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QUESTIONNAIRE DE PLANIFICATION

QCDD-A-003

Data Collection Questionnaire


Confidential

File no.:

Client name 1:

Client name 2:

Client type:

Questionnaire completed on:

Updated:

Financial planner:

*You can insert your logo here to personalize this document. This document was created for informational purposes only. The IQPF can not be held responsible for errors or losses incurred following its use.

SECTION 1: PERSONAL INFORMATION

Residence and job

Client 1:

Client 2:

|_| Mr.

|_| Ms.

|_| Mr.

|_| Ms.

Address:

Since (date):

Date and place of birth:

Date and place of birth:

Start date of residence in Canada:

Start date of residence in Canada:

Citizenship:

Citizenship:

S.I.N.:

S.I.N.:

Home phone:

Home phone:

Office phone:

Office phone:

Cell phone:

Cell phone:

Fax:

Fax:

Email:

Email:

|_| employer |_| self-employed |_| retired

|_| employer |_| self-employed |_| retired

Name:

Name:

Address:

Address:

Since (date):

Since (date):

Position:

Position:

Job type: |_| 1|_| 2|_| 3|_| 4

Job type: |_| 1|_| 2|_| 3|_| 4

1. Permanent2. Temporary3. Independent4. No job

Civil and matrimonial status

Client 1:

Client 2:

Since (date)

Since (date)

|_| single

|_| single

|_| married/civil union

|_| married/civil union

|_| de facto union[footnoteRef:1] [1: Also indicate civil status under the Civil Code of Québec.]

|_| de facto union1

|_| widowed

|_| widowed

|_| legally separated

|_| legally separated

|_| divorced

|_| divorced

Support payments

Client 1

Client 2

|_| paid |_| received |_| not applicable

|_| paid |_| received |_| not applicable

Marriage or civil union contract (append a copy to the questionnaire)

|_| partnership of acquests|_| separation of property |_| community of property|_| other|_| n/a

Cohabitation agreement (append a copy to the questionnaire)

|_| yes|_| no|_| not applicable

Surrender of family property rights



Children

Grandchildren

First name

Date of birth

Job

Annual income

Civil status

Last name

First name

Date of birth

1)

2)

3)

Comments:

Other information

Client 1

Client 2

|_| smoker|_| non-smoker |_| never smoked

|_| smoker|_| non-smoker |_| never smoked

State of health: |_| 1|_| 2|_| 3|_| 4

State of health: |_| 1|_| 2|_| 3|_| 4

1. Excellent2. Good3. Fair4. Poor

Details:

Professional advisors

Name

Firm and address

Phone

Fax

Email

Lawyer

Notary

Accountant or tax expert

Account manager

Financial security advisor

Broker’s representative

Liability insurance broker or agent

Other:

For the Client 2, if different:

Name

Firm and address

Phone

Fax

Email

Lawyer

Notary

Accountant or tax expert

Account manager

Financial security advisor

Broker’s representative

Liability insurance broker or agent

Other:

SECTION 2: GOAL SUMMARY

Personal and family situation

Yes

No

Comments

Get married or enter civil union

|_|

|_|

Live in a de facto union

|_|

|_|

Get divorced

|_|

|_|

Adopt children

|_|

|_|

Have children

|_|

|_|

Separate

|_|

|_|

Other:

|_|

|_|

Financial situation

Yes

No

Comments

Evaluate net worth

|_|

|_|

Evaluate cost of living

|_|

|_|

Eliminate personal debts

|_|

|_|

Establish a savings strategy

|_|

|_|

Purchase a home

|_|

|_|

Review investment strategy

|_|

|_|

Help children or grandchildren pursue higher education

|_|

|_|

Other:

|_|

|_|

Tax situation

Yes

No

Comments

Reduce income taxes

|_|

|_|

Optimize after-tax investment income

|_|

|_|

Evaluate compensation method

|_|

|_|

Evaluate business structure

|_|

|_|

Use income-splitting strategies

|_|

|_|

Other:

|_|

|_|

Protection situation

Yes

No

Comments

Draft or update a mandate in case of incapacity

|_|

|_|

Draft or update a general power of attorney

|_|

|_|

Review personal disability protection

|_|

|_|

Review business-related disability protection

|_|

|_|

Review other personal sickness or accident protections

|_|

|_|

Review other business-related sickness or accident protections

|_|

|_|

Other:

|_|

|_|

Retirement situation

Yes

No

Comments

Retire at age . Maintain a cost of living of , in today’s dollars.

