Questionnaire Insurance Planning

Transcription

1 SAVING : INVESTING : PLANNING Questionnaire Insurance Planning F advis use only: Questionnaire date: Location: Number/ID: First name: Last name: Fax: 1 of 11

2 1 Personal Infmation About You and Your Partner (if applicable) You Your partner 1. Social Security #: 2. First name: 3. Middle initial: 4. Last name: 5. Date of birth: 6. Gender: O Male O Female O Male O Female 7. U.S. citizen: O Yes O No O Yes O No 8. Marital status: O Married O Single O Separated O Divced O Widowed O Domestic partner 9. Mailing address: CITY STATE ZIP 10. Your home phone: 11. Your wk phone: 12. Your cellphone: 13. Your wk fax: 14. Your address: 2 Personal Assumptions 1. What is your marginal federal income tax rate? (select only one; rates f 2017) 0% 15% 25% 28% 33% 35% 39% 2. At what rate do you and your partner expect your earnings to rise each year? a. You: b. Your partner: 3. What education inflation rate (if applicable) would you like used in your plan? 4. What long-term rate of return befe retirement would you like used in your plan? % % % % 2 of 11

3 Dependent Infmation 3 Name Gender Date of birth Relationship (Default is child) Parent Child Stepchild Grandchild Other 1. Male Female 2. Male Female 3. Male Female 4. Male Female 5. Male Female 6. Male Female Special needs 7. If any of your children has a special need f services relating to an extradinary physical, educational medical condition, either inside outside of the home, complete the following: Annual amount: $ No. of years services will be required: Start in year: 8. If your parents have a special need f services relating to an extradinary physical medical condition, either inside outside of the home, complete the following: Annual amount: $ No. of years services will be required: Start in year: 4 Income Infmation You Your partner 1. Salary: $ /yr. /yr. 2. Bonus/commissions: $ /yr. /yr. 3. Net self-employment income: $ /yr. /yr. 3 of 11

4 5 U.S. Government Employee Infmation You Your partner 1. If employed by the U.S. government, please indicate: Military service Military service Civil service Civil service Education Infmation 6 Student s Year to Years Annual cost first name start school of school 1. Avg. public college (default) Avg. private college Other: $ /yr. 2. Avg. public college (default) Avg. private college Other: $ /yr. 3. Avg. public college (default) Avg. private college Other: $ /yr. 4. Avg. public college (default) Avg. private college Other: $ /yr Parental assets set aside f education: 7. Coverdell education savings acct. / Section 529 plan assets: 8. Other education assets (including UGMA/UTMA): Avg. public college (default) Avg. private college Other: $ /yr. $ $ $ 9. Percent of need to be covered by savings: 100% (default) % 4 of 11

5 7 Retirement Infmation You Your partner Retirement age: Age 65 (default) Age 65 (default) Age Age Do you expect to receive Social Security (SS)? Yes No Yes No If currently receiving benefits, your monthly SS amount: $ /mo. $ /mo If not currently receiving SS, the monthly amount you expect (in current dollars) [Note: leave blank if you want an estimate calculated f you]: $ /mo. $ /mo. 5 of 11

6 8 Other Retirement Infmation You Your partner 1. Retirement savings plan balance: $ $ 2. Your current annual contribution f retirement plans/annuities: $ /yr. $ /yr. 3. Your employer s annual contribution to your account: $ /yr. $ /yr. 4. Annual traditional IRA contribution: $ /yr. $ /yr. 5. Annual Roth IRA contribution: $ /yr. $ /yr. Pension infmation Annual benefit Age benefits begin Index rate % to surviving Military (COLA) partner Civil Service You: 6. $ /yr. $ %* Retirement age (default) % % M C Age 7. $ /yr. $ %* Retirement age (default) % % M C Age Your partner: 8. $ /yr. $ %* Retirement age (default) % % M C Age 9. $ /yr. $ %* Retirement age (default) % % M C Age 6 of 11

7 9 Insurance Infmation Disability insurance Policies insuring you: (Complete either question 1 2.) 1. Sum of disability policy benefits represented as a percentage of current salary: % OR 2. Monthly disability policy benefits represented as a dollar amount: $ /mo. Policies insuring your partner: (Complete either question 3 4.) 3. Sum of disability policy benefits represented as a percentage of current salary: % OR 4. Monthly disability policy benefits represented as a dollar amount: $ /mo. Life insurance You Your partner 5. Liabilities paid off at death: (select only one) Pay off all debts (default) Pay off all debts (default) Pay off only mtgages Pay off debts other than mtgages Don t use insurance to cover debts Pay off only mtgages Pay off debts other than mtgages Don t use insurance to cover debts 6. Percent of current expenses continuing after death: 80% (default) 80% (default) (Assume education costs will be paid off at death.) % % 7. Monthly income continuing after death: (Exclude any partner earnings.) $ /mo. $ /mo. 8. Number of years to cover family income needs after death: years years 9. Retirement plan assets of the decedent: Use f surviv s Use f surviv s (select only one.) current needs (default) current needs (default) Reserve f Reserve f surviv s retirement surviv s retirement 10. Estate administrative costs: $ $ (default is 5% of decedent s solely owned assets) Surviv income benefit* 11. Monthly amount at your death: $ /month provided f beneficiary, starting in the year 20 lasting f years, and with an annual cost-of-living adjustment of % 12. Monthly amount at your partner s death: $ /month provided f beneficiary, starting in the year 20 lasting f years, and with an annual cost-of-living adjustment of % *If fields are left blank: begins in current year, lasts until death, with no cost-of-living adjustment. 7 of 11

