Insurance

Kiran Bedi
Realtor, Mortgage Consultant and Life Insurance Agent

(408) 780-6282

Client Financial Goals & Needs Assessment – IUL Suitability Questionnaire

Full Name: Age:

Marital Status:   Number of Dependents:

Occupation & Employer:   Annual Income:

State of Residence:

Primary Financial Goals (check all that apply):

Do you currently have life insurance? If yes, type and amount:

Estimated life insurance need:

Focus:

Risk Tolerance:

Investment Horizon:

Liquidity Needs (expected withdrawals in next 5–10 years?):

A

Are you contributing to IRA/401k?

Interested in tax-free retirement income?

Concerned about rising taxes?

Budget for Monthly/Annual Premium:

Preferred Funding Strategy:

Health Conditions, Medications, Declines:

Retirement Age & Income Goal:

Self-Employed or Business Owner? .

Desired Riders (LTC, Chronic, Overloan, etc.):

Outstanding Loans or Debts: