Fillable Questionnaire: Uncovering Key Concerns for Your Capital (New York Life)

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Questionnaire: Uncovering Key Concerns for Your Capital (New York Life)

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Protecting assets against judgment creditors
Keeping income taxes as low as feasible
Providing for adequate retirement income
Matching capital assets with risk tolerance
Protecting future income from death/disability
Keeping estate taxes and costs as low as possible
Questionnaire: Uncovering Key
Concerns for Your Capital
At least six key areas should be addressed when accumulating and protecting capital: asset protection,
income taxation,
retirement income, capital asset risk, income protection and, estate planning. The following
questions may help you
identify your areas of greatest concern. Using the below scales, rank your agreement
or disagreement with the
statements below by marking the appropriate response.
A
sset Protection Capi
t
al
A
sset Risk
I am concerned abou
t
pro
t
ectin
g
my asse
t
s
f
rom
j
ud
g
ment
creditors, lawsuits, and other legal processes.
Agree Agree Neutral
Disagree Disagree
Somewhat Somewhat
I have taken reasonable measures to protect my assets from
judgment creditors, lawsuits, and other legal processes.
Agree Agree Neutral
Disagree Disagree
Somewhat Somewhat
Iamcomfor
t
able wi
t
htheoverallcapi
t
al risk associa
t
ed wi
t
h
my current asset diversification.
Agree Agree Neutral
Disagree Disagree
Somewhat Somewhat
Income Ta
x
a
t
ion IncomeProtection
I wan
t
t
o keep my income
t
a
x
es as low as feasible.
Agree Agree Neutral
Disagree Disagree
Somewhat Somewhat
I have taken reasonable steps to keep my income taxes as
low as feasible
Agree Agree Neutral
Disagree Disagree
Somewhat Somewhat
Iwan
t
t
o protect my future income and/or spouse
s
f
uture
income from death or disability.
Agree Agree Neutral
Disagree Disagree
Somewhat Somewhat
I have taken reasonable measures to protect my future income
and/or spouse’s future income from death or disability.
Agree Agree Neutral
Disagree Disagree
Somewhat Somewhat
Re
t
i
r
ement Es
t
ate Plannin
g
I am concerned about having adequate income at retirement for
myself and/or my spouse.
Agree Agree Neutral
Disagree Disagree
Somewhat Somewhat
I have taken reasonable measures to provide adequate income
at retirement for myself and/or my spouse.
Agree Agree Neutral
Disagree Disagree
Somewhat Somewhat
I wan
t
t
okeep es
t
a
t
e
t
axes and es
t
a
t
e cos
t
s as low as feasible.
Agree Agree Neutral
Disagree Disagree
Somewhat Somewhat
I have taken reasonable steps to distribute my assets fairly to
my heirs and to keep my estate costs as low as feasible.
Agree Agree Neutral
Disagree Disagree
Somewhat Somewhat
Using the numbers 1-3, please rank the top 3 of the following areas in the order which are of greatest concern:
Adequately addressing these areas will normally
require legal, tax, and investment advice. Consult 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.
Name %
Owned
Relation A
g
e
CONFIDENTIAL QUESTIONNAIRE
AgentName/Code:_____________________________GO:____________________Phone#:_______________________
2. Client’s Name
____________________ M_ F_
2.
Spouse’s Name
_____________________
M_F_
Age: DOB: State of Domicile Age: DOB: State of Domicile
U.S. Citizen?: Yes_ No_ If no, what country:_ _
U.S. Citizen?: Yes_ No_ If no, what country:
3.
Children and other Beneficiaries
Name
A
g
e Relation Marital Status Income # o
f
Children Concerns
4.
Balance Sheet
a. Total Assets (non-pension
) $ Cash, Securities, Real Estate, Annuities, etc.
b.
T
otal Pension Assets $ 401(
k
)s, IRAs, SEPs, other Quali
f
ied Plans Assets
c.
T
otal Liabilities $ Mort
g
a
g
es and other Liabilities
d.
T
otal Net Worth $ Assets (lines a + b) minus Liabilities (line c).
5.
Life Insurance
Company
T
ype o
f
Ins
Owne
r
Insured Bene
f
iciary Net Cash Value
Annual
Premiums
Death Bene
f
it
6.
Annual Income 7. Business Owner? Yes No If yes, then:
Businesstype:Partnership__SCorp__C Corp__LLC__LLP__Sole__Other__
1. How do you plan to fund your retirement? ____________________________________________________
2. Do you provide care to someone with special needs? Yes___ No___
3. Are you currently holding significant cash savings in a long-term, low-interest bearing account such as a
savings account? ________________________________________________________________________
4. Are you currently utilizing your annual gifting exclusion? Yes___ No___
This material includes a discussion of one or more tax related topics prepared to assist in the promotion or marketing of the transactions or matters
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 agents
and employees, may not provide legal, tax, or accounting advice. Consult your own professional advisers before implementing any planning strategies.
©2016NewYorkLifeInsuranceCompany.Allrightsreserved. 2of2
SMRU507576(exp.7.31.2022)
Client $
Spouse $
T
otal Income $
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Questionnaire: Uncovering Key Concerns for Your Capital (New York Life)

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Completed 10 March 2021

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