Client Data Gathering - Oak Road Wealth Management

Personal Information

Your Name(Required)

First Middle Last

Birthdate(Required)

Your Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Gender

Male

Female

Marital Status(Required)

Spouse's Name(Required)

First Middle Last

Spouse's Birthdate(Required)

Spouse's Gender

Male

Female

Spouse's Phone(Required)

Spouse's Email(Required)

Spouse's Address (if different)

Street Address Address Line 2 City State ZIP Code

Your Employment

Current Employer

Job Position

Salary

Bonus

Do you have any stock options?

Yes

No

What age do you plan on retiring?

Do you have another employer?

Yes

No

Employer 2

Job Position

Salary

Bonus

Spouse's Employment

Spouse's Employer

Job Position

Salary

Bonus

Do you have any stock options?

Yes

No

What age do you plan on retiring?

Do you have another employer?

Yes

No

Spouse's Employer 2

Job Position

Salary

Bonus

Annuities, Pensions, Social Security

Do you currently, or expect to have in the future, income from the following (check all that apply)

Social Security

Pension

Annuities

Please List the current or expected income from the above sources

Family

How many children do you have?

Child 1 Name

First Last

Age

Child 2 Name

First Last

Age

Child 3 Name

First Last

Age

Child 4 Name

First Last

Age

Child 5 Name

First Last

Age

Child 6 Name

First Last

Age

Child 7 Name

First Last

Age

Are you caring for any other dependents?

Yes

No

Your Retirement Accounts

Please check the retirement accounts you currently have:

401(k)

IRA(s)

Other

401(k) Employer

Pre-Tax Account Balance

Roth Account Balance

Pre-Tax Employee Deferral (%)

Roth Employee Deferral (%)

Employer Contribution (%)

Traditional IRA(s) Balance

Roth IRA(s) Balance

Monthly Pre-Tax Contributions ($)

Monthly Roth Contributions ($)

List any other retirement accounts and their balances here:

Spouse's Retirement Accounts

Please check the retirement accounts you currently have:

401(k)

IRA(s)

Other

401(k) Employer

Pre-Tax Account Balance

Roth Account Balance

Pre-Tax Employee Deferral (%)

Roth Employee Deferral (%)

Employer Contribution (%)

Traditional IRA(s) Balance

Roth IRA(s) Balance

Monthly Pre-Tax Contributions ($)

Monthly Roth Contributions ($)

List any other retirement accounts and their balances here:

Assets

Please check all assets you own

Bank Accounts

Certificates of Deposit

Taxable Investment Accounts

Annuities

Home

Bank Accounts

Estimated Aggregate Balance

Certificates of Deposit

Estimated Aggregate Balance

Taxable Investment Accounts

Estimated Aggregate Balance

Annuities

Estimated Aggregate Value

Home

Estimated Value of Your Home

Other

Please list any other assets you own and their value

Estate Planning Documents

Please check all the estate documents you currently have

Will

Trust

Power of Attorney

Living Will

Other

Will

Name

Year

Where

State

Trust

Name

Year

Where

State

Power of Attorney

Name

Year

Where

State

Living Will

Name

Year

Where

State

All Others

List any other estate documents, the year it was established, and the state where it was established

Liabilities

Please check all the liabilities you currently have

Mortgage

Auto Loan

Credit Card Debt

Student Loans

Personal Loan

Other

Mortgage

Owner

Start Date

End Date

Interest Rate

Monthly Payment

Original Balance

Current Balance

Auto Loan

Owner

Start Date

End Date

Interest Rate

Monthly Payment

Original Balance

Current Balance

Credit Card Debt

Owner

Current Balance

Interest Rate

Monthly Payment

Student Loans

Owner

Start Date

End Date

Interest Rate

Monthly Payment

Original Balance

Current Balance

Personal Loan

Owner

Start Date

End Date

Interest Rate

Monthly Payment

Original Balance

Current Balance

Other

Please list any additional loans, their interest rate, monthly payment, and current balance

Retirement Goals

Basic Information

Your Planned Retirement Age

Spouse's Planned Retirement Age

Expected Regular Yearly Expenses in Retirement

Travel Goals in Retirement

Expected Travel Spending

Frequency

ex. One-Time, Annual, Every Other Year

Leave a Bequest

Description

Amount

Other Goals

Please list any other additional retirement goals, their frequency, and the amount needed