Personal Risk Assessment Form

This personal Risk Assessment Form will help you analyze the financial risk in your life, so that you can be sure you are taking the right steps to protect your assets and grow your wealth. You will receive a personalized report with recommendations on actions you may want to take to secure your financial future. All information is 100% confidential.

First Name

Last Name

Your Current Age:

Spouse Current Age:

What is your desired retirement age?:

What is your Spouse's desired retirement age?:

What is your desired monthly income in retirement?

Your occupation?

Your spouse's occupation?

What are your primary financial concerns?

How do you feel about risk in retirement?

Are you concerned about the risk of outliving your money?

What is your monthly Social Security income?

What is your spouse's monthly Social Security income?:

Do you have existing or future pension income?

Does your spouse have existing or future pension income?

What is the survivorship percentage on the pensions? (if applicable)

Do you have any other streams of income?

Approximate amount of liquid money? (checking and savings accounts, bank CDs, stocks, etc.):

Approximate amount of money in qualified plans? (IRAs, 401k, 403b, TSP, etc.)

What are your approximate monthly expenses?

Are your parents still living?

Are you likely to have to pay for your parent's care?

Are you expecting to receive an inheritance?

If you suffered from and survived a critical illness, such as cancer, a heart attack or a stroke, do you have a plan in place to minimize your financial risk and protect your assets?

Is there anyone in or outside of your household that’s dependent on your income?

How much life insurance do you currently have in-force?

Are there any other financial areas that you have questions or concerns about?

If you got hurt or fell ill and were unable to work for an extended period of time, how long could you survive without a paycheck?

Do you have a will, and if so, when was it last updated?

Who else would be involved in the decision to optimize and protect your income and assets?