|_|

|_|

Evaluate options for cashing out RRSPs, RRIF, annuities, etc.

|_|

|_|

Choose between a defined benefit pension plan and transfer to a LIRA

|_|

|_|

Set up an individual pension plan

|_|

|_|

Other:

|_|

|_|

Situation at death

Yes

No

Comments

Draft or update the will

|_|

|_|

Determine life insurance needs

|_|

|_|

Maintain current cost of living for heirs for years

|_|

|_|

Provide additional bequests for heirs

|_|

|_|

Provide other bequests, such as to a foundation

|_|

|_|

Minimize taxes payable on death

|_|

|_|

Business: ensure continuation of the business after death

|_|

|_|

Other:

|_|

|_|

SECTION 3: FINANCE

Actif

Client 1

Client 2

Passif

Client 1

Client 2

Determination of cost of living

How much do you save annually in your RRSP?

How much do you save annually in your TFSA?

How much do you save annually in an unregistered account?

Are you expecting any unusual income or expenses in the next year (e.g., trips, renovations)?

|_| yes

|_| no

Comments:

Have you made funeral pre-arrangements?

|_| oui

|_| non

Commentaires :

SECTION 4: TAXATION

Determination of after-tax income

Complete Appendix C using tax returns (or summaries) for the last three years.

Client 1

Client 2

Annual earnings:

$

$

Form (salary, commissions, business income, dividends):

If earnings are variable, enter possible range:

Client 1

Client 2

Gross rental income:

$

$

Deductible expenses:

$

$

Net rental income before depreciation:

$

$

Capital cost allowance:

$

$

Net rental income:

$

$

Client 1

Client 2

Effective (or average) tax rate

%

%

Marginal tax rate

%

%

Net capital losses from prior years[footnoteRef:2] [2: In most cases, it is preferable to confirm this information with the tax authorities.]

$

$

TFSA contribution rights

$ $

$

Taxable capital gains declared in last 3 years:

Year:

Amount:

Have you sold any property since the beginning of the year?

|_| yes

|_| no

If so, complete the following chart.

Description

Year of acquisition

Quantity

Net proceeds of disposition

ACB

UCC

Gain or loss

Recapture of depreciation

1)

2)

3)

Home Buyer’s Plan (HBP) or Lifelong Learning Plan (LLP)

HBP |_|

LLP

Client 1

Client 2

Year of withdrawal

Amount withdrawn

$

$

Amount of annual reimbursement

$

$

Balance no January 1st

$

$

Comments:

What amount is available for the capital gains deduction from the sale of qualified small business corporation shares? What amount is available for qualified farming or fishing property?

Client 1

Type of property

Amount available

QSMCSs

Qualified farming or fishing property

Client 2

Type of property

Amount available

QSMCSs

Qualified farming or fishing property

Have any of your investments been chosen mainly for tax reasons?

Do you have foreign investment property ?

|_| yes

|_| no

Comments:

For all the years when the total cost of foreign investment assets exceeds the CA$100,000 threshold, a declaration must be made in the federal tax return and federal form T1135 must be filed.

Did you make an election in your 1994 tax return in relation to property you owned on February 22, 1994?

|_| yes

|_| no

If so, complete the following table:

Description

Quantity

Amount of election$

Other:

SECTION 5: RETIREMENT

Client 1

Client 2

yes

no

yes

no

Are you eligible for the Old Age Security pension (OAS)?

|_|

|_|

|_|

|_|

Are you eligible for the Québec Pension Plan or the Canada Pension Plan (append a statement of contributions)?

|_|

|_|

|_|

|_|

Do you belong to a registered pension plan (RPP), a supplemental pension plan, a stock option plan, etc.?

|_|

|_|

|_|

|_|

If so, please append a copy of the most recent statement of participation and all documentation concerning the plan (brochures, regulations, etc.) and complete note 15 in the personal balance sheet.

Do you belong to a group RRSP[footnoteRef:3] or group DPSP offered by your employer? [3: Details about the investments held inside the RRSP are provided in Section 3 – Finances, of this question, in the personal balance sheet.]

|_|

|_|

|_|

|_|

If so, append a copy of the most recent statement of participation .

