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Confidential Questionnaire

You are here: Home / Clients / Resources / Confidential Questionnaire

Confidential Questionnaire

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  • Your Information

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  • Spouses Information

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  • Beneficiaries

    Click on the "+" button to add more information
  • NameRelationshipDate of BirthDependent?Resides? (City & State) 
  • Work Information

  • DescriptionAmount 
  • Spouses Work Information

  • DescriptionAmount 
  • Retirement Plans

  • Spouses Retirement Plans

  • Do you have the following estate planning documents?

  • MM slash DD slash YYYY
  • Indicate which of the following statements summarize your attitudes or beliefs using a scale of 1-5.

    1 being most true and 5 least true
  • Please enter a number from 1 to 5.
  • Please enter a number from 1 to 5.
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  • Please enter a number from 1 to 5.
  • Please enter a number from 1 to 5.
  • Please enter a number from 1 to 5.
  • Please enter a number from 1 to 5.
  • Advisor Relationships - Satisfaction Rating

    Where applicable, please rate your working relationships with each of the following advisors. 1 being dissatisfied and 5 being very satisfied
  • Please enter a number from 1 to 5.
  • Please enter a number from 1 to 5.
  • Please enter a number from 1 to 5.
  • Please enter a number from 1 to 5.
  • Please enter a number from 1 to 5.
  • Please enter a number from 1 to 5.
  • Life Insurance

  • MM slash DD slash YYYY
  • Spouses Life Insurance

  • MM slash DD slash YYYY
  • Long Term Care Insurance

  • MM slash DD slash YYYY
  • Spouses Long Term Care Insurance

  • MM slash DD slash YYYY
  • Disability Insurance

  • MM slash DD slash YYYY
  • Spouses Disability Insurance

  • MM slash DD slash YYYY
  • Assets

  • Bank NameType (checking, Savings, money market)Account OwnerAverage Value 
  • Type (IRA, Roth, 401(k), 403(b), etc.)Account OwnerInterest Rate (if CD. Fixed Ann)CompanyApproximate Value 
  • Type (ESA. 529 UTMA, UGMA)Recipient/ChildInterest Rate (CD. Fixed Ann)CompanyApproximate Value 
  • Type (Indiv, Joint, TOD, etc.)Recipient/ChildInterest Rate (CD. Fixed Ann)CompanyApproximate Value 
  • Personal Property

  • TypeEstimated Value 
  • TypeEstimated Value 
  • Liabilities

  • DescriptionInterest Rate (%)Average Monthly PaymentCurrent Balance 
  • DescriptionInterest Rate (%)Average Monthly PaymentCurrent Balance 
  • DescriptionInterest Rate (%)Average Monthly PaymentCurrent Balance 
  • DescriptionInterest Rate (%)Average Monthly PaymentCurrent Balance 
  • DescriptionInterest Rate (%)Average Monthly PaymentCurrent Balance 
  • DescriptionInterest Rate (%)Average Monthly PaymentCurrent Balance 
  • These items may be needed, should you choose to engage our services:

    • Prior Year Tax Return
    • Paycheck Stubs
    • Brokerage Account Statements
    • Mutual Fund Account Statements
    • Trust Account Statements
    • Employee Benefits Booklet
    • Retirement Plan Account Statements
    • Divorce Decrees
    • Loan Documents
    • Insurance Policies
    • POA Documents
    • Trust Documents
    Thank you for your interest in Vision Financial Advisory Corporation, PC! Please complete and return the Confidential Questionnaire email to dawn.phillips@visionfinancialpc.com or return by mail to Vision Financial Advisory Corp, PC at 5787 Balsam Dr., Hudsonville, MI 49426

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