Retirement Planning Questionnaire
RetireNow Insurance & Financial Services
Date
*
-
Month
-
Day
Year
Date
Personal Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Gender
Please Select
Male
Female
Transgender
Gender-neutral
Prefer not to answer
Marital Status
Please Select
Single
Married
Divorced
Widowed
Spouse Contact Information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Current Situation
Are you already retired?
Yes
No
If not, what is your current income? (annual, $)
When are you planning to retire? (how many years from now)
Include your spouse in your retirement plan?
Yes
No
Is your spouse already retired?
Yes
No
N/A
What is your spouse's current income? (annual, $)
When is your spouse planning to retire? (how many years)
Considering all of your retirement accounts: (Pension, 401k, TSA, 403b, 457b), will that amount be enough to support your retirement lifestyle?
*
Yes
No
Not Sure
Finance
How much income will support your retirement lifestyle? ($)
*
Less than $50,000 /year
Less than $100,000 /year
$150,000 - $350,000 /year
$500,000+ /year
Not Sure
How much are you currently contributing a month to your retirement accounts? ($)
*
Considering all bills at home, what is an estimated monthly amount of all bills? ($)
*
Considering all credit cards, what is the total amount of all credit cards? ($)
*
What is your consolidated total ($) of all of your retirement accounts?
*
Less than $100,000
$100,000 - $400,000
$500,000+
Not Sure, I would like to talk to an Advisor
What is your desired income in retirement? (monthly)
*
Do you currently have Life Insurance, what type?
*
Term
Whole Life
Indexed Universal Life
I'm not sure, I want to talk to an Agent
Legal
Do you have a Will or Living Trust?
Yes
Not yet
Lifestyle
Where do you plan to live during retirement?
Do you plan to finish life in your home or at a professional assisted living facility?
*
Home
Assisted living
Live with relatives
Submit
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