protect income in the event of disablity or death Fund an annual vacation/cruise/trip Ensure estate is in good order for heirs Preserve estate assets for heirs Create a legacy for others Your Two Greatest WishesWish 1. Time Horizon ConsiderationsWish 2. Time Horizon ConsiderationsYour Biggest ConcernWhat is the one concern most likely to keep you awake at night? Financial InformationCash Flow - Are you in control of your cash flow?YesNoNot sureInvestment - Do you have a plan in place?YesNoNot sureCredit - Is your debt structured efficiently and cost effectively?YesNoNot sureProtection Insurance - Are you adequately covered?YesNoNot sure
