your financial and personal information...

Your financial and personalinformation document

UBS Financial Services Inc. ubs.com/fs

UBS Financial Services Inc. is a subsidiary of UBS AG. ©2011 UBS Financial Services Inc. All rights reserved. Member SIPC. 12.23_BRO_8.5x11_JU0430_KelP

CFP® is a certification mark owned by Certified Financial Planner Board of Standards, Inc.

CIMA® is a registered certification mark of the Investment Management Consultants Association, Inc. in the United States of America and worldwide.

Neither UBS Financial Services Inc. nor any of its employees provide legal or tax advice. You should consult with your personal legal or tax advisor regarding your personal circumstances.

Peter E. Kelly Jr., CFP®

Senior Vice President–[email protected]

Mindy K. NightingaleSenior Registered Client Service [email protected]

ubs.com/team/kellyandperez

James C. Perez, CFP®, CIMA®

Vice President–InvestmentsWealth [email protected]

UBS Financial Services Inc.401 East Las Olas Boulevard, Suite 2300Fort Lauderdale, FL 33301800-327-8218

Kelly and Perez Wealth Management Group

Jim Mindy Peter

Private and confidential 3

Client Spouse

Date:

Full legal name:

Social Security #:

Location of SS cards:

Phone number:

Place of birth: City State City State Country Country

Date of birth: / / / /

If citizen of foreign country, date entered USA:

Father’s name:

Mother’s maiden name:

Place of marriage/civil union:

Date married/ civil union:

If widowed, date of spouse’s death:

If divorced, date of divorce:

If a veteran, branch:

Dates of service:

Personal information

If you or your spouse passes away or becomes unable to make financial decisions, will you know:

– Where to find important financial documents?

– Whom to call to adjust taxes, claim disability benefits and execute powers of attorney?

– At what institution(s) your assets are held?

Completing this financial information booklet and keeping it with other important documents that chronicle your financial life will help you answer “yes” to these and other important questions.

Ask yourself some tough questions:

– This document

– Passwords and safe combinations

– Bank, brokerage and mutual fund statements

– Insurance policies

– Copies of your last will and testament, living will and healthcare proxy, power of attorney and/or trust documents

– Loan paperwork, leases, property deeds, auto titles

– Tax returns

– U.S. savings bonds

– Copies of beneficiary designation forms for:– IRAs– Retirement plans– Insurance policies

– List of safe deposit box contents, the key or combination

Important documents to keep handy but in a safe place

Private and confidential Private and confidential 54

Key contacts

Key contacts (continued)Personal information (continued)

Accountant: Name Phone number

Street City State Attorneys: Name Phone number Street City State Banker: Name Phone number Street City State Physician: Name Phone number

Street City State Specialist: Name Phone number

Street City State

Life insurance agent: Name Phone number

Street City StateProperty and casualty agent: Name Phone number

Street City State

Other: Name Phone number

Street City State

Financial Advisor: Name

Phone number

Address Financial Advisor: Name

Phone number

Address

Child’s name: Date of birth Place of birth

1.

Address

2.

Address

3.

Address

4.

Address


Investment accounts (brokerage, IRA, trust)

Owner Institution Account number

Contact Phone number















Personal accounts (checking, savings, etc.)









Retirement Accounts (pension, 401(k))









Financial information


Financial information (continued)

Credit cards

Owner Type of card Card number




Real estate/property: Location Deed location

Location Deed location

Rent Mortgage Payment to: Company or bank/branch City

Company or bank/branch City

Safety deposit boxes located at: Bank/branch/city Number

Address

Bank/branch/city Number

Address Major possessions/automobile(s): Make Financing/ Title location leasing company

Make Financing/ Title location leasing company

Artwork and collectibles: Description Location

Description Location




Employment history

Most current employer: Client Phone number

Spouse Phone number

Group life insurance: Yes No Yes No Client Spouse

Disability: Yes No Yes No Client Spouse

Stock options: Yes No Yes No Client Spouse

Insurance

Medical/healthcareinsurance: Primary healthcare provider Policy number

Long-term care insurance provider Policy number

Other medical insurance provider Policy number


PersonalBirth certificate: Location

Passport/citizenshippapers: Location

Adoption papers: Location

Marriage certificate: Location

Family death certificates: Location

Prenuptial agreement: Location

Divorce or separationagreement: Location

Military discharge papers: Location

Appraisal and inventory of valuable items: Location

TaxPrior years’ federal and state returns: Location

Federal/state gift tax returns: Location

Property and school tax records: Location

Small businessIncorporation/ ownership papers: Location

Buy/sell agreements: Location

Important nonfinancial documents

Life insurance/V.A. benefits: Company Policy number

Company Policy number

Company Policy numberAutomobile insurance: Company Policy number

Property insurance: Company Policy number

Estate planning

Attorney: Name Phone number

Location of Original will:

Living will:

Letter of last instruction:

Personal and charitable trust documents:

HIPAA agreements:

Power of attorney

Financial : Name Phone number

Document location

Medical: Name Phone number

Document location

Financial information (continued)


Important information regarding serious illness or death

Church/temple: Name Phone number

Personal contacts: Name Phone number

Name Phone number Name Phone number Name Phone number

Name Phone number Name Phone number

I have made funeralarrangements with: Name Phone number

Burial plot arrangements: Cemetery name Phone number

I have not made arrangements but would like the following: Preferred funeral home Address Type of service

Type of arrangements (burial/cremation)

Cemetery

If planning a cremation, whatis your preference for the cremains?

Information I wouldlike included in my obituary:

Preferred memorialdonations:


Notes Notes

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