Generic Life Insurance Needs Analysis Worksheet 2014-10

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LIFE INSURANCE NEEDS ANALYSIS WORKSHEET

Client Data Client Name Age Annual Income


Primary
Spouse
Number of Family Members

HOUSEHOLD LIABILITIES:
Mortgage Balance
Car Loans
Lines of Credit
Credit Cards
Final Expenses
Emergency Fund
SUB TOTAL $0 (A)

LEGACY NEEDS AND WANTS:


Education Fund
Legacy Fund for Children
Charitable Bequest
Other
SUB TOTAL $0 (B)
Version 2014-10

FAMILY INCOME NEED: PRIMARY FAMILY INCOME NEED: SPOUSE

What percentage of your income do you wish to replace? 0% What percentage of your income do you wish to replace? 0%
Annual Income to Replace $ - Annual Income to Replace $ -
Subtract annual CPP/QPP survivor/orphan income benefits Subtract annual CPP/QPP survivor/orphan income benefits
Annual Income Shortage $ - Annual Income Shortage $ -
Number of years required (Age 65 - current age): 65 Number of years required (Age 65 - current age): 65

Income Replacement (Income x Percentage x years required) $ - Income Replacement (Income x Percentage x years required) $ -
(C) (D)

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LIFE INSURANCE NEEDS ANALYSIS WORKSHEET

FINANCIAL ASSETS AVAILABLE: PRIMARY FINANCIAL ASSETS AVAILABLE: SPOUSE


*Use? *Use?
Liquid Savings 1 $ - Liquid Savings 1 $ -
RRSPs 0 $ - RRSPs 0 $ -
Non-registered Investments 0 $ - Non-registered Investments 0 $ -
TFSA 0 $ - TFSA 1 $ -
Other 0 $ - Other 0 $ -
TOTAL $ - TOTAL $ -
(E) (F)
*Generally speaking, retirement assets should not be included in the calculation for life insurance because these assets are earmarked for the surviving spouse's retirement

TOTAL LIFE INSURANCE NEEDS


PRIMARY SPOUSE
This needs analysis demonstrates a life insurance need of (A+B+C-E) = $ - This needs analysis demonstrates a life insurance need of (A+B+D-E) = $ -

I currently own life insurance form all sources equal to I currently own life insurance form all sources equal to

My net need for life insurance as of today is $ - My net need for life insurance as of today is $ -

At this time I have decided to purchase additional coverage of At this time I have decided to purchase additional coverage of

I furthermore decline purchasing and acknowledge the shortfall of $ - I furthermore decline purchasing and acknowledge the shortfall of $ -

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Primary Client Name 0 Spouse Client Name 0

Primary Client Signature Spouse Client Signature

Broker Name

Broker Signature DATE:

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LIFE INSURANCE NEEDS ANALYSIS WORKSHEET

MEETING NOTES:

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