Name
Social
Security
Date of Birth
______________________________
_____________________ __________________
______________________________
_____________________ __________________
______________________________
_____________________
__________________
______________________________
_____________________
__________________
______________________________
_____________________
__________________
______________________________
_____________________
__________________
______________________________
_____________________
__________________
Please include children's and
spouses information, if applicable. Also include
information of
any non-family member you wish to designate as a beneficiary
on your
retirement accounts.
Name of Account Holder (1) : ____________________________________________
Home Street Address ______________________________________________________________
City _________________________ State ___________________ Zip _____________________
Home Phone___________________ Home Fax ________________ Email __________________
Driver's License# _______________ Expiration: _________________ State ________________
Employer Name and Occupation ______________________________________ Years ____
Employer Street Address ____________________________________________________________
City _______________________________ State ________________ Zip __________________
Work Phone ______________ Work Fax ____________________ Email __________________
401k/403B Investment Firm ______________________ Balance in Plan __________________
Name of Account Holder (2) : ____________________________________________
Home Street Address ______________________________________________________________
City _________________________ State ___________________ Zip _____________________
Home Phone___________________ Home Fax ________________ Email __________________
Driver's License# _______________ Expiration: _________________ State ________________
Employer Name and Occupation ______________________________________ Years ____
Employer Street Address ____________________________________________________________
City _______________________________ State ________________ Zip __________________
Work Phone ______________ Work Fax ____________________ Email __________________
401k/403B Investment Firm ______________________ Balance in Plan ___________________
Other Key Advisors:
Accountant ________________ Firm Name ___________________ Email _________________
Attorney ________________
Firm Name ___________________ Email __________________
Do You Have a Will Prepared? _____________
Bank /Credit Union ( Checking and Savings) ___________________________________________
Cash Reserve Amount on Hand (Savings for Unexpected Needs) _____________
Current Investment Accounts Maintained at the Following Firms:
(Please also provide recent statement copy for each account)
Firm ____________________ Advisor Name _____________________ Amount _____________
Firm ____________________ Advisor Name _____________________ Amount _____________
Firm ____________________ Advisor Name _____________________ Amount _____________
Firm ____________________ Advisor Name _____________________ Amount _____________
Firm ____________________ Advisor Name _____________________ Amount _____________
Firm ____________________ Advisor Name _____________________ Amount _____________
Summary of Real Estate:
Approximate Value of Home
____________ Loans
Outstanding _________________
Other Real Estate Mkt Value
____________ Loans
Outstanding _________________
Other Investments Including Partnerships, etc.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Summary of Non-Real Estate Debts and Financial Obligations:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Retirement Goals:
Planned Retirement Date _________________________
Expected Annual Income Necessary if You Retired Now (Today) _______________
Current Combined Household Annual Income _____________
Planned Savings in Current Year ______________
Overall Financial Goals:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Note: Please do not email this information but rather fax to 503-293-3507
or send via traditional mail.
Parish & Company
10260 SW Greenburg Road, Suite 400
Portland, Oregon 97223
Fax: 503-293-3507
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