Green Financial client update form

Date

Name

Address

Street address, P.O. box, company name, c/o

City

state

Zip Code

Preferred Contact Method

Phone Email Mail

Primary Contact Number

Secondary Contact Number

Primary Email Address

Secondary Email Address

Current Employer and Occupation

If not already in retirement, when do you plan to retire?

Annual Household Income

Liquid Net Worth

Net Worth

Tax Bracket

What are your average monthly expenses?

Have there been, or do you expect, any material changes to your financial situation that could impact your investment planning over the next 3-5 years? (employment, college, marital status, children, major purchase, etc)?

Yes No

If yes, please indicate the changes here

Do you anticipate needing to make any withdrawals from your investment accounts over the next 3-5 years, outside of any you already take regularly?

Yes No

If yes, please indicate the changes here

Is an inheritance part of your overall financial planning (receiving or giving)?

Yes No

If yes, please indicate the changes here

8a.

Have you planned for unexpected loss of income via disability insurance?

Yes No

8b.

If married and both are working, do you both have coverage?

Yes No

9a.

Have you planned for unexpected nursing home/in-home care needs via LTC INS?

Yes No

9b.

If married, do you both have long-term care coverage?

Yes No

10a.

Have you planned for the financial care of your dependents via life insurance?

Yes No

10b.

If married, do you both have life insurance?

Yes No

12.

Please check any topics you would like to discuss with an advisor:

13.

Customer service is important to us. please provide any feedback you have on the service you have received from our staff over the past year:

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Reminder note: Please make sure you have designated beneficiaries for all of your assets and review them periodically. Also it is important to have a valid will and directives in place and to ensure someone knows where to find your important documents.

Investment Advisor Representative offering securities & advisory services through Cetera Advisors LLC, a Registered Investment Advisor, Broker/Dealer, member FINRA, SIPC. Green Financial Resources, LLC is otherwise unaffiliated with Cetera Advisors LLC. Office located at 3700 Crestwood Pkwy NW, Duluth, GA 30096

Green Financial Resources

Contact Info

Client Update Form

Green Financial client update form

Click here to print the completed form for your records before submitting

Contact Info

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