Visionary Values Financial
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Home
About
Insurance Types
Contact
Get An Insurance Quote
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Step
1
of 3
Gender
Male
Female
They
Marital Status
Married
Single
Civil Partnership
Common-Law
Cohabiting
Divorced
Separated
Widowed
Next
What type of Insurance do you want?
*
Life Insurance
Annuities
Do you already have an Insurance
Yes
No
Next
Cover Amount for Life Insurance
Policy Duration for Life Insurance
In the last 5 years have you had any of these?
*
Depression
Anxiety
Stress
Any Other Mental Health Issue
None of these
Have you ever had any of these?
*
Eating Disorder
Bipolar Disorder
Manic Depression
Schizophrenia
Psychosis
None of these
In the last 5 years have you had any of these?
*
Raised blood pressure, cholesterol, or chest pain
Diabetes or raised blood sugar
Anemia, blood clot, or anything else affecting your blood
A growth, lump, or cyst
Asthma, sleep apnoea, or anything else affecting your lungs or breathing
Kidney stones, urinary infection or anything else affecting your kidneys, prostate, bladder or urine
Back pain, sciatica, whiplash or anything else affecting your back or neck
Impaired, blurred or double vision, optic neuritis or anything else affecting your eyes
None of these
Desired Annuity Amount
*
Preferred Annuity Duration
*
In the last 5 years, have you experienced any of the following financial situations? (Select all that apply)
*
Sudden loss of income
Large medical expenses
Major financial debt
None of these
Have you ever invested in any of the following? (Select all that apply)
*
Fixed annuities
Variable annuities
Indexed annuities
None of these
What are your primary financial goals with an annuity? (Select all that apply)
*
Lifetime income security
Investment growth
Tax-deferred savings
Estate planning benefits
What is your risk tolerance? (Select one)
*
Low (Prefer guaranteed returns)
Medium (Some market exposure is fine)
High (Willing to take risks for higher returns)
Do you have any other retirement savings or investment plans? (Select all that apply)
*
401(k) or Pension Plan
Stocks or Mutual Funds
Real Estate Investments
None of these
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