Questionnaire - Adaptive Wealth Solutions

First Name*
Last Name*
Relationship Status*
- Married
- Single
- Cohabitating
- Divorced
Spouse's First Name*
Spouse's Last Name*
Your Current Work Status*
Select your whether you are still working or whether you are retired here.
Your Spouse's Current Work Status*
Select your whether your spouse still working or whether your spouse is retired here.
Your Date of Birth*
MM
DD
YYYY
Spouse's Date of Birth*
MM
DD
YYYY

Do You Have Children?
Name and Age of Your Children
Name Birthdate (MM/DD/YYYY) Notes

Press the (+) button at the end of the row to add a row.
Notes

If you would like to add any further information regarding your children, you may enter it here.

Financial Planning Priorities

Please list your top financial planning priorities.
Have You Worked With A Financial Professional Before?

Your Current Annual Income*
Enter your current annual income here. If you are retired, enter the income you earned the year before you retired.
Spouse's Current Annual Income*
Enter your spouse's current annual income here. If your spouse is retired, enter the income your spouse earned the year before they retired.
Current Annual Expenses*
Enter your current annual expenses here. Do not include investment contributions in this number.
When Do You Plan To Retire*
Enter the year you plan to retire
When Doess Your Spouse Plan To Retire
Enter the year your spouse plans to retire
When Did You Retire?*
Enter the year you retired
When Did Your Spouse Retire?
Enter the year your spouse retired.

Best Estimate of Total Assets*
Estimate the value of a home, rental home, and the value of your investments, and any other assets you possess.
Best Estimate of Total Liabilities*
Estimate the value of any mortgages, auto loans, credit cards, home equity loans, and other debts you possess.

Investment Information*
Choose whether you would like to enter the information in manually or upload the files.
Best Estimate Of Your Taxable Investment Assets*
Enter only the portion of your total portfolio value that is in taxable (brokerage) accounts. This includes all stocks, bonds, mutual funds, ETFs, CDs, and cash.
Best Estimate Of Tax-Deferred Investment Assets*
Enter only the portion of your total portfolio value that is in tax-deferred accounts such as the IRAs, 401(k)s, 403(b)s, or the TSP.
Best Estimate Of Tax-Free Investment Assets*
Enter only the portion of your total portfolio value that is in tax-free accounts such as the Roth IRAs, Roth 401(k)s, Roth 403(b)s, or Roth TSPs. Also include any other non-taxable assets in this number. If it doesn't say "Roth" on the account then it is likely a traditional retirement account and should be included in the prior entry.
File Upload*
Drop files here or
If possible, upload relevant account statements here in PDF format. Screenshots are also acceptable. You may also email the statements at a later time and supply estimates instead by choosing Manual Entry.
Are You Currently Contributing To Your Investments? (Check All That Apply)
- Taxable (Brokerage Accounts)
- Tax-Deferred (401(k), IRA, etc.)
- Tax-Free (Roth IRA, Roth 401(k), etc.)
Check any type of investment to which you are currently contributing. If you are not contributing to any investments, leave this blank.
Current Annual Contributions To Taxable Accounts
Enter the current annual contributions you make to your brokerage accounts.
Current Annual Contributions To Tax-Deferred Accounts
Enter the current annual contributions you make to your tax-deferred accounts (401(k)s, IRAs, etc.).
Current Annual Contributions To Tax-Free Accounts
Enter the current annual contributions you make to your tax-free accounts (Roth 401(k)s, Roth IRAs, etc.).

Sources of Retirement Income (If Applicable)
- Pension
- Part-Time Work
Please select which sources of retirement income you expect to receive.
Annual Pension Income
Please enter the annual amount you would receive from a pension during retirement. Enter income in today's dollars.
Spouse's Annual Pension Income
Please enter the annual amount you would receive from a pension during retirement. Enter income in today's dollars.
Annual Income From Part-Time Work
Your best estimate of the annual income you would receive from part-time work. Enter in today's dollars.
Spouse's Annual Income From Part-Time Work
Your best estimate of the annual income you would receive from part-time work. Enter in today's dollars.
Until What Age Will You Continue The Part-Time Work?
Until What Age Will Your Spouse Continue The Part-Time Work?
Do You Know Your Social Security Benefits At Full Retirement Age?*
- Yes
- No
If you have your Social Security benefit statement or access it online and can provide your estimated benefits, answer "Yes". Otherwise, your Social Security benefits will be estimated from your income.

Your Social Security Benefits
Enter your Social Security benefits. Enter either your current benefits if you have already begun taking benefits or the benefits you would receive at Full Retirement Age (this is important). This number can be ascertained from your Social Security statement under the "Your Estimated Benefits" section. It's the first number under the Retirement section.
Spouse's Social Security Benefits
Enter your spouse's Social Security benefits. Enter either their current benefits if they have already begun taking benefits or the benefits they would receive at Full Retirement Age (this is important). This number can be ascertained from their Social Security statement under the "Your Estimated Benefits" section. It's the first number under the *Retirement section.
Best Estimate Of Expenses During Retirement
Enter your expected retirement expenses in today's dollars. The best estimate is typically your current expenses, as spending decreases in one area tend to be offset by spending increases in another.

Best Phone Number*
Best Email*
Your Zip Code*
Sign Me Up For Free Educational Videos & Resources*
- Yes, Sign Me Up!
Sign me up for the client newsletter to receive updates about Adaptive Wealth Solutions portfolio performance, market commentary, and receive emails when new articles are posted to RealizeYourRetirement.com. You will need to confirm your subscription by clicking on the link in the confirmation email.
Questions/Comments (Optional)
Supporting Documentation
Drop files here or
Attach any supporting documents.

Client Questionnaire

Step 1 of 9 - Completed