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This is now the stage in which you tell me a little more about yourself and what your priorities are. You have concluded that the Indexed Universal Life plan has a place in your overall strategy in accomplishing your retirement needs to provide for your family in the event of your unexpected death or illnesses qualified to be covered under the Living Benefit provisions of the plan/plans selected.

Sharing your focused goals will help ensure that whatever plan in enacted, it will be appropriate and meet your stated needs and outcome.
 
 
 
 
* First Name : 
* Last Name : 
* Email Address : 
 
 
 
What is your occupation?
   
 
 
 
If applicable, what is your spouse or domestic partners occupation?
   
 
 
 
Is your occupation likely to change in the next 5 years?
 
Yes
 
No
 
Not sure
 
 
 
Will you be expecting any significant changes in your income both good or bad and if so, what do you expect?
   
 
 
 
When you do you anticipate that you will retire?
 
5-10 years from now
 
11-20 years from now
 
21-30 years from now
 
31-40 years from now
 
Never
 
Already retired
 
 
 
What would you say is your number one financial goal?
   
 
 
 
What portion of your total accumulated retirement assets are you willing to put at risk or lose in the market? All of it? 50%? None? Write your answer below.
   
 
 
 
How much life insurance coverage do you believe you should own?
 
1 years worth of my gross income
 
10 years of my gross income
 
20 years of my gross income
 
I don't need it at all
 
I'm not sure
 
 
 
If applicable, how much life insurance coverage should your spouse or domestic partner have?
 
1 years worth of their gross income
 
10 years of their gross income
 
20 years of their gross income
 
I don't need it at all
 
I'm not sure
 
 
 
Do you have children living with you or needing your financial support and if so, how many?
   
 
 
 
Will you be paying for college and if so, how much of their college are you will to pay?
 
We don't plan on paying any portion of the college expenses
 
We want to cover up to 25% of that they are paying
 
We will cover up to 50% of their expenses
 
It will be all covered by either ourselves or any family members
 
 
 
If applicable, what type of college savings program have you started?
 
Coverdale IRA
 
529 plan
 
Other cash value policy
 
Savings account
 
Brokerage account
 
Other
 
 
 
 
If you are participating in a company sponsored 401k, Simple IRA, SEP, 403b or 457 plan, how much are you deferring away in terms of either a percent of your income or flat dollar amount per pay period and the number of pay periods per year?
   
 
 
 
If you are participating in a employer sponsored plan, how much per pay period is your employer contributing in terms of a percent or dollar amount per pay period?
   
 
 
 
What percentage of your income do you believe you should be saving in order to be successful for your retirement?
 
1-3%
 
4-7%
 
7-10%
 
10-15%
 
More than 15% a year
 
 
 
What percentage of your total amount of your invested retirement assets are you willing to risk to market loss?
 
0-25%
 
25-50%
 
75-100%
 
None of it. Can't afford to lose any of it.
 
 
 
Debt is a problem for many people. Would you describe yourself as having a debt problem and if so, what actions have you taken to eliminate it?
   
 
 
 
Do you have items such as cars or other major purchases that are soon to be paid off, and if so, can you describe what it is?
   
 
 
 
Are you a home owner, and if so, how soon were you planning to have it paid off?
 
1-5 years
 
6-10 years
 
11-15 year
 
16-20 years
 
More than 21 years
 
Already paid off
 
 
 
If you are not a home owner, do you plan on purchasing one and what is your time frame in doing so?
 
Already a home owner
 
1-5 years
 
6-10 years
 
Don't envision seeing buying a home anytime soon
 
 
 
If you currently have a mortgage and it has been a while since you have refinanced or you are looking at the possibility of an equity line of credit or reverse mortgage, would you like to have me recommend someone to assist you?
 
Yes
 
No
 
 
 
At the time of retirement, will you be staying where you are currently residing or will you be relocating to another state or country?
 
Staying where I am at
 
Have plans to move to another state
 
Will be moving to another country
 
Have no idea at this point what the plan will be
 
 
 
If you do not have a will, you should seriously consider obtaining one. I don't provide legal advise but setting up a will is in many cases simple to do whether you do it through an online service or through a local attorney. The cost can vary greatly. If you would like to speak to a local attorney, would you like me to provide you with a couple of options?
 
I already have a will and it fairly current
 
I have one but it would be a good idea to have a local attorney review it.
 
I can handle the constructing of a will myslef
 
I would like you to make recommendations on local attorneys to speak to
 
 
 
How motivated are you to work with me and to set up a plan for your future?
 
Very motivated
 
Motivated but I still have questions
 
Not very motivated
 
I will not be setting up a plan
 
 
 
Other than yourself/yourselves, are there any other decision makers such as attorneys, accountants, financial advisors, family or friends that would be involved in assisting you in your decision and if so, who is it and what is their background and relationship to you?
   
 
 
 
When it comes to mutual accountability, which statement below best describes you thought and belief.
 
A. It is important that both myself and the person I am working with keep solid on agreements such as meeting on time, completing task, submitting requested documents, responding back promptly. In short, complete accountability.
 
B. That a general effort be made to keep to scheduled meetings and task but things and circumstances change and that should allow for flexibility.
 
C. It is very difficult to make solid commitments on either party and that we simply just have to go with the flow.
 
D. There should be no concern about mutual accountability. If it happens, it happens. If it doesn't, no big deal.
 
 
 
Above and beyond what you are already and setting aside for retirement or college savings, how much money per month are you willing to comfortably set aside?
   
 
 
 
Assuming that a plan could be put together that met your level of comfort and accomplished the items discussed, would there be any reason why you couldn't take action and implement it?
 
Yes
 
No
 
Other