Chamberlain Experior Group

Expert Financial Analysis · Comprehensive Client Questionnaire

Section 1 of 128%

Section 1 — Client Information

Primary applicant & co-applicant details

Primary Applicant

First Name

Middle Name

Last Name

Date of Birth

Gender

Marital Status

Annual Income ($)

Cell Phone

Occupation / Title

Employer / Business

Employment Status

Years with Employer

Co-Applicant / Spouse

First Name

Last Name

Relationship

Date of Birth

Occupation

Annual Income ($)

Dependants

Number of dependants

Ages (comma-separated)

Citizenship / Residency

Section 2 — Income & Cash Flow

All monthly income sources and expenditures

Primary Applicant — Monthly Income

Employment Income (gross)

Self-Employment / Business

Rental Income

Govt Benefits (CPP/OAS/EI)

Child Benefits / Support Received

Other Income

Co-Applicant — Monthly Income

Employment Income (gross)

Self-Employment / Business

Other Income

Monthly Expenditures

Housing

Mortgage / Rent

Property Tax

Condo / Strata Fees

Home Insurance

Vehicle & Transportation

Vehicle Insurance (all vehicles)

Fuel / Gas

Maintenance & Repairs

Car Loan / Lease Payment

Parking / Tolls / Transit

Registration / Licensing

Utilities & Household

Utilities (hydro/gas/water)

Phone / Internet / Cable

Groceries & Household

Other Household

Children & Family

Childcare (daycare/babysitting)

Tuition / Private School

School Activities & Trips

Children's Extracurriculars

Child Support / Alimony Paid

Money Sent to Family (remittances)

Other Family Obligations

Health & Wellness

Medical / Dental (out-of-pocket)

Prescriptions / Medications

Gym / Fitness Memberships

Other Health & Wellness

Pet Care

Pet Food & Supplies

Vet & Medications

Grooming / Boarding

Pet Insurance

Subscriptions & Memberships

Streaming (Netflix/Disney+/etc.)

Software / Digital Platforms

Online Business / Pro Tools

Other Subscriptions

Club / Association Memberships

Magazine / News Subscriptions

Lifestyle & Personal

Entertainment & Dining Out

Travel & Vacations (avg/mo)

Clothing & Personal Care

Hobbies & Recreation

Tobacco / Smoking / Vaping

Cannabis

Alcohol

Lottery / Gambling (avg/mo)

Giving & Other

Charitable Giving / Donations

Religious / Tithing

Other Expenses

Live Cash Flow Summary

Total income/mo

Total expenses/mo

Monthly surplus

Expense ratio

Budgeting Style

No formal budget Mental / informal Spreadsheet / app Detailed written budget

Section 3 — Assets & Net Worth

All assets across registered, real estate, and personal accounts

Cash & Liquid

Chequing ($)

Savings ($)

GICs / Term Deposits ($)

Cash on Hand ($)

Registered & Investment

RRSP – Primary ($)

RRSP – Co-App ($)

TFSA – Primary ($)

TFSA – Co-App ($)

RESP ($)

Pension ($)

Non-Reg Investments ($)

Stocks / ETFs / Bonds ($)

Mutual Funds ($)

Crypto / Alternatives ($)

Life Ins. Cash Value ($)

Business Value ($)

FHSA ($)

RDSP ($)

Real Estate & Property

Primary Residence Value ($)

Mortgage Outstanding ($)

Investment Property ($)

Investment Property Mortgage ($)

Vehicle(s) Total Value ($)

Other Personal Property ($)

Live Net Worth

Total assets

Liquid assets

Registered assets

Real estate equity

Estate Planning

Will

Power of Attorney

Estate Plan

Section 4 — Liabilities & Debt

All outstanding debts and obligations

Creditor / Lender	Balance ($)	Monthly Pmt ($)	Rate (%)	Type

Debt Summary

Total debt

Monthly payments

Debt-to-income

Net worth

Primary debt goal

Missed payments in last 2 years

Section 5 — Insurance & Protection

Existing coverage and priorities

Primary Applicant Coverage

Policy Type

Death Benefit ($)

Annual Premium ($)

Work Group Coverage ($)

Co-Applicant Coverage

Policy Type

Death Benefit ($)

Annual Premium ($)