8 9 Insurance Infmation (continued) Policies insuring you: Death Outstanding Policyowner* Beneficiary Policy type * benefit loan balance Client Partner Trust Other Client Partner Trust Other Second Term Cash to die value 13. $ $ 14. $ $ 15. $ $ 16. $ $ 17. $ $ Policies insuring your partner: Death Outstanding Policyowner* Beneficiary Policy type * benefit loan balance Client Partner Trust Other Client Partner Trust Other Second Term Cash to die value 18. $ $ 19. $ $ 20.$ $ 21. $ $ 22. $ $ 23. Do you have a long-term care policy? Yes No (default) 24. Does your partner have a long-term care policy? Yes No (default) * Select only one answer Optional questions f insurance underwriting purposes only 25. Do you smoke? Yes No (default) 26. Does your partner smoke? Yes No (default) 27. Do you have any serious health issues? Yes No (default) 28. Does your partner have any serious health issues? Yes No (default) 29. Does your family have a histy of heart disease? Yes No (default) 30. Does your partner s family have a histy of heart disease? Yes No (default) 8 of 11

9 10 Investment Asset Infmation Cash/cash equivalents: $ 2. Fixed-income assets: $ 3. Equity assets: $ Liability Infmation 1. Total mtgage balance(s): $ (include home equity loans and home equity lines of credit) 2. Other total outstanding debt balance(s): $ 12 Expense Infmation* 1. Total mtgage payments: $ /year (exclude property taxes and homeowners insurance) 2. Total other debt payments: $ /year 3. Total living expenses, excluding debt payments: $ /year * F assistance in calculating the numbers in this section please refer to the online calculat on the Financial Planning Ptal. 9 of 11

10 Appendix To find your marginal income tax rate, use your federal income tax return and locate taxable income. Go to the chart below that cresponds to your filing status to find your marginal tax rate f 2017 tax year. Unmaried Individuals (Other than Surviving Spouses and Heads of Households) 2017 Taxable Income Over But Not Over Marginal Tax Rate $0 $9,325 10% $9,326 $37,950 15% $37,951 $91,900 25% $91,901 $191,650 28% $191,651 $416,700 33% $416,701 $418,400 35% $418, % Married Individuals Filing Separately 2017 Taxable Income Over But Not Over Marginal Tax Rate $0 $9,325 10% $9,326 $37,950 15% $37,951 $76,550 25% $76,551 $116,675 28% $116,676 $208,350 33% $208,351 $235,350 35% $235, % Married Individuals Filing Jointly and Surviving Spouses 2017 Taxable Income Over But Not Over Marginal Tax Rate $0 $18,650 10% $18,651 $75,900 15% $75,901 $153,100 25% $153,101 $233,250 28% $233,251 $416,700 33% $416,701 $470,700 35% $470, % Heads of Households 2017 Taxable Income Over But Not Over Marginal Tax Rate $0 $13,350 10% $13,351 $50,800 15% $50,801 $131,200 25% $131,201 $212,500 28% $212,501 $416,700 33% $416,701 $444,550 35% $444, % 10 of 11

11 Your Future is Calling. Meet It with Confidence. CLICK VALIC.com CALL VISIT your financial advis This infmation is general in nature, may be subject to change, and does not constitute legal, tax accounting advice from any company, its employees, financial professionals other representatives. Applicable laws and regulations are complex and subject to change. Any tax statements in this material are not intended to suggest the avoidance of U.S. federal, state local tax penalties. F advice concerning your situation, consult your professional attney, tax advis accountant. Securities and investment advisy services offered through VALIC Financial Adviss, Inc. ( VFA ), member FINRA, SIPC and an SEC-registered investment advis. VFA registered representatives offer securities and other products under retirement plans and IRAs, and to clients outside of such arrangements. Annuities issued by The Variable Annuity Life Insurance Company ( VALIC ). Variable annuities distributed by its affiliate, AIG Capital Services, Inc. ( ACS ), member FINRA. VALIC, VFA and ACS are members of American International Group, Inc. ( AIG ). American International Group, Inc. (AIG) is a leading global insurance ganization. Founded in 1919, today AIG member companies provide a wide range of property casualty insurance, life insurance, retirement products and other financial services to customers in me than 80 countries and jurisdictions. Copyright The Variable Annuity Life Insurance Company. All rights reserved. VC (06/2017) J EE 11 of 11