Dear Valued Client,

I wanted to take this opportunity to thank you for placing your confidence in Maier & Associates Financial Group, Inc. I also want to assure you that we will never take you for granted and will put your best interest ahead of our own.

Over the years, we have established a set of values that we live by and I would like to take a minute to share them with you.

HelpingOthers

Placing importance on assisting other people

Independence

Ability to be self-directed in one’s thoughts and actions

Service

Placing importance on serving others with quality and value

Excellence

Pursuit of the highest level of optional performance

Integrity

Firm adherence to a moral code and/or set of values; "'walking the talk"

Honesty

Telling the truth, not engaging in deception, is forthright and candid

As you can see from our values, we are truly dedicated to assisting our clients in pursuing their financial objectives. Again, thank you for placing your confidence in our firm. We look forward to a long and rewarding relationship.

Sincerely.

Wayne C. Maier. BFA^TM CEO

In order to thoroughly define your goals and prioritize your needs and objectives, please complete this financial profile. In addition to the questions asked, we request that you provide us with any additional information that you feel is pertinent to your financial situation. This should include copies of the following:

• Your most current tax return and W2s
• Your investment and/or brokerage statement(s), including the pages that show how the account is invested.
• Your employer sponsored plan statement(s), including the pages that show how the account is invested. Also include the investment choices available within the plan.
• Your benefits and insurance policy statement(s), including coverage details
• A recent pay stub
• Recent Social Security statements
• Pension estimates reflecting the following:

1. Benefits on the day you would like to retire
2. Benefits for your spouse, if you were to pass away today
3. Benefits on the day of your full retirement age

• Estate planning documents
• Property & Casualty declaration pages

In addition to the information requested above, please be prepared to discuss the following (if applicable):

• Savings rate and budget analysis
• Current and long term liabilities
• Age at which you wish to stop working
• Income at retirement coupled with Social Security
• Current or future estate and legal needs

COMPLETING THE FINANCIAL PROFILE

On the following pages, we request that you complete the date to the best of your ability. If you would like our help or guidance, we would be happy to assist you during the data gathering process.

Please know that all personal and financial data discussed and collected is treated with strict confidentiality whether or not you become a client. By completing this form, we will assume that the information provided is both complete and accurate to the best of your ability.

Physical Address

Mailing Address (if different)

Home Phone

1. Recent Social Security statements. If you do not have a recent statement, please go to www.ssa.gov, create a login and print your Social Security statements. If you do not have access to a computer or would like assistance, we can help do this at your next meeting.
2. If you will have a pension, please provide estimates reflecting the following:

• Your benefit at the age you would like to retire.
• Your spouse’s benefit, if you were to pass away today.
• Your benefit at your full retirement age.

Cash Equivalents (Checking, Savings, Cash, etc…)

Assets

Balance

Yield %

Holding Time

Ownership

Other Investments (401(k), 403(b), IRA, Stocks, Mutual Funds, Bonds, 529 Plans, etc…)

Assets

Balance

Yield %

Holding Time

Ownership

Life Insurance Information

Individual Life Insurance

Client #1

• Death Benefit: 
• Type of Policy: 
• Premium: 
• Loan Amount: 
• Cash Value: 
• Year Purchased: 
• Company: 

Client #1

• Death Benefit:
• Type of Policy:
• Premium:
• Loan Amount: 
• Cash Value:
• Year Purchased:
• Company:
  

Disability Insurance Information

Short Term Disability                                           Client #1                          Client #2

• Type of Coverage (group or personal)
• Current Monthly Benefit
• Elimination Period
• Benefit Period
• Current Annual Premium
• Cost of Living Increase

Long Term Disability                                             Client #1                                Client #2

• Type of Coverage (group or personal)
• Current Monthly Benefit
• Elimination Period
• Benefit Period
• Current Annual Premium
• Cost of Living Increase

Long Term Care Insurance

Long Term Care Insurance                                 Client #1                                    Client #2

• Nursing Home Daily Benefit
• Elimination Period
• Benefit Period
• Home Health Care Daily Benefit
• Current Annual Premium
  

College Savings

• Number of years you want to fund for each child?
• In today’s dollars, how much per year do you want to provide for each child?
• Current dollars set aside for each child?
• Monthly savings for each child?

Concerns and Objectives

• Are you anticipating any major lifestyle changes? (retirement, moving, etc)
• If so, what changes are you expecting?
• Are you comfortable with your current cash flow?
• Do you anticipate any significant changes in your cash flow?
• Do you anticipate any major expenditure in the near future?
• If so what expenditures are you expecting?

Retirement Planning

• If you plan on working after retirement, estimate your expected income:
• How long do you plan on working after retirement?
• What is your estimated cost for healthcare?
• Will you have health care benefits through your employer after retirement?

Protection

• Do you or your spouse have any potential health problems?
• Do you and your spouse have adequate medical coverage?
• Are you eligible for a Health Savings Account?
• Do you have one? And is it funded?
• Do you and your spouse have personal liability
  coverage (Umbrella policy)?

Estate Planning (please provide copies of documents)

• Do you have updated / adequate wills?
• Have you established any trust?
• Are you the beneficiary of any trusts?
• Will you be receiving a significant inheritance?
• Is proper titling of property a concern?

PLEASE LIST TWO OF YOUR FINANCIAL GOALS FOR THE FOLLOWING TIME FRAMES:

• 1 – 2 years:
• 3 – 5 years:
• 10+ years:

FINANCIAL AND PERSONAL PLANNING QUESTIONS:

• What worries you about your financial situation?
• If you are not on track, what are you willing to change to get back on track?
• What traits (personal & professional) are you looking for in your financial planner?
• What are your expectations of the professionals at Maier & Associates Financial Group, Inc., this process and this experience?
• If we can help you accomplish one thing in the next 6 months, what would that be?
• Describe your experience(s) with other advisors (legal, tax, financial, etc.)
• What is something that you enjoy doing outside of work?
• Are you an emotional or logical decision maker?