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Step 1 of 16

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Personal Information

Client

Name
MM slash DD slash YYYY
Employment Status
Is there a co-client

Co-Client

Name
MM slash DD slash YYYY
Employment Status

Important Relationships

Family Relationships
Name
Date of Birth
Relationship
 
Professional Relationships
Name
Role
Contact Information
 

Expectations & Concerns

What do you most look forward to? What worries or concerns you? Select what applies to you.

Client Expectations

No Work
Part-Time Work for a Few Years
Never Completely Retire
Active Lifestyle
Quiet Lifestyle
Time to Travel
Time with Friends and Family
Opportunity to Help Others
Moving to a New Home
Start a Business
Less Stress - Peace of Mind
Quiet Lifestyle
Other

Client Retirement Concerns

Not having a paycheck anymore
Running out of money
Suffering investment losses
Leaving money to others
Spending too much
Cost of health care/long-term care
Current or future health issues
Dying early
Living too long
Getting Alzheimer’s (or other illness)
Going into a nursing home
Being bored
Too much time together
Parents needing care
Family needs financial help
Kids moving home
Care for child with special needs
Other

Co-Client Expectations

No Work
Part-Time Work for a Few Years
Never Completely Retire
Active Lifestyle
Quiet Lifestyle
Time to Travel
Time with Friends and Family
Opportunity to Help Others
Moving to a New Home
Start a Business
Less Stress - Peace of Mind
Quiet Lifestyle
Other

Co-Client Retirement Concerns

Not having a paycheck anymore
Running out of money
Suffering investment losses
Leaving money to others
Spending too much
Cost of health care/long-term care
Current or future health issues
Dying early
Living too long
Getting Alzheimer’s (or other illness)
Going into a nursing home
Being bored
Too much time together
Parents needing care
Family needs financial help
Kids moving home
Care for child with special needs
Other

Social Security Benefits

If available, provide your Social Security estimate from ssa.gov

Client

Are you eligible?
When to start

Co-Client

Are you eligible?
When to start

Retirement Income

(Pension, part-time work, rental property, annuities, royalties, alimony)

Client

List
Description
Monthly Income
Start Year
Year it Ends
% Survivor Benefit
Does the amount inflate
 

Co-Client

List
Description
Monthly Income
Start Year
Year it Ends
% Survivor Benefit
Does the amount inflate
 

Savings

Extra Savings

How willing are you to save more?

Net Worth

Insurance

Have your insurance reviewed and analyzed to see if you have enough coverage.

Client

Group/Term Life Insurance
Cash Life Insurance
Disability Insurance
Long-Term Care Insurance
Cash Value Life Insurance

Co-Client

Group/Term Life Insurance
Cash Life Insurance
Disability Insurance
Long-Term Care Insurance
Cash Value Life Insurance

Investment Assets

Identify all the resources you have to fund your Goals. Don’t worry about determining the exact amounts, reasonable estimates are fine. If available provide your investment statements.

Client

Retirement Plans (e.g., 401k, 403b)
Current Value
Annual Additions
 
Employer Match
Current Value
Annual Additions
 
Traditional IRA
Current Value
Annual Additions
 
Roth IRA
Current Value
Annual Additions
 
529 Savings Plan
Current Value
Annual Additions
 
Annuities
Current Value
Annual Additions
 
HSA
Current Value
Annual Additions
 
Taxable / Brokerage
Current Value
Annual Additions
 
Real Estate Assets
Current Value
Annual Additions
 
Crypto Assets
Current Value
Annual Additions
 
Business Interest
Current Value
Annual Additions
 
Stock Options
Current Value
Annual Additions
 
Other
Current Value
Annual Additions
 
Drop files here or
Max. file size: 50 MB.

    Co-Client

    Retirement Plans (e.g., 401k, 403b)
    Current Value
    Annual Additions
     
    Employer Match
    Current Value
    Annual Additions
     
    Traditional IRA
    Current Value
    Annual Additions
     
    Roth IRA
    Current Value
    Annual Additions
     
    529 Savings Plan
    Current Value
    Annual Additions
     
    Annuities
    Current Value
    Annual Additions
     
    HSA
    Current Value
    Annual Additions
     
    Taxable / Brokerage
    Current Value
    Annual Additions
     
    Real Estate Assets
    Current Value
    Annual Additions
     
    Crypto Assets
    Current Value
    Annual Additions
     
    Business Interest
    Current Value
    Annual Additions
     
    Stock Options
    Current Value
    Annual Additions
     
    Other
    Current Value
    Annual Additions
     
    Drop files here or
    Max. file size: 50 MB.

