Client Intake — Kevin Richey

Welcome

This intake takes about 10 minutes. The more you share, the better I can prepare for our conversation — so we spend our call on strategy, not data collection.

Your information is private and secure
No obligation — this is for our dream conversation only
Skip anything you're not comfortable sharing

About You

Basic contact and financial information.

First Name *

Last Name *

Date of Birth *

Email *

Cell Phone

Home Phone

Street Address

City

State

Postal Code

Country

Income

Your income only — spouse or partner income is collected on the next step if applicable.

Monthly Gross Income ($)Pre-tax monthly income. Used for underwriting.

Monthly Take-Home *After-tax, post-deduction

Additional Monthly Income

Monthly Expenses ($)Rent, utilities, groceries, subscriptions, and regular household spending — exclude debt payments, which are collected later.

Financial Profile

Tax Filing Status

Marginal Tax Bracket (%)Your household marginal rate, or your individual rate if different from your spouse. Whole number (e.g. 22).

Smoker?

Gender Required by carriers for life insurance illustrations

Height

e.g. 5 ft 10 in

Weight (lbs)

Business / Employment Type

Occupation

Premium Funds Source

Major Health Conditions (optional)

Do you have a spouse or significant other to include?

Yes No

Dependents

Children or other dependents. Skip if none.

Beneficiaries

Who should receive the policy proceeds? Allocations should total 100% per class.

Do you have any existing life insurance policies?

Yes No

Assets

Savings, investments, retirement accounts, property. Skip if you'd rather not share.

Do you have any mortgages?

Yes No

Do you have any vehicle loans?

Yes No

Do you have any credit card debt?

Yes No

Do you have any other loans? (student, personal, HELOC, etc.)

Yes No

Goals & Context

This shapes how I approach our conversation.

Primary Goal *

Monthly Premium Budget How much are you comfortable putting toward a new whole life policy each month? Your advisor will refine this with you.

Planning Horizon (years)How many years before you expect to need access to capital? How long until you will need to access the Cash Value via a loan?

Risk Tolerance

Prior IBC Experience

Anything Else?

Questions, context, or anything you want me to know before our call.

✅

You're all set.

I've received your intake and I'll review it before our call. You'll hear from me shortly with a summary of what I'm seeing.

If you need to reach me before then, reply to the email I sent you.