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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