Start Today

To begin the path of Financial Freedom, please fill out the fact finding survey below, so the experts at Dottenwhy Financial Group, LLC can get you started today!

* Indicates required field

Name *

First

Last

Spouses Name *

First

Last

Birthdate *

Gender Assigned at Birth *

M F

Gender Assigned at Birth *

M F

Desired Retirement Age *

Number of Children, Ages *

Drivers License State of Issue *

Current Concerns

Future Expenditures *

Real Estate

Personal Residence Information

Mortgage Payment (P&I only) *

Outstanding Mortgage *

Term Remaining (Years) *

Interest *

Debt Related

Please list any outstanding debts other than mortgages *

Insurance

Personal Life Insurance

Spouse/Significant Other Life Insurance

General Health *

Type of Insurance *

General Health *

Type of Insurance *

What was the rating? *

Preferred (very healthy and no tobacco use) Standard Non-tobacco (some medical conditions and no tobacco use) Tobacco

Death Benefit *

Yearly Premium *

Cash Value *

What was the rating? *

Preferred (very healthy and no tobacco use) Standard Non-tobacco (some medical conditions and no tobacco use) Tobacco

Death Benefit *

Yearly Premium *

Cash Value *

Income & Expenses

Personal Income

Wages/Salary *

Social Security *

Pension *

Investment Income *

Rental Income *

Other Income *

Total Income *

Desired Retirement Income *

Spouse/Significant Other Income

Wages/Salary *

Social Security *

Pension *

Investment Income *

Rental Income *

Other Income *

Total Income *

Desired Retirement Income *

Do you expect a significant change in cash flow in the near future? *

Yes No

Do you expect a significant change in cash flow in the near future? *

Yes No

If yes, please explain *

Investment Accounts:
Non-Qualified Accounts, Qualified Accounts, Savings Accounts

Any asset not listed *

Redirected Money

Monthly Over-Payments from Debts *

Monthly Contribution to Investments *

Spending Planner (Found discretionary money) *

Amount to Pull from Qualified Accounts *

Amount to Pull from non-Qualified Accounts *

1035 Exchange *

Life Ins. Premium Being Replaced Monthly *

Other Available Money (Future) *

Total *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *