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Life in Business Confidential
Questionnaire
Bus
iness planning includes one or more of the following general areas of concern: buy-sell planning, key
employee retention and/or insurance, business succession planning, and retirement planning and/or
income protection for business owners. Use the check-boxes below to indicate which of these
apply to your client. Check all boxes that apply.
Buy-Sell Planning
Key Employees
A buy-sell agreement is a signed, written agreement
among existing owners under which a deceased or
departing owner’s interest would be purchased by the
business or remaining owners.
There is no buy-sell agreement in place
There is a partially funded agreement in place
There is a fully funded agreement in place
This is not an area of concern
For these purposes, a key employee is one whose
contributions are significant and who would be difficult
to replace. A retention plan is a compensation plan
specifically designed to retain key employees.
The business has at least one key employee
There are no retention plans in place
No key person life insurance policies are in place
This is not an area of concern
Business Succession
Business Owners
A business succession plan is a well-considered set of
procedures and financial arrangements whereby the
business will continue under new ownership when the
existing owner departs.
At least one successor owner has been identified
Potential successors lack experience
There is no succession plan in place
This is not an area of concern
Two potential needs of many business owners are to
protect dependents in the event of the owner’s
premature death and to build retirement savings outside
the business.
The owners’ dependents are not fully protected
Owners’ retirement planning is incomplete
Owners’ retirement distributions will be taxable
This is not an area of concern
Using the numbers 1-6, please rank the following areas in the order which are of greatest concern:
Buy
-Sell Planning
Key Employee Retention
Key Person Insurance
Business Succession
Income Protection for Owner’s Dependents
Business Owner Retirement Planning
Adequately addressing these areas will normally
require legal, tax, and investment advice. You
should seek the services of a qualified attorney,
accountant, or investment professional for
applicable legal, tax, or investment advice.
Your
New York life agent may assist you with death
benefit protection and other estate and
retirement planning aspects relating to life
insurance.
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AGENT INFORMATION
Name & Approved Designations: _____________________________________________________________________
Address: _________________________________________________________________________________________
Phone #: _________________________________ Email: ____________________________________________
BUSINESS INFORMATION
Business name: ___________________________________________________________________________
Location: ___________________________________________________________________________
Principal business activity: ___________________________________________________________________________
Structure:
Partnership LLC taxed as C Corp
S Corporation Sole Proprietorship
C Corporation LLP
LLC taxed as partnership Nonprofit
LLC taxed as S Corp Other ______________________________________
Estimated value: ___________________________________________________________________________
Annual net income: ___________________________________________________________________________
Years in operation: ___________________________________________________________________________
Growth trend: ___________________________________________________________________________
Ownership:
Name Age Gender
Ownership
%
Married?
Indicate family relationships among owners (if any):
___________________________________________________________________________________________________
Other relevant considerations (including related businesses):
__________________________________________________________________________________________
3
BUY-SELL PLANNING
Date Executed: ____________________________________________________________________________________
Type:
Cross Purchase Entity Purchase/Stock Redemption
Hybrid/Wait & See Other ____________________________________________
Triggering Events:
Death Disability
Retirement Other ____________________________________________
Funding:
Policy
Type
Insured Owner Beneficiary
Cash
Value
Death
Benefit
SU
CCESSION
Potential successor owners:
Name Age Position
Experience in the
Business
Gender
Indicate family relationships among successors and/or current owners (if any):
_________________________________________________________________________________________
Owners’ objectives:
Providing for retirement Surviving spouse’s financial security
Inheritance equalization Tax efficiency
Control* Other ___________________________________________________
* I.e., control of any assets used to finance a transition of ownership
4
KEY EMPLOYEES
Name Age Compensation
Time to
Replace*
Contribution
%*
* If possible, estimate the time it would take to replace each employee, and the employee’s annual percentage
contribution, to company net profits.
KEY PERSON INSURANCE
Policy
Type
Insured Owner Beneficiary
Cash
Value
Death
Benefit
Is the business required to maintain significant cash holdings for bonding or other purposes?
Yes No
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addressed. It is not intended (and cannot be used by any taxpayer) for the purpose of avoiding any IRS penalties that may be imposed upon the tax
payer. Taxpayers should always seek and rely on the advice of their own independent tax professionals. New York Life Insurance Company, its affiliates
and subsidiaries, and agents and employees of any thereof, may not provide legal, tax, or accounting advice. Individuals should consult their own
professional advisers before implementing any planning strategies.
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