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Kiran Bedi
Realtor, Mortgage Consultant and Life Insurance Agent
(408) 780-6282
Client Financial Goals & Needs Assessment
IUL Suitability Questionnaire
1. Personal Information
First Name
*
Last Name
*
Email
*
Date
Age
Marital Status
Number of Dependents
Occupation & Employer
Annual Income
State of Residence
2. Financial Objectives
Wealth accumulation
Retirement planning
Leaving a legacy
College funding for children
Tax-advantaged growth
Income protection for family
Business succession or key-person planning
Long-term care planning
Estate planning
3. Insurance Needs
Do you currently have life insurance?
Yes
No
If yes, type & coverage
Coverage you believe you need
Are you more focused on
Protection
Investment/Growth
Both equally
4. Risk Tolerance
Very conservative (minimal to no risk)
Moderate (some fluctuations acceptable)
Aggressive (willing to take risks for higher returns)
5. Investment Horizon & Liquidity
5–10 years
10–15 years
15+ years
Need withdrawals in 5–10 years?
Yes
No
If yes, for what purpose?
6. Tax Planning
Are you maxing out retirement accounts?
Yes
No
Interested in building tax-free retirement income?
Yes
No
Concerned about rising tax rates?
Yes
No
7. Budget for Premiums
Less than $200/month
$200–$500/month
$500–$1,000/month
$1,000+/month
Are you looking for
Minimum premium / Max death benefit
Maximum premium / cash accumulation
Balanced strategy
8. Health Status
Health conditions
Medications
Ever declined life insurance?
9. Retirement Goals
Desired retirement age
Desired retirement income
Currently saving?
Yes
No
If yes, how?
10. Additional Considerations
Please be assured that your e-mail address will never be sold, shared or used for any other purpose without your permission.