Do you always contribute the annual maximum to your RRSP* or spousal RRSP?

|_|

|_|

|_|

|_|

When do you make your annual RRSP or spouse RRSP contribution?

End of year

|_|

|_|

Beginning of year

|_|

|_|

Systematic savings program

|_|

|_|

Additional information about the RRSP:

Deduction limit for

Minus: Unused contributions previously reported and available to deduct in

Available contribution room for

Excess contributions

Obtain Appendix 7 and the most recent federal notice of assessment

Other information:

SECTION 6: LEGAL ASPECTS AND ESTATES

Client 1

Client 2

yes

no

N/A

yes

no

N/A

Do you have a will?

|_|

|_|

|_|

|_|

If so, append a copy.

Is there a “last survivor” clause in your marriage or civil union contract?

|_|

|_|

Does your will still reflect your last wishes?

|_|

|_|

|_|

|_|

Do you want to leave a bequest to a charity?

|_|

|_|

|_|

|_|

Have you drawn up a protection mandate (mandate in case of incapacity)?

|_|

|_|

|_|

|_|

Do you have a general power of attorney?

|_|

|_|

|_|

|_|

Do you have commitments arising from a previous marriage or union?

|_|

|_|

|_|

|_|

|_|

|_|

Do you serve as the administrator of the assets of another person (tutor, liquidator, trustee or mandatary)?

|_|

|_|

|_|

|_|

|_|

|_|

Do you have a shareholders’ or partners’ agreement?

|_|

|_|

|_|

|_|

|_|

|_|

Comments:

Note:It is important to get a copy of all existing legal documents.

SECTION 7: INVESTMENTS

Client 1

%

Client 2

%

Determination of investor profile

Cash securities

Fixed-income securities

Growth securities

100

100

Do you subscribe to an RESP?

|_| yes

|_| no

|_| n/a

Comments:

If so, please provide the most recent account statements.

yes

no

n/a

yes

no

n/a

Are any of your loans for investment purposes?

|_|

|_|

|_|

|_|

|_|

|_|

yes

no

yes

no

Are any of your investments accounts to finance a specific plan or project?

|_|

|_|

|_|

|_|

SECTION 8: INSURANCE

Client 1

Client 2

yes

no

N/A

yes

no

N/A

Do you have life insurance [footnoteRef:4]? [4: You must obtain recent statements to understand the provisions of the contracts.]

|_|

|_|

|_|

|_|

Do you have disability insurance *?

|_|

|_|

|_|

|_|

|_|

|_|

Do you have critical illness insurance *? Long-term care? Access to care?

|_|

|_|

|_|

|_|

|_|

|_|

Are your loans covered by life insurance with the lending institution?

|_|

|_|

|_|

|_|

|_|

|_|

Are your loans covered by disability or critical illness insurance with the lending institution?

|_|

|_|

|_|

|_|

|_|

|_|

Does a corporation hold insurance on your life?

|_|

|_|

|_|

|_|

|_|

|_|

QCDD-A-003



14

APPENDIX A

Personal balance sheet as at

Client 1$

Client 2$

Total$

ASSETS

Cash and near-cash assets

Bank accounts (note 3)

Life insurance cash surrender value (note 4)

Non-registered investments (note 5)

Tax-free savings account (note 6)

Advances receivable (note 7)

Other:

Total cash and near-cash assets

Personal assets

Principal residence (note 8)

Secondary residence (note 9)

Automobiles (note 10)

Antiques, works of art, jewellery, collections (note 11)

Other:

Total personal assets

Income-producing assets

Equity ownership in a private corporation or partnership (note 12)

Rental property (note 13)

Other:

Total income-producing assets

Deferred taxation plans

RRSP, RPDB or RRIF (note 14)

Registered Pension Plan (note 15)

LIRA or LIF (note 16)

RESP or RDSP (note 17)

Québec pension plan (QPP) (note 18)

Other assets:

Total deferred taxation plans

TOTAL ASSETS

LIABILITIES

Accounts payable (note 19)

Unpaid credit card balances

Credit purchases

Taxes payable

Other:

Total accounts payable

Personal loans (note 20)

Bank overdraft

Line of credit

Car

RRSP

Investments

Advances received from a private corporation

Other:

Total personal loans

Mortgage loans (note 21)

Principal residence

Secondary residence

Rental property

Other:

Total mortgage loans

Future income taxes (note 22)

TOTAL LIABILITIES

NET WORTH

Notes to the personal balance sheet

NOTE 1: Personal, professional and family situation

NOTE 2: Accounting conventions

Assets and liabilities are evaluated at their estimated current value.

