SAVING : INVESTING : PLANNING Questionnaire Personal financial overview For advisor use only: Questionnaire date: Location: Number/ID: First name: Last name: Fax: Email: 1 of 6
1 Personal information 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: MM/DD/YYYY MM/DD/YYYY 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 Divorced O Widowed O Domestic partner 9. Mailing address: CITY STATE ZIP 10. Your home phone: 11. Your work phone: 12. Your cellphone: 13. Your work fax: 14. Your email address: 2 Income and tax information 1. Salary: 2. Bonus/commissions: 3. Net self-employment income: 4. What is your marginal federal income tax rate? (select only one; rates for 2017) 0% 15% 25% 28% 33% 35% 39.6% 2 of 6
3 Education information Student's first name Year to start school Years of school Annual cost 1. $ /yr. 2. $ /yr. 3. $ /yr. 4. $ /yr. 5. $ /yr 6. Parental assets set aside for education: $ 4 Retirement information You Your partner 1. Retirement age: Age 65 (default) Age 65 (default) Age Age 2. Total tax-qualified retirement savings plan balance: $ $ 3. Your current annual contribution to retirement plans/annuities (include any employer match): $ /yr. $ /yr. 4. Annual benefit at retirement (in future dollars) from defined-benefit pension plan(s): $ /yr. $ /yr. 5. Cost-of-living adjustment (COLA) on defined-benefit pension plan(s): % % 6. Additional annual saving for retirement (amount saved each year until first retirement): $ /yr. $ /yr. 7. Additional assets reserved for retirement: $ /yr. $ /yr. 3 of 6
5 Insurance information Your insurance policy: 1a. Sum of disability policy benefits represented as a percentage of pay: % 1b. Sum of total death benefits from your life insurance policies: $ Your partner s insurance policy: 2a. Sum of disability policy benefits represented as a percentage of pay: % 2b. Sum of total death benefits from your life insurance policies: $ 6 3. What are the dates of birth of your dependent children? a. / / b. / / c. / / d. / / e. / / 4. Do you have a long-term care policy? Yes No (default) 5. Does your partner have a long-term care policy? Yes No (default) Other information 1. Do you have a will? Yes No (default) 2. Does your partner have a will? Yes No (default) 3. Approximate value of your liquid investment assets (cash accounts, bonds, stocks, mutual funds, etc.), excluding retirement plan assets: 4. Approximate value of your illiquid assets (real estate, business assets, etc.): $ $ 5. Total current mortgage balance(s): $ 6. Total other outstanding debt balance(s), including credit cards: $ 7. Total monthly debt payments, including mortgage payments (do not include property taxes or homeowners insurance): $ /mo. _ 8. Total monthly living expenses (exclude debt payments): _ $ /mo. 9. Amount you have reserved for short-term emergencies: $ 4 of 6
Appendix To find your marginal income tax rate, use your federal income tax return and locate taxable income. Go to the chart below that corresponds to your filing status to find your marginal tax rate for 2017 tax year. Unmaried Individuals (Other than Surviving Spouses and Heads of Households) 2017 $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% $418,401-39.6% Married Individuals Filing Separately 2017 $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% $235,351-39.6% Married Individuals Filing Jointly and Surviving Spouses 2017 $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% $470,701-39.6% Heads of Households 2017 $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% $444,551-39.6% Source: Internal Revenue Service. 5 of 6
Your Future is Calling. Meet It with Confidence. CLICK VALIC.com CALL 1-800-426-3753 VISIT your financial advisor This information is general in nature, may be subject to change, and does not constitute legal, tax or accounting advice from any company, its employees, financial professionals or 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 or local tax penalties. For advice concerning your situation, consult your professional attorney, tax advisor or accountant. Securities and investment advisory services offered through VALIC Financial Advisors, Inc. ( VFA ), member FINRA, SIPC and an SEC-registered investment advisor. 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 ). AIG is a leading international insurance organization serving customers in more than 100 countries and jurisdictions. AIG companies serve commercial, institutional, and individual customers through one of the most extensive worldwide property-casualty networks of any insurer. In addition, AIG companies are leading providers of life insurance and retirement services in the United States. All products and services are written or provided by subsidiaries or affiliates of AIG. Non-insurance products and services may be provided by independent third parties. AIG common stock is listed on the New York Stock Exchange and the Tokyo Stock Exchange. www.aig.com. Copyright The Variable Annuity Life Insurance Company. All rights reserved. VC 13164 (05/2017) J101142 EE 6 of 6