      Liabilities

      1st Mortgage
      Current Balance
      Monthly Payment
      Interest Rate
       
      2nd Mortgage
      Current Balance
      Monthly Payment
      Interest Rate
       
      HELOC
      Current Balance
      Monthly Payment
      Interest Rate
       
      Bank Notes
      Current Balance
      Monthly Payment
      Interest Rate
       
      Personal Loans
      Current Balance
      Monthly Payment
      Interest Rate
       
      Credit Card
      Current Balance
      Monthly Payment
      Interest Rate
       
      Auto Loans
      Current Balance
      Monthly Payment
      Interest Rate
       
      Other
      Current Balance
      Monthly Payment
      Interest Rate
       
      Drop files here or
      Max. file size: 50 MB.

        Retirement Age

        When would you like to retire? Enter your Target Retirement Age. Then, indicate how willing you are to delay retirement beyond that age, if it helps you fund your Goals.

        Client

        How willing are you to retire later?

        Co-Client

        How willing are you to retire later?

        Living Expense

        If you know your Montly expenses please enter them here, If you would like to use our worksheet, continue to the next page.

        Expenses

        Budget Worksheet

        Identify exactly where your money is going each month. Use this worksheet to assist you to map out your monthly income and expenses so that you may have an accurate assessment of your monthly budget figure.

        Income (Monthly Total)

        Expenses (Monthly Total)

        Results

        Retirement Retirement Lifestyle Goals

        Lifestyle Goals are above and beyond what you need to pay for basic expenses. Rate the importance of each Goal on a scale of 10 1. Needs (10, 9, 8), Wants (7, 6, 5, 4), and Wishes (3, 2, 1).

        Most Common Goals

        Travel College, Car, Home Improvement, Health Care Gift or Donation

        Other Goals

        Wedding, New Home, Celebration, Major Purchase, Start Business, Provide Care, Leave Bequest, Private School or Other

        List
        Importance High Low 10 to 1
        Description
        Start Year
        Amount
        How Often
        How Many Times
         

        Estate Planning

        Philanthropy

        Education Planning

        Risk Score

        How much market risk are you willing to accept? On a scale of 1 to 100, with 1 being the lowest risk and 100 being the highest risk, what’s your risk score?

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        © 2022 Tushaus Wealth Managment. There are no warranties implied.

        Tushaus Group, LLC (“RIA Firm”) is an investment adviser located in Scottsdale, AZ. Tushaus Group, LLC may only transact business in those states in which it is registered, or qualifies for an exemption or exclusion from registration requirements. Tushaus Group, LLC’s web site is limited to the dissemination of general information pertaining to its advisory services, together with access to additional investment-related information, publications, and links. Accordingly, the publication of Tushaus Group, LLC’s web site on the Internet should not be construed by any consumer and/or prospective client as Tushaus Group, LLC’s solicitation to effect, or attempt to effect transactions in securities, or the rendering of personalized investment advice for compensation, over the Internet. Any subsequent, direct communication by Tushaus Group, LLC with a prospective client shall be conducted by a representative that is either registered or qualifies for an exemption or exclusion from registration in the state where the prospective client resides. For information pertaining to the registration status of Tushaus Group, LLC, please contact the state securities regulators for those states in which Tushaus Group, LLC maintains a registration filing. A copy of Tushaus Group, LLC’s current written disclosure statement discussing Tushaus Group, LLC’s business operations, services, and fees is available at the SEC’s investment adviser public information website – www.adviserinfo.sec.gov or from Tushaus Group, LLC upon written request. Tushaus Group, LLC does not make any representations or warranties as to the accuracy, timeliness, suitability, completeness, or relevance of any information prepared by any unaffiliated third party, whether linked to Tushaus Group, LLC’s web site or incorporated herein, and takes no responsibility therefor. All such information is provided solely for convenience purposes only and all users thereof should be guided accordingly.

        This website and information are provided for guidance and information purposes only. Investments involve risk and unless otherwise stated, are not guaranteed. Be sure to first consult with a qualified financial adviser and/or tax professional before implementing any strategy. This website and information are not intended to provide investment, tax, or legal advice.

        The firm is a registered investment adviser with the state of Arizona, California, Colorado, Texas, Kansas and Missouri, and may only transact business with residents of those states, or residents of other states where otherwise legally permitted subject to exemption or exclusion from registration requirements. Registration with the United States Securities and Exchange Commission or any state securities authority does not imply a certain level of skill or training.

        Insurance products and services are offered and sold through Tushaus Partners, LLC and individually licensed and appointed insurance agents.

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        • About Us
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          • Chase Tushaus
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          • Kenzie Trusela
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