NOTE 3: Bank accounts

Financial institution

Type of account

Balance$

1)

2)

3)

Total:

NOTE 4: Life insurance cash surrender value

Type of contract

Cash surrender value$

Comments

1)

2)

Total:

NOTE 5: Non-registered investments

Liquid securities

Savings bonds

Issuer

Series

Interest rate

Maturity

Face value$

Accrued value$

1)

2)

Total:

Term deposits or guaranteed investment certificates maturing in less than 1 year


Date of deposit

Date of maturity

Interest rate

Accrued value$

1)

2)

3)

Total:

Bonds maturing in less than 1 year

Issuer

Date of acquisition

Cost of acquisition$

Interest rate

Maturity

Market value$

1)

2)

3)

Total:

Money market mutual fund

Description

Date of acquisition

MER

ACB$

Number of units

Market value$

Total$

1)

2)

3)

Total:

Other liquid securities

Total:

Fixed-income securities

Term deposits or guaranteed investment certificates


Date of deposit

Date of maturity

Interest rate

Accrued value$

1)

2)

3)

Total:

Bonds

Issuer

Date of acquisition


Interest rate

Maturity

Market value$

1)

2)

3)

Total:

Stripped bonds

Issuer

Date of acquisition


Rate of return

Market value$

1)

2)

;

Total

Note: Also indicate interest declared each year on income tax return.

Redeemable preferred shares

Description

Date of acquisition

ACB$

Rate of return

Maturity

Quantity

Market value$

Total$

1)

2)

3)

Total:

Fixed income mutual funds

Description

Date of acquisition

ACB$

Rate of return

Maturity

Quantity

Market value $

1)

2)

3)

Total:

Other fixed income securities

Total:

Growth securities

Common shares

Description

Date of acquisition

ACB$

Annual dividend

Quantity

Market value$

Total$

1)

2)

3)

4)

Total:

Perpetual preferred shares

Description

Date of acquisition

ACB$

Rate of return

Maturity

Quantity

Market value$

Total$

1)

2)

3)

Total:

Growth securities mutual funds

Description

Date of acquisition

MER

ACB$

Number of units

Market value$

Total$

1)

2)

3)

Total:

Income trusts

Description

Date of acquisition

ACB$

Annual distributions$

Quantity

Market value$

Total$

1)

2)

3)

Total:

Note: The ACB should be adjusted downward each year to reflect capital distributions.

Other growth securities

Total:

NOTE 6: Tax-free savings account (TFSA)

LIQUID SECURITIES

Savings bonds

Issuer

Series

Interest rate

Maturity

Face value$

Accrued value$

1)

2)

Total:



Date of deposit

Date of maturity

Interest rate

Accrued value$

1)

2)

3)

Total:


Issuer

Date of acquisition


Interest rate

Maturity

Market value$

1)

2)

3)

Total:


Description

Date of acquisition

MER

ACB $

Number of units

Market value$

Total$

1)

2)

3)

Total:


Total:

FIXED-INCOME SECURITIES



Date of deposit

Date of maturity

Interest rate

Accrued value$

1)

2)

3)

Total:

Bonds

Issuer

Date of acquisition


Interest rate

Maturity

Market value$

1)

2)

3)

Total:

Stripped bonds

Issuer

Date of acquisition

Cost of acquisition $

Rate of return

Market value$

1)

2)

Total:


Description

Date of acquisition

ACB$

Rate of return

Maturity

Quantity

Market value$

Total$

1)

2)

3)

Total:


Description

Date of acquisition

ACB$

Rate of return

Maturity

Quantity

Market value $

1)

2)

3)

Total:


Total:

GROWTH SECURITIES

Common shares

Description

Date of acquisition

ACB $

Annual dividend

Quantity

Market value $

Total $

1)

2)

3)

4)

Total:


Description

Date of acquisition

ACB $

Rate of return

Maturity

Quantity

Market value $

Total $

1)

2)

3)

Total:

Growth securities mutual funds

Description

Date of acquisition

MER

ACB

$

Number of units

Market value $

Total $

1)

2)

3)

Total:

Income trusts

Description

Date of acquisition

ACB $

Annual distributions $

Quantity

Market value $

Total $

1)

2)

3)

Total:


Total:

Total TFSA:

NOTE 7: Advances receivable

NOTE 8: Principal residence

Address

Year of acquisition

Price paid$

Municipal evaluation$

Market value$

Note: Include the price paid for major improvements or renovations. If the market value differs from the municipal evaluation, identify the evaluation method.

