Retirement Questionnaire

This survey will help us to assess your retirement objectives and identify a strategy that may help you toward reaching your retirement lifestyle and income goals. If you're interested in learning more about how we analyze your retirement needs, please complete the questionnaire below.

Step 1 of 6 - Personal Information
 

Spouse
















Step 2 of 6 - Assets and Liabilities

Personal Assets (Household)

$
$
$

Invested Assets and Securities (Household)

$
$
$
$
$
$

Qualified Assets

Spouse

$ $
$ $
$ $

Insurance Protection

Spouse

$ $
$

Liabilities (Household)

$
$
$
Step 3 of 6 - Income and Expenses

Current Annual Income

Spouse

$ $
% %
-

Projected Retirement Monthly Income

Spouse

$ $
$ $
$ $
$  
-

Expenses (Household)

%
 

Current
Monthly Expenses

Projected Retirement
Monthly Expenses

$ $
$ $
$ $
$ $
$ $
$ $
-

Future Savings Plans
Annual Contributions

Spouse

$ $
$ $
Step 4 of 6 - Risk Tolerance

Different investors have different levels of risk tolerance. The following Risk Tolerance Questionnaire has been designed to measure your ability and willingness to accept uncertainties in the performance of your investments.
(Risk Tolerance questionnaire was developed by Ibbotson Associates.)

1.




2.




3.





4.
 Possible Average Value at the End of One YearChance of Losing Money at the End of One Year
$106,00013%
$108,00020%
$109,00026%
$110,00028%
5.





6.
a)





b)





c)





d)





7.
portfolio gains and losses






8.

9.

International securities are primarily a diversification tool. They offer different opportunities from domestic equity and debt in terms of industrial composition and expectations for economic growth (across both regions and countries). The primary diversification benefit of international stocks and bonds is due to low correlation coefficients with domestic asset classes. International securities carry additional risks, including currency exchange fluctuation and different government regulations, economic conditions and accounting standards. The value of a portfolio's investment in foreign securities may fall due to adverse political and social developments abroad. These risks are generally greater for investments in emerging markets than in more developed countries. Focusing on one economic sector increases the vulnerability to any single political or regulatory development.

 

Step 5 of 6 - Lifestyle Aspirations

People have different ways they would like to use their financial resources at a certain point in their lives. What are your aspirations on how you would like to use your time and financial resources in the future? Please allocate 100 points to the following activities to indicate how important each is to you.

 

Assign Points

 

Total = 0

Step 6 of 6 - Assess Your Retirement Needs

This will help you identify your retirement financial goals, and prioritize five key retirement needs: income, legacy, long-term care, health care and spousal survivor income. Following is a list of issues/concerns people have about their futures.

Please indicate below to what extent you are concerned about the various topics.

 Extremely ConcernedVery ConcernedConcernedSomewhat ConcernedNot Concerned

Please rank the items above from 1 to 5, 1 being the greatest concern and 5 being the least concern.

Income Goal

$ or %
%

Please indicate below to what extent you are concerned about the various topics.

 Extremely ConcernedVery ConcernedConcernedSomewhat ConcernedNot Concerned

Legacy Goal

$
%

Spousal Income Goal

$

Long-term Goal



Health Care Goal


Thank You for Completing the Questionnaire

This questionnaire is not a fact finder; rather, it is a tool for us to learn more about your personal and financial goals and objectives. It is not meant as an opportunity to gather the detailed information that would be necessary for us to determine your suitability for the purchase of an investment product; it is merely an introductory exploration into the ways in which we might be able to work together. If you choose to explore further the ways in which we can assist you with your financial goals, we will ask you for more detailed financial and personal information.

Please confirm that you are not a robot

"AXA" is the brand name of AXA Equitable Financial Services, LLC and its family of companies, including AXA Equitable Life Insurance Company (NY, NY), AXA Advisors, LLC, and AXA Distributors, LLC. AXA S.A. is a French holding company for a group of international insurance and financial services companies, including AXA Equitable Financial Services, LLC. The obligations of AXA Equitable Life Insurance Company are backed solely by its claims-paying ability.

Securities offered through AXA Advisors, LLC (NY, NY 212-314-4600), member FINRA, SIPC. Investment advisory products and services offered through AXA Advisors, LLC, an investment advisor registered with the SEC. Annuity and insurance products offered through AXA Network, LLC, which conducts business in CA as AXA Network Insurance Agency of California, LLC, in UT as AXA Network Insurance Agency of Utah, LLC, in PR as AXA Network of Puerto Rico, Inc. AXA Advisors, AXA Equitable Life Insurance Company (AXA Equitable), and AXA Network are affiliated companies and do not provide tax or legal advice.

© 2014 AXA Equitable Life Insurance Company. All rights reserved.

1290 Avenue of the Americas, New York, NY 10104, (212) 314-4600

GE-105014 (06/15)(Exp.06/17)