RETIREMENT SAVINGS QUESTIONS (Customized and personalized)
First Name: Last Name:
Gender: Smoker: Married: Birthdate:
Phone Number (Including area code): Email Address:
INSURANCE & ANNUITIES
INCOME PLANNING
EMPLOYEE BENEFIT PLANS
BUSINESS PLANNING
I'M ALSO READY TO TAKE ACTION ON:
NOTES!
ALL INFORMATION PROVIDED IS CONFIDENTIAL !
I was referred by:
Do you currently have a Defined Benefit Plan i.e. Pension Plan?
Height:
Weight:
Insurance
Annuities
Retirement Income
Tax Avoidance Strategies
Your INDEPENDENT Resource
949.954.4445
Resident State:
If yes, are you still contributiing to the plan?
Are you self-employed?
Do you currently have access to a 401k, 403b etc..with employer matching?
If Yes, are you contributing?
If Yes, how much per month are you contributing?
What % per month is your employer contributing?
Any Health Issues? (List in the NOTES area below?
If we designed a plan for you, how much would you like to contribute monthly?
Do you currently have a traditional IRA?
If Yes, how much is in the account?
Do you currently have a ROTH IRA?
If Yes, how much is in the account?
Do you have access to a Health Savings Account?
Did you elect the HSA compatible health plan?
Are you contributing to the HSA Account?
If Yes, how much each month?
Is any one depending on your financially?
If Yes, who?
What is your annual income?
Do you currently have life insurance?
If Yes, kind?