NOTE 9: Secondary residence

Address

Year of acquisition

Price paid$


Market value$

Note: Include the price paid for major improvements or renovations. If the market value differs from the municipal evaluation, identify the evaluation method.

NOTE 10: Cars

Model

Year


Market value$

1)

2)

Total:

NOTE 11: Antiques, works of art, jewellery, collections

Description

ACB$

Market value$

1)

2)

3)

Total

Note: Specify how market value was established. If there are charitable objectives, indicate the date and circumstances of acquisition of these assets.

NOTE 12: Equity ownership in a private corporation or partnership

Description

% ownership

ACB$

Market value$

1)

2)

Total:

Note: Identify the evaluation method. The company’s financial statements can be.

NOTE 13: Rental property

Description

Address

Date of acquisition

ACB$

UCC$


Market value$

1)

Land portion

n/a

2)

Land portion

n/a

Total

NOTE 14: Registered Retirement Savings Plan (RRSP), Deferred Profit-Sharing Plan (DPSP) or Registered Retirement Income Fund (RRIF)

LIQUID SECURITIES

Savings bonds

Issuer

Series

Interest rate

Maturity

Face value$

Accrued value$

1)

2)

Total:



Date of deposit

Date of maturity

Interest rate

Accrued value$

1)

2)

3)

Total:


Issuer

Date of acquisition


Interest rate

Maturity

Market value$

1)

2)

3)

Total


Description

Date of acquisition

MER

ACB$

Number of units

Market value $

Total$

1)

2)

Total:


Total:

FIXED-INCOME SECURITIES



Date of deposit

Date of maturity

Interest rate

Accrued value$

1)

2)

3)

Total:

Bonds

Issuer

Date of acquisition


Interest rate

Maturity

Market value$

1)

2)

3)

Total:

Stripped bonds

Issuer

Date of acquisition

Cost of acquisition $

Rate of return

Market value$

1)

2)

Total:


Description

Date of acquisition

ACB$

Rate of return

Maturity

Quantity

Market value$

Total$

1)

2)

3)

Total:


Description

Date of acquisition

ACB$

Rate of return

Maturity

Quantity

Market value $

1)

2)

3)

Total:


Total:

GROWTH SECURITIES

Common shares

Description

Date of acquisition

ACB $

Annual dividend

Quantity

Market value $

Total $

1)

2)

3)

4)

Total:


Description

Date of acquisition

ACB $

Rate of return

Maturity

Quantity

Market value $

Total$

1)

2)

3)

Total:

Growth mutual funds

Description

Date of acquisition

MER

ACB$

Number of units

Market value $

Total$

1)

2)

3)

4)

Total:

Income trusts

Description

Date of acquisition

ACB$


Quantity

Market value $

Total$

1)

2)

3)

Total:


Total:

Total RRSP or RRIF:

NOTE 15: Registered Pension Plan

Defined benefits

Participant

Contribution rate

Pension accumulation rate

Earnings subject to contributions$

Current value $

Other features

1)

2)

Other relevant information:

Defined contribution

Participant

Contributionrate

Employer contribution rate

Earnings subject to contributions$

Market value $

Other features

1)

Investment characteristics:

2)

Investment characteristics:

NOTE 16: Voluntary Retirement Savings Plan (VRSP), Locked-In Retirement Account (LIRA) or Life Income Fund (LIF)

LIQUID SECURITIES

Savings bonds

Issuer

Series

Interest rate

Maturity

Face value$

Accrued value$

1)

2)

Total:

Term deposits or (Guaranteed investment certificates) maturing in less than 1 year


Date of deposit

Date of maturity

Interest rate

Accrued value$

1)

2)

3)

Total:


Issuer

Date of acquisition


Interest rate

Maturity

Market value$

1)

2)

3)

Total:

Money market mutual funds

Description

Date of acquisition

MER

ACB$

Number of units

Market value $

Total$

1)

2)

3)

Total:


Total:

FIXED INCOME SECURITIES



Date of deposit

Date of maturity

Interest rate

Accrued value$

1)

