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Confidential Personal Planning

Questionnaire
Prepared for: Peyton Manning

Provided by:

Table of Contents
Personal Information ...........................2
Children ............................................2
Residence Information.........................2
Professional Advisor Information ...........2
Employment/Income Information ..........2
Financial Information...........................3
Insurance Information .........................3
Planning Priorities ...............................3
Important Information.........................4

Confidential Personal Planning Questionnaire

Personal Information
Name:
Date of Birth:
E-Mail Address:
Height/Weight:
Tobacco Use?:
Hazardous
Occupation?:

Client
______________________
Peyton Manning
03
24
1976
______/______/________
pmanning@Dbroncos.com
______________________
____ft____inches/____lbs.
6
5
230
__Yes __ No ___________
__Yes __ No ___________
______________________
Professional athlete

Spouse
______________________
Ashley Manning
1973
______/______/________
amanning@wife.com
______________________
____ft____inches/____lbs.
5
8
135
__Yes __ No ___________
__Yes __ No ___________
______________________
philanthropist

Children
Name:
Date of Birth:

Child 1
Child 2
Child 3
_________
_________
_________
Marshal Williams Manning
Mosley Thompson Manning
__/__/____
__/__/____
__/__/____
3
31 2011
3 31 2011

Child 4
_________
__/__/____

Residence information
Street Address:
__________________________________________________
18
Victory Lane
City, State, Zip:
__________________________________________________
Denver,
Colorado
Home Phone No:
__________________ Cell Phone No: ___________________
504 6754698
Own?
Mortgage Payment: _________
Mortgage
Balance:
___________
$20,000
$1,800,000
Rent?
Monthly Rent: ___________

Professional Advisor Information


Clients Will:
Spouses Will:
Attorneys Name:
Accountants Name:

Date __________
Type __________________________
Reciprocal
Date __________
Type __________________________
Reciprocal
_________________________
Phone No.: _____________
Ari Fleischer
_________________________
Phone No.: _____________
JJ Watt

Employment/Income Information
Occupation:
Employer:
Business Street
Address:
City, State, Zip:
Phone Number:
Fax Number:
E-Mail Address:
Annual Income:
Other Income:

Client
_____________________
Professional NFl Athlete
_____________________
Denver Broncos
_____________________
Mile High Stadium
_____________________
_____________________
Denver, Colorado
_____________________
_____________________
_____________________
DenverBroncos@MileHigh.com
_____________________
$15,000,000
_____________________
$12,000,000

Confidential Personal Planning Questionnaire

Spouse
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________
______________________

Financial Information
Assets
Savings
__________
$4,000,000
$2,000,000
Investments
__________
IRA(s)
__________
$1,000,000
$6,000,000
Real Estate
__________
Business Interests
__________
$800,000
Personal Property
__________
$3,000,000
Other
__________
$16,800,000
Total Assets
__________
Current Monthly Systematic Savings:

Liabilities
Installment Loans
Mortgage(s)
Charge Accounts
Credit Cards
Personal Notes
Business Debt
Other
Total Liabilities
___________

____________
$200,000
____________
____________
$1,000,000
$900,000
____________
____________
$2,500,000
____________
____________
$4,600,000
____________

Insurance Information
Life Insurance
Policy
Policy
Face
Annual
BeneInsured
Company
Number
Date
Amount
Premium
ficiary
__________
________
_________
_____
________
________
_______
yes
Nationwide
2131513255
05/90
$3,000,000
$200,000
__________ ________ _________ _____ ________ ________ _______
__________ ________ _________ _____ ________ ________ _______
__________ ________ _________ _____ ________ ________ _______
Long-Term Care Insurance
Policy
Policy
Daily
Benefit
Annual
Insured
Company
Number
Date
Benefit
Period
Premium
yes
Nationwide
151464135156 _____
05/90
__________
________
_________
________ _______
_______
__________ ________ _________ _____ ________ _______
_______
Other Insurance
Monthly Disability Benefit:
Client ___________
Spouse ___________
Critical Illness Insurance Benefit:
Client ___________
Spouse ___________
Health Insurance:
Client __________
Spouse ___________
P&C Expiration Dates:
Auto ______
Homeowners ______
Other _______

Planning Priorities
High
Medium
Protecting Familys Lifestyle
_____
_____
Protecting Income
_____
_____
Providing Education Funds
_____
_____
Implementing Savings Plan
_____
_____
Planning for Retirement
_____
_____
Minimizing Estate Shrinkage
_____
_____
Planning for Business Continuation
_____
_____
Other: ______________________
_____
_____
How much do you feel comfortable setting aside on a monthly

Confidential Personal Planning Questionnaire

Low
_____
_____
_____
_____
_____
_____
_____
_____
basis?:

None
_____
_____
_____
_____
_____
_____
_____
_____
_________

Important Information
This fact finder serves to help identify your financial needs and priorities and may be
used in developing proposed solutions consistent with your needs and objectives. In
completing this fact finder, you are entrusting our organization with certain personal
and confidential financial data. We recognize that our relationship with you is based on
trust and we hold ourselves to the highest standards in the safekeeping and use of your
confidential information.
The information, general principles and conclusions presented in this report are subject
to local, state and federal laws and regulations, court cases and any revisions of same.
While every care has been taken in the preparation of this report, neither VSA, L.P. nor
The National Underwriter Company is engaged in providing legal, accounting, financial
or other professional services. This report should not be used as a substitute for the
professional advice of an attorney, accountant, or other qualified professional.

VSA, LP

All rights reserved (VSA ff-01 ed. 01-12)

Confidential Personal Planning Questionnaire