VFG Retirement Planning Questionnaire
Personal Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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.
Emergency Contact Information
Type a question
Same as spouse
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Current Situation
Are you already retired?
*
Yes
No
If not, what is your current income? (annual, $)
*
When would you like to retire?
*
10 years, 15 years, 20 years, 25 years+
Include your spouse in the plan?
Yes
No
Is your spouse already retired?
Yes
No
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
Face Value
Term (months) / Type
Premium per Year
Benefit
Term Policies
Permanent Policies
Disability Insurance
Care Insurance
Legal
Have you compiled a list of contact information for your closest family?
*
Yes
Not yet
Have you updated your will and living will?
*
Yes
Not yet
I need one
Responsible person for your will and living will
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Lifestyle
Where do you plan to live during retirement?
*
Do you plan to finish life in home or in assisted living?
*
Home
Assisted living
Date
*
-
Month
-
Day
Year
Date
Please feel free to leave additional comments. I would love to hear about your retirement plans!
Signature
Please verify that you are human
*
Submit
Submit
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