Additional Coverage

Disability Insurance

Critical Illness

Long-Term Care

Protection Priorities (1=low, 5=high)

Income Replacement (Life)

Disability / Income Protection

Critical Illness Coverage

Mortgage / Debt Protection

Children's Education Funding

Estate / Legacy Planning

Coverage Gap Estimate

Total death benefit

Income multiple

Recommended (10×)

Coverage gap

Section 6 — Retirement Planning

Goals, assumptions, and projected needs

Retirement Age – Primary

Retirement Age – Co-App

Life Expectancy Estimate

Income Goal (% of current)

RRSP Contributions/mo ($)

TFSA Contributions/mo ($)

Est. Pension Benefit/mo ($)

Current Retirement Savings ($)

Inflation Rate (%)

Pre-Retirement Return (%)

In-Retirement Return (%)

Retirement Projection

0 yrs

Years to retirement

Projected nest egg

Needed at retirement

Surplus / Gap

Retirement Vision

Modest – stay local Comfortable – occasional travel Active – frequent travel Luxury

Describe your ideal retirement

Section 7 — Education Savings

RESP and post-secondary planning

Plan to save for education?

Current RESP Balance ($)

Monthly RESP Contribution ($)

Maximizing CESG?

Type of education

Section 8 — FHSA & RDSP

First Home Savings Account and Disability Savings Plan

First Home Savings Account (FHSA)

Eligibility – Primary

FHSA Balance ($)

Annual Contribution ($)

Target Home Purchase Date

Down Payment Goal ($)

Registered Disability Savings Plan (RDSP)

Qualify for DTC?

RDSP Balance ($)

Annual Contribution ($)

Section 9 — Investment Profile & Risk Tolerance

Objectives and comfort with market volatility

Primary investment objective

Investment time horizon

Investment experience

If portfolio dropped 20%

Risk Tolerance (1=very conservative · 10=very aggressive)

ConservativeAggressive5

Comfortable investing in

Section 10 — Tax Planning

Tax situation and optimization opportunities

Self-employed / Business owner?

Marginal Rate – Primary (%)

Marginal Rate – Co-App (%)

Maximizing RRSP?

Maximizing TFSA?

Currently Receiving

Section 11 — Financial Goals & Priorities

Select your goals and set your action timeline

Select all goals that apply

Describe your most important financial goal

How soon would you like to take action?

Currently working with another advisor?

Section 12 — Review & Generate Report

Confirm information and generate your Expert Financial Analysis

Summary Snapshot

Household income/mo

Monthly expenses

Monthly surplus

Net worth

Total debt

Life coverage

Consent

I consent to Chamberlain Experior Group collecting and using my information

I consent to receiving electronic communications

Advisor Notes

CHAMBERLAIN EXPERIOR GROUP · EXPERT FINANCIAL ANALYSIS

Expert Financial Analysis

Net Worth

Monthly Surplus

Debt-to-Income

Retirement Readiness

Cash Flow Analysis

Total household monthly income$0

Total monthly expenses$0

Monthly surplus / (deficit)$0

Expense-to-income ratio0%

Housing costs$0

Transportation costs$0

Total subscriptions & memberships$0

Pet care total$0

Family obligations (support/remittances)$0

Cash flow health—

Net Worth Statement

Total assets$0

Liquid assets$0

Registered assets (RRSP/TFSA/RESP/FHSA)$0

Non-registered investments$0

Real estate equity$0

Total liabilities$0

Net worth$0

Debt Analysis

Total monthly payments$0

Debt-to-income ratio0%

Debt goal—

Debt health assessment—

DEBT-TO-INCOME RATIO

0%Healthy <36%Elevated 36–43%High >43%

Insurance & Protection Gap

Current life coverage$0

Recommended (10× annual income)$0

Coverage gap / surplus$0

Disability coverage—

Critical illness—

Top protection priorities—

Retirement Projection

Years to retirement—

Target retirement income (inflation-adjusted)$0

Projected nest egg$0

Required nest egg$0

Surplus / shortfall$0

Monthly savings (RRSP + TFSA)$0

Retirement readiness—

RETIREMENT READINESS

Investment Profile

Objective—

Risk tolerance—

Time horizon—

Recommended asset mix—

Tax Optimization Opportunities

Priority Action Plan

Issues ranked by urgency