**It’s Time to Take Control of Your Finances and**

Build a Legacy Your Family Will Thank You For.

Your Privacy Matters

Please answer each question honestly and to the best of your knowledge. Your responses are kept confidential and are used solely to help us understand your financial goals and prepare personalized recommendations for your strategy session. Nothing you share in this form automatically disqualifies you from coverage. Our goal is to provide you with the most accurate guidance and recommendations based on your unique situation.

First Name *

Last Name *

Date of birth *

Gender *

Email *

Phone *

State *

What is your marital status? *

How many dependent children do you currently have? *

Employment Status *

Household Income (annually)? *

Do you currently have life insurance coverage? *

Health Information

The next few questions relate to your general health and medical history. Your responses are kept confidential and are used solely to help us better understand your situation and prepare for your strategy session. This information is never shared outside of the insurance and underwriting process without your permission.

Height (approximately) *

Weight (approximately) *

Do you currently use, or have used in the past, tobacco or nicotine products? *

Do you currently use marijuana or cannabis in any form? *

Have you ever been diagnosed with any medical conditions? *

Have you ever been diagnosed with a mental health condition? *

Have you had any surgeries within the past 10 years? *

Have you been hospitalized within the past 10 years? *

Within the past 5 years, have you been declined, rated, postponed, or offered life insurance with a higher premium? *

Debt & Credit

Our ultimate goal is to help you build a strong financial foundation. Your credit score and current debt do not determine whether we can work together. They simply help us understand your overall financial picture and identify opportunities that may strengthen your long-term strategy. In some cases, we may prepare additional recommendations designed to help improve your financial foundation before or alongside your wealth-building plan. Therefore, we encourage you to please answer honestly.

What is your approximate credit score? *

An estimate is perfectly acceptable as this information is used solely to help us prepare personalized recommendations.

Which of the following types of debt do you currently have? (Select all that apply) *

You do not need to provide balances at this time. This information simply helps us better understand your financial picture before your strategy session.

Which of the following financial goals are your highest priorities? (Select up to 3) *

If we determine you're a good fit, approximately how much are you comfortable allocating monthly toward your long-term financial strategy? *

If we identify a strategy that aligns with your financial goals, when would you ideally like to move forward? *

As soon as possible

Within the next 2 weeks

Within the next 30 days

Our recommendations are prepared for individuals who are ready to take action within the next 30 days if we identify a strategy that aligns with their goals.

How did you hear about us? *

BEFORE YOU SUBMIT

Please review and acknowledge each statement below.

I certify that the information I have provided in this Legacy Profile is true and accurate to the best of my knowledge. I understand that this Legacy Profile is not an insurance application and is used to prepare personalized recommendations for my strategy session. I understand that completing this Legacy Profile does not guarantee approval for insurance coverage and that any offer of coverage is subject to the underwriting guidelines of the insurance carrier. I understand the purpose of the Big Picture Strategy Review and acknowledge that, if we identify a strategy that aligns with my goals, I am prepared to move forward with the implementation process within my preferred timeline. *

I have read, understand, and agree to each of the acknowledgments above.

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from Solomon Financial Solutions. Message frequency varies. Message & data rates may apply. Reach out to (470) 574-4051 for assistance. You can reply STOP to unsubscribe at any time.

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