GE Financial Planning Questionnaire

REQUESTED DOCUMENTS, IF APPLICABLE:___ Personal Financial Statement ___ Most Recent Paystub___ Investment Statements (401(k), Brokerage, IRA, 529, etc.) ___ Social Security Statements ___ Liability Statements (Mortgage, Business, Car, etc.) ___ Previous Year’s Tax Return ___ Insurance Statements (Life, Disability, Long-term Care) ___ Estate Documents (Will, POA, Trust)

REQUESTED GE DOCUMENTS, IF APPLICABLE:___ RSUs/Stock Options Detail ___ Leadership Life___ Long-Term Incentive Statement, Investments, Schedules ___ Beneficiary Statement___ Fidelity RSP Statement & Source Details ___ Insurance Summary___ Deferred IC/ Salary details ___ Enrollment Summary___ GE Pension Estimates (Vested/Projected) ___ UBS Statement

Name Date of Birth Phone EmailClient: ___________________________ _____________ ______________ _____________________________Spouse: ___________________________ _____________ ______________ _____________________________

Child: ___________________________ _____________ Child: ___________________________ _____________Child: ___________________________ _____________ Child: ___________________________ _____________Notes: _____________________________________________________________________________________________________________________________________________________________________________________________________________

RESIDENCE: Address: _______________________________________________________________________________________________Value: _____________________ Mortgage (Balance, Rate, Payment): $ _____________________ ______ % $ _________________________

GOALS: Client Spouse At what age(s) would you like to retire? _______ _______What are you plans for retirement? (Education Funding? Vacation Home? Weddings?):________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

INCOME: Source Whose Amount BonusSalary: _______________________ $___________ /annual $___________ /annualSalary: _______________________ $___________ /annual $___________ /annualOther: _______________________ $___________ /annual $___________ /annualNotes: __________________________________________________________________________________________________________________________________________________________________________________________________________

EXPENSES:Average after-tax monthly spending: $______________Average estimated leftover income after all savings, expenses, and taxes: $______________Comments: ___________________________________________________________________________________________________________________________________________________________________________________________________________

BUSINESS INTEREST/RENTAL PROPERTIES (AS APPLICABLE):Location: _________________________________________________ Ownership %: _______________Entity Type (Sole Proprietorship, LLC, S Corp, C Corp, Partnership): ________________________Estimate or Actual Value: _______________________ Lease Income/Payments: __________________Debt (Balance, Rate, Payment) $________________ ______% $____________________________Do you plan to sell with business? ________________________________________________________________________If multiple, please attach schedules.

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