2)

3)

Total:

Bonds

Issuer

Date of acquisition


Interest rate

Maturity

Market value$

1)

2)

3)

Total:

Stripped bonds

Issuer

Date of acquisition


Rate of return

Market value$

1)

2)

Total:


Description

Date of acquisition

ACB$

Rate of return

Maturity

Quantity

Market value$

Total$

1)

2)

3)

Total:


Description

Date of acquisition

MER$

ACB$

Nomber of units

Market value$

Total$

1)

2)

3)

Total:


Total:

GROWTH SECURITIES

Common shares

Description

Date of acquisition

ACB $

Annual dividend

Quantity

Market value$

Total$

1)

2)

3)

4)

Total ;

Growth mutual funds

Description

Date of acquisition

MER

ACB$

Number of units

Market value $

Total$

1)

2)

3)

4)

Total:

Income trusts

Description

Date of acquisition

ACB$


Quantity

Market value $

Total$

1)

2)

3)

Total:


Total:

Total LIRA or LIF:

NOTE 17: Registered Education Savings Plan or Registered Disability Savings Plan

Note:The RESP should only appear in the subscriber’s personal balance sheet and the value is equal to contributions made. The total value of the RDSP should appear in the beneficiary’s personal balance sheet.

NOTE 18: Québec Pension Plan

Client

Accrued pension at age 65

Discount rate

Life expectancy

Current value$

Before 65

65 and +

Comments:

NOTE 19: Accounts payable

Description

Maturity date

Interest rate

Amount$

1)

2)

3)

4)

5)

Total:

NOTE 20: Personal loans

Description

Date of loan

Date of maturity

Payments$

Interest rate

Original amount$

Balance$

1)

2)

3)

4)

5)

Total:

NOTE 21: Mortgage loans

Lender

Description

Date of loan

Date of maturity

Payments$

Amortization

Frequency

Interest rate

Original amount$

Balance$

1)

2)

3)

4)

Total

NOTE 22: Future income taxes

Client 1

Asset

FMV$

Estimated tax rate

Future income tax$

Client 2

Asset

FMV$

Estimated tax rate

Future income tax$

QCDD-A-003


NOTE 23: Life, disability and other insurance contracts


42

Life insurance

Issuer

Underwriting year

Type of contract

Owner

Adherent

Insured

Beneficiary$

Annual premium$

Cash surrender value$

Adjusted cost base$

Capitalization fund

Death benefit

Payer

Comments:

Disability insurance

Salary (group insurance)

Issuer

Premium$

Waiting period

Monthly income$

Taxation of benefits

Duration of benefits

%indexation

Profession protected for (years)

Comments:

Income loss

Issuer

Underwriting year

Premium $

Waiting period

Monthly income $


% indexation

Profession protected for (years)

Comments:


43

QCDD-A-003


Overhead

Issuer

Underwriting year

Premium$

Waiting period

Monthly protection$


Other features

Comments:

Critical illness, long-term care insurance and other insurance coverage

Issuer

Underwriting year

Premium$

Insured capital$

Illnesses covered

Comments:

NOTE 24: Legal documents

NOTE 25: Tax information

NOTE 26: Contractual commitments

NOTE 27: Contingencies

NOTE 28: Employee stock program

NOTE 29: Events subsequent to the balance sheet date

QCDD-A-003



14

APPENDIX B

Budget

name:

projected budget for the year

EXPENSES

Client 1$

Client 2$

Total$

Food

Groceries

Restaurant

Subtotal

Accommodations

Rent, mortgage payment

Maintenance and repairs

Insurance premiums (home and contents)

Property and school taxes

Heat, electricity, water

Phone, cable, internet

Other

Subtotal

Household operations

Domestic help, maintenance

Child care

Animal expenses

Cleaning products

Yard work

Other

Subtotal

Furnishings and equipment

Clothing (purchases, cleaning)

Transportation costs

Automobile purchase (cash)

Loan payments

Insurance, permits

Maintenance and repairs

Gas and oil

Parking

Public transit

Subtotal

Health care

Health, dental insurance premiums, etc.

Non-refundable medical expenses

Subtotal

Personal care

Hair care, aesthetician, beauty products

Supplies and other services

Subtotal

Leisure and entertainment

Pleasure vehicles

Sports, camping

Shows, outings

Books, newspapers, CDs, DVDs, photos, etc.

