VFG Retirement Planning Questionnaire

VFG Retirement Planning Questionnaire
Personal Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Marital Status*
Spouse Contact Information
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Information
Same as spouse
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Current Situation
YesNo
If not, what is your current income? (annual, $) *
When would you like to retire?*
10 years, 15 years, 20 years, 25 years+
YesNo
YesNo
If not, what is your spouse's current income? (annual, $)
When is your spouse planning to retire? (year)
Finance
How much of your (and your spouse's) assets in total? ($)*
How much coverage do you have to protect you or your family your?*
Do you have any other financial sources such as pension, 401K, etc.? *
Total of your financial sources

Insurance Information

Legal
YesNot yet
YesNot yetI need one
Responsible person for your will and living will*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Lifestyle
Where do you plan to live during retirement?*
HomeAssisted living
Date*

MonthDayYear
Date
Please feel free to leave additional comments. I would love to hear about your retirement plans!
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Personal Information