Thank you!

Thank you for your interest in a Discovery Visit with an Advisor on our team. You will be asked to complete a series of questions below to help us understand your current financial situation. Please note, if you start the electronic questionnaire below, you will NOT be able to stop and save the information. If you are not prepared to complete the online form now, please click the button below to download the MWM Financial Questionnaire PDF. Once you have filled it out, please scan the completed file and use the Secure File Upload link below to return the completed questionnaire to us so we can better prepare for our Discovery Visit! Once received, someone from our office will be contacting you by email to schedule a time to meet with a member in person, over the phone or via Zoom. Please don't hesitate to give us a call at 480-550-6556 or send us an email at info@MartinsenWealth.com if you have any questions. We can't wait to visit with you!

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Financial Questionnaire

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Step 1 of 5

20%

General Information

Name*

First Last

Nickname

Date of Birth

YYYY

Primary Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Current/Former Employer

Retired

Yes

Desired Retirement Date

YYYY

Client Email*

Occupation

Emp. (City, St, Zip)

Spouse Name

First Last

Spouse Nickname

Spouse Date of Birth

YYYY

Spouse Current/Former Employer

Spouse Retired

Yes

Spouse Desired Retirement Date

YYYY

Spouse Email

Spouse Occupation

Spouse Emp. (City, St, Zip)

Home Phone

Client Cell*

Spouse Cell

Income Information

Please list MONTHLY income from each source:

Self Gross Salary (Wages, Round to Nearest Whole Number)

Spouse Gross Salary (Wages, Round to Nearest Whole Number)

Self Social Security (Round to Nearest Whole Number)

Spouse Social Security (Round to Nearest Whole Number)

Self Pension (Round to Nearest Whole Number)

Spouse Pension (Round to Nearest Whole Number)

Self IRA/401(k) Distributions (Round to Nearest Whole Number)

Spouse IRA/401(k) Distributions (Round to Nearest Whole Number)

Self Income from Investments (Round to Nearest Whole Number)

Spouse Income from Investments (Round to Nearest Whole Number)

Self Rental Income (Real Estate, Round to Nearest Whole Number)

Spouse Rental Income (Real Estate, Round to Nearest Whole Number)

List any other sources of income and their amounts for yourself and your spouse below:

Expenses

What is the monthly cost to support your life-style? (Not just living expenses, round to nearest whole number)

Desired monthly "net spending" in your retirement? (Round to Nearest Whole Number)

The most accurate way to understand your true living expenses is to add what actually came out of your bank account in the last 12 months. Please consider the following: Utilities, vacations, dinners, hobbies, etc.

Cash Flow

Is your current cash flow sufficient and comfortable?

Yes

If you answered no, please explain:

Are you planning any major lifestyle changes?

Yes

If you answered yes, please explain:

Do you anticipate any significant changes in cash flow?

Yes

If you answered yes, please explain:

Do you foresee purchases over $20,000 in the next 3 years?

Yes

If you answered yes, please explain:

Objectives

What are your financial objectives? (Check all that apply)

Retirement Income

Develop a more conservative portfolio

Pass assets to beneficiaries

Protect assets from market volatility

Reduce fees

Reduce taxes

Other

If you answered other, please explain:

Risk Assessment Questionnaire

The Risk Assessment Questionnaire can help to determine an appropriate mix of financial vehicles for a financial strategy, based on the answers given to the questions below. This page must be completed for compliance purposes.

What do you think a reasonable rate of return is? (for client)

What do you think a reasonable rate of return is? (for spouse)

What percentage of your money would you be OK with losing?

(for client)

What percentage of your money would you be OK with losing?

(for spouse)

What is your risk tolerance on a scale of 1-99? (for client)

What is your risk tolerance on a scale of 1-99? (for spouse)

How much short-term, immediate cash do you want available? (Round to Nearest Whole Number)

(for client)

How much short-term, immediate cash do you want available? (Round to Nearest Whole Number)

(for spouse)

There are four things you can do with your nest egg. Which two are the most important to you and your spouse?

Spend it

Purchase financial products with risk of loss to principal

Pass it on to family through inheritance

Purchase financial products, including insurance products without the risk of loss to principal

Long-Term Goals and Expectations - Your views of how a financial vehicle should perform over the long-term

What is your goal for your retirement resources? Which two are the most important to you and your spouse?

