CalRima Financial & Insurance Agency
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Planning Questionnaire
First Name
Last Name
Birthdate
Spouse's First Name
Spouse's Last Name
Spouse Birthdate
Phone Number
Your total IRA values
Your spouse's total IRA values
Your current income from IRA
Your Spouse's Current Income from IRA
When do you expect to pull money out of your IRA?
When does your spouse expect to pull money out of their IRA?
What is you and your spouse's life expectancy?
What do you consider a reasonable rate of return?
Do you own your own home?
Yes
No
What is the value of your home?
How much is owed against the home?
Do you have significant assets outside of your IRA and home?
Yes
No
If so, ballpark how much are they worth?
What do you consider a reasonable rate of return on your home?
What do you consider a reasonable rate of return on other assets?
Is there any other info that may be applicable?
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