Present Position™

03

Vehicle Insurance Property Insurance Liability Insurance

Date

Last Name

Present Position

First Name

Age

Disability Insurance Medical Insurance Government Plans

Client

Spouse

Child

TM

Child

Wills & Documents Trusts & Ownership

Life Insurance

Child

Child

Occupation

Income

Client Spouse

WCA/Checking

Savings

Credit Union

Total Income $

Savings Bonds

Certificates

Money Market

%

% of Income Saved

Additional Information

Tax Deferred

Tax Free

Tax Deductible

Government Bonds Corporate Bonds

Municipal Bonds

Debt Window

Type of Loan

Principal & Interest

Unpaid Balance Rate Months to Pay

Preferred Stocks

Bluechip Stocks

Growth Sector

Collectibles

Real Estate

Business/Shelters

S 300 -INT-R 1309

IMPORTANT: Read reverse side

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