Personal Financial Information Survey Name First Last Date MM slash DD slash YYYY Annual Income:Your Salary (Gross)Spouse/Partner Other Income (Gross)Total Salary (Gross)Your Bonus (Gross)Spouse/Partner Bonus (Gross)Total Bonus (Gross)Your Other IncomeSpouse/Partner Other IncomeTotal Other IncomeYour Total Annual IncomeSpouse/Partner Total IncomeTotal Annual IncomeYour Total Annual ExpensesSpouse/Partner Total Annual ExpensesTotal Annual ExpensesAnnual Savings:Your Retirement Plan SavingsSpouse/Partner Retirement Plan SavingsTotal Retirement Plan SavingsYour Other SavingsSpouse/Partner Other SavingsTotal Other SavingsYour Total SavingsSpouse/Partner Total SavingsTotal SavingsAssets (What You Own):Your Amount in Checking & Savings AccountSpouse/Partner Amount in Checking & Savings AccountTotal Amount in Checking & Savings AccountYour Amount in RetirementSpouse/Partner Amount in RetirementTotal Amount in RetirementYour Other InvestmentsSpouse/Partner Other InvestmentsTotal Other InvestmentsYour Total Cash and InvestmentsSpouse/Partner Total Cash and InvestmentsTotal Cash and InvestmentsYour Home ValueSpouse/Partner Home ValueTotal Home ValueYour Other Real EstateSpouse/Partner Other Real EstateTotal Other Real EstateYour Auto, Boat, etc.Spouse/Partner Auto, Boat, etc.Total Auto, Boat, etc.Your Other Assets (Jewelry, Artwork, Coins, etc)Spouse/Partner Other Assets (Jewelry, Artwork, Coins, etc)Total Other Assets (Jewelry, Artwork, Coins, etc)Your Other AssetsSpouse/Partner Other AssetsTotal Other AssetsYour Total AssetsSpouse/Partner Total AssetsTotal AssetsDebts/Liabilities (What You Owe):Your MortgageSpouse/Partner MortgageTotal MortgageYour Credit CardsSpouse/Partner Credit CardsTotal Credit CardsYour Education LoansSpouse/Partner Education LoansTotal Education LoansYour Auto, Boat, etc. LoanSpouse/Partner Auto, Boat, etc. LoanTotal Auto, Boat, etc. LoanYour Other LoansSpouse/Partner Other LoansTotal Other LoansTotal DebtsSpouse/Partner Total DebtsTotal DebtsYour Net WorthSpouse/Partner Net WorthTotal Net WorthTom O'Shea (203)254-8344 Claddagh, LLC tomoshea@claddaghllc.com 1735 Post Road Fairfield, CT 06824 www.claddaghllc.com Completion of this questionnaire is for informational and planning purposes only. It does not supersede any data or information reported on official Cambridge or spans company forms. The information is provided by you (the client), and should be reviewed periodically. Claddagh, LLC and Cambridge are not affiliated. Registered Representative, Securities offered through Cambridge Investment Research, Inc.. A broker/dealer, Member FINRA/SIPC. Investment Advisor Representative, Cambridge Investment Research Advisors, Inc., a Registered Investment Advisor. If any of the information is incorrect, you should notify your financial advisor. The information provided by you should be reviewed periodically and update when either the information or your circumstances change.NameThis field is for validation purposes and should be left unchanged. My Office 1735 Post Road, Suite 2CFairfield, Connecticut 06824 Call Us Phone: 203-254-8344Fax: 888-533-6332 Email Us tomoshea@claddaghllc.com