Annual Client Update

Your info

Client details

First name

Last name

Partner / spouse name optional

Email address only if changed

Home address only if changed

Retirement accounts

401(k), Roth 401(k), ESOP & HSA

Client — balances

401(k) balance

Roth 401(k) balance

Client — contribution rates

Pre-tax 401(k) contribution

Roth 401(k) contribution

Employer match

Partner — balances

401(k) balance

Roth 401(k) balance

Partner — contribution rates

Pre-tax 401(k) contribution

Roth 401(k) contribution

Employer match

ESOP

ESOP status

Participating Not participating N/A

ESOP balance

Recent vesting / distributions

HSA

HSA status

Have HSA No HSA N/A

HSA balance

Annual contribution

Income

Salary & compensation

Client

Annual salary / gross income

Has your income changed since we last spoke?

Yes, changed No change

Partner

Annual salary / gross income

Has partner's income changed since we last spoke?

Yes, changed No change

Additional income sources optional

Property

Home details

Housing situation

Own Rent No change

Estimated home value

Remaining mortgage balance

Monthly mortgage payment

Monthly rent cost

Insurance

Coverage details — only if changed from last meeting

Life insurance

Any changes to life insurance?

Yes, changed No change N/A

Coverage amount

Policy type

Notes optional

Disability insurance

Any changes to disability insurance?

Yes, changed No change N/A

Monthly benefit amount

Coverage type

Notes optional

New accounts & assets

Anything new we should know about

Have you opened any new financial accounts?

Yes No

Details optional

Life changes

Has anything significant changed?

Got married or divorced Had or adopted a child Changed jobs or retired Bought or sold a home Major health change Received an inheritance or gift None of the above

Anything else for Mason to know? optional

✓

Update received — thank you!

Mason will review your responses before your next meeting. If anything needs follow-up, he'll be in touch at the email on file.

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Update received — thank you!