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Home Equity Retirement Income Planner

This Intake and Analysis allows us to understand the financial goals and objectives you the advisor are looking to achieve with your client and allows us to create a strategic reverse mortgage proposal based on that information.
* Required Fields

    Advisor Information

    NOTE: * = required information

    Today's Date*

    Advisor Name*

    Advisor Phone*

    Advisor Email*

    Financial Goals (Required)

    What are the pressing financial goals and/or concerns that you have for this client? (See example here)

    Reverse Mortgage Strategy (Required)

    What role do you see the Reverse Mortgage playing In the client's overall retirement income strategy – Please give as much detail as possible. (See example here)

    Client Information

    Client's First Name

    Client's Last Name

    Client's Date of Birth* (mm/dd/yyyy)

    Client's Best Phone Number

    Client's Best Email Address

    Spouse Information

    Spouse's First Name

    Spouse's Last Name

    Spouse's Date of Birth (mm/dd/yyyy)

    Property Information

    Estimated Home Value*

    Property Address

    City: State: Zip:*

    Liens Against Property
    (Mortgages and/or Home Equity Loans)

    Outstanding Balance #1:* (even if its zero)

    Outstanding Balance #2:

    Outstanding Balance #3:

    Total Monthly Loan Payments:* (even if its zero)

    Client Income and Asset Information

    Estimated Monthly Income*

    Estimated Retirement Savings*

    Spouse Income and Asset Information

    Estimated Spousal Monthly Income

    Estimated Retirement Savings Spouse

    Additional Notes

    Please add any other notes that may help us in developing a plan for your client.

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