Financial Analysis Information Form | New Way Home

Name *Birth date

AddressCityZip code

Email *CellEmployerGross monthly income$

Second applicant / spouse

NameBirth dateEmailCellEmployerGross monthly income$

Children

Child 1 nameBirth date

Child 2 nameBirth date

Child 3 nameBirth date

Child 4 nameBirth date

Income & property taxes

Do you normally receive a tax return? Yes No

If yes, how much?$Total annual property taxes$

Liquid / emergency funds

Current checking and savings accounts$

Retirement

How much is currently saved for retirement?Person 1$Person 2$

Are any savings still with a previous employer?

Person 1 Yes No

Person 2 Yes No

If yes, how much?Person 1$Person 2$

Would you prefer to roll these funds over to your control?

Person 1 Yes No

Person 2 Yes No

Do you currently contribute to an employer retirement plan?

Person 1 Yes No

Person 2 Yes No

If yes, how much per pay period?Person 1 ($ or %)Person 2 ($ or %)

Employer contribution per pay periodPerson 1 ($ or %)Person 2 ($ or %)

How often are you paid?Person 1Person 2

Future funds for children

Would you like to save for your children's future? Yes No

Child	Desired savings	Current savings	Current monthly savings
Child 1
Child 2
Child 3
Child 4

Debt

Account type	Lender / account name	Balance	Rate	Minimum payment	Extra paid every month
Mortgage
Auto lender 1
Auto lender 2
Student loan 1
Student loan 2
Credit card 1
Credit card 2
Credit card 3
Credit card 4

Auto & home insurance

Auto insurance companyAnnual auto premium$Home / renters insurance companyAnnual home / renters premium$How many years ago did you last shop auto/home insurance?

Life insurance & will

Would you want income replacement after an early death? Yes No

If yes, desired monthly incomePerson 1$Person 2$

Number of years income should be replaced

Child 1 amount$Child 2 amount$Child 3 amount$Child 4 amount$

Employer life insurance amountPerson 1$Person 2$

Amount paid for employer coveragePerson 1$Person 2$

Personal life insurance amountPerson 1$Person 2$

Insurance companyAnnual premium$

Is your current life insurance agent a close friend or family member? Yes No

Any tobacco or nicotine use in the past 12 months?

Person 1 Yes No

Person 2 Yes No

Any vaping?

Person 1 Yes No

Person 2 Yes No

Any THC use?

Person 1 Yes No

Person 2 Yes No

Any major health issue in the past 12 months?

Person 1 Yes No

Person 2 Yes No

If yes, please explain

What's important to you?

Rate each item from 1 (least important) to 5 (most important), or choose N/A.