Collections, crafts

Vacations, trips

Other

Subtotal

Education

Tuition

Books, supplies

Other

Subtotal

Contributions, donations, gifts

Tobacco and alcohol

Debt repayment (other than car and mortgage)

Income taxes (federal and provincial)

Financial security

Life insurance

Disability insurance (income insurance)

Accident insurance, liability insurance, etc.

Drug insurance

Pension plan contributions

Other

Subtotal

Miscellaneous expenses

Financial fees

Professional fees

Union or professional dues

Lottery tickets

Charitable donations

Other

Subtotal

TOTAL EXPENSES

APPENDIX C

Determination of after-tax income available and cost of living

Year:

Name:

Client 1

Client 2

Total

$

$

$

Sources of income

Employment income

Employment or self-employment income (net)

Rental income

Investment income

Support payments received (paid)

Annuities and other pensions

Other income

Total gross income

Income taxes and contributions

QPP or CPP contributions

Employment insurance contributions

QPIP contributions

Pension plan contributions

Provincial taxes

Federal taxes

Total taxes and contributions

Income available

Less:

Non-RRSP savings

RRSP contributions

Change in cash and debt[footnoteRef:5] [5: The change in debt equals the difference in the balance of personal loans.]

Cost of living

APPENDIX D

Estate statement as at

Death of the client 1

$

Death of the Client 2

$

Simultaneous death

$

Net worth according to balance sheet

Plus:

Life insurance[footnoteRef:6] [6: The life insurance proceeds must be payable to the estate.]

-

-

-

-

Insured liabilities

Future income taxes

Other:

Sub-total:

Less:

Life insurance cash surrender value

Death-related expenses

Taxes payable on death (note 1)

Specific bequests

Charitable donations

Other

Subtotal:

ESTATE ASSETS

Plus: Sums received by heirs as beneficiaries

Less: Income taxes assumed by heirs

Value transferred to universal heirs

NOTE 1: Taxes payable on death

a) Death of the client 1

Description

Income (loss) $

Capital gain (loss)$

Total:

×50% =

Taxable income

Tax rate:

Income taxes:

Charitable donations: × rates applicable to the donation

Tax credit for charitable donations:

Income taxes payable on death:

b) Death of the client 2

Description

Income (loss)

$


Total:

×50% =

Taxable income

Tax rate:

Income taxes:




c) Simultaneous death

Description

Income (loss)

$


Total:

×50% =

Taxable income

Tax rate:

Income taxes:




APPENDIX E

Cash position of the estate as at

Client 1

$

Client 2

$

Simultaneous death

$

Cash and near-cash assets according to personal balance sheet

Plus:

Life insurance

Registered retirement savings[footnoteRef:7] [7: If the registered assets are not left to the spouse and are instead included in the calculation of taxes payable on death in the estate statement.]

Other:

Subtotal:

Less:

Liability to be repaid

Cash surrender value – life insurance

Death-related expenses

Taxes payable on death

Specific bequests of cash or near-cash securities

Charitable donations of cash or near-cash securities

Other:

CASH SURPLUS (DEFICIT)

Plus: Sums received by heirs as beneficiaries

Less: Income taxes assumed by heirs

Cash available for universal heirs

APPENDIX F

Risk tolerance questionnaire

Name:

1. In general, how would your best friend describe you as a risk taker?

a) A real gambler

b) Willing to take risks after completing adequate research

c) Cautious

d) A real risk avoider

2. You are on a TV game show and can choose one of the following. Which would you take?

a) $1,000 in cash

b) 50% chance at winning $5,000

c) A 25% chance at winning $10,000

d) A 5% chance at winning $100,000

3. You have just finished saving for a “once-in-a-lifetime” vacation. Three weeks before you plan to leave, you lose your job. You would:

a) Cancel the vacation

b) Take a much more modest vacation

c) Go as scheduled, reasoning that you need the time to prepare for a job search

d) Extend your vacation, because this might be your last chance to go first-class

4. If you unexpectedly received $20,000 to invest, what would you do?

a) Deposit it in a bank account, money market account, or an insured CD?

b) Invest it in safe high-quality bonds or bond mutual funds

c) Invest it in stocks or stock mutual funds

5. In terms of experience, how comfortable are you investing in stocks or stock mutual funds?

a) Not at all comfortable

b) Somewhat comfortable

c) Very comfortable

6. When

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