To grow aggressively

To grow with caution

To grow significantly

To avoid losing money

To grow moderately

Suppose the stock market performs poorly over the next decade, what would you expect from your retirement investments?

To lose money

To make a modest gain

To make very little or nothing

To be little affected by what happens in the stock market

To make out with a little gain

Short-Term Risk Attitude - Your attitude toward short-term volatility

Which of these statements would best describe your attitude about the next 12 months' performance of retirement investments?

I don't mind if I lose money

If I suffered a loss of greater than 10% I'd get concerned

I can tolerate a small loss

I'd have a hard time stomaching any losses

I wouldn't worry about losses in that time frame

Employer Retirement Plans

Pension Details

If there is a Lump Sum Option, what is the lump sum amount? (Round to Nearest Whole Number)

(for client)

If there is a Lump Sum Option, what is the lump sum amount? (Round to Nearest Whole Number)

(for spouse)

If there is an annual Cost of Living Adjustment (COLA), what is the annual increase as a percent?

(for client)

If there is an annual Cost of Living Adjustment (COLA), what is the annual increase as a percent?

(for spouse)

If there is a Survivor Benefit, what percent does the survivor receive?

(for client)

If there is a Survivor Benefit, what percent does the survivor receive?

(for spouse)

Are you currently contributing to an employer retirement plan?

(for client)

Yes

Are you currently contributing to an employer retirement plan?

(for spouse)

Yes

If yes, what type? (ex. 401k, 403b, 457, TSP, Simple IRA, SEP IRA)

What percent of your income do you contribute? (for client)

What percent of your income do you contribute? (for spouse)

What percent does your employer match? (for client)

What percent does your employer match? (for spouse)

Does the employer offer a "Roth" option? (for client)

Yes

Does the employer offer a "Roth" option? (for spouse)

Yes

Do you max fund an Individual Retirement Account (IRA) Annually? (for client)

Yes

Do you max fund an Individual Retirement Account (IRA) Annually? (for spouse)

Yes

Comments

This field is for validation purposes and should be left unchanged.

480.550.6556

Thank you!

Financial Questionnaire

General Information

Income Information

Expenses

Cash Flow

Objectives

Risk Assessment Questionnaire

Long-Term Goals and Expectations - Your views of how a financial vehicle should perform over the long-term

Short-Term Risk Attitude - Your attitude toward short-term volatility

Employer Retirement Plans

TEMPE OFFICE

VALENCIA OFFICE

TUCSON OFFICE

REMOTE OFFICE

Ready to Take the Next Step?

Schedule a Complimentary Meeting
Services available in all 50 States

Give Us a Call

480.550.6556

Send Us a Fax

480.452.1691

Email Us

info@martinsenwealth.com

Connect With Us

Main Office

7855 S. River Parkway, Suite 206, Tempe, AZ 85284

Additional Locations

25350 Magic Mountain Parkway, Suite 300 Valencia, CA 91355

4767 E. Camp Lowell Drive,
Tucson, AZ 85712

Stay Informed the Easy Way

Quick Links

480.550.6556

Thank you!

Financial Questionnaire

General Information

Income Information

Expenses

Cash Flow

Objectives

Risk Assessment Questionnaire

Long-Term Goals and Expectations - Your views of how a financial vehicle should perform over the long-term

Short-Term Risk Attitude - Your attitude toward short-term volatility

Employer Retirement Plans

TEMPE OFFICE

VALENCIA OFFICE

TUCSON OFFICE

REMOTE OFFICE

Ready to Take the Next Step?

Schedule a Complimentary MeetingServices available in all 50 States

Give Us a Call

480.550.6556

Send Us a Fax

480.452.1691

Email Us

info@martinsenwealth.com

Connect With Us

Main Office

7855 S. River Parkway, Suite 206, Tempe, AZ 85284

Additional Locations

25350 Magic Mountain Parkway, Suite 300 Valencia, CA 913554767 E. Camp Lowell Drive,Tucson, AZ 85712

Stay Informed the Easy Way

Newsletter Subscription

Quick Links

Schedule a Complimentary Meeting
Services available in all 50 States

25350 Magic Mountain Parkway, Suite 300 Valencia, CA 91355

4767 E. Camp Lowell Drive,
Tucson, AZ 85712