Long-Term Care Needs Data Input
Client Information
Client Info Spouse Info
Courtesy Title
First Name
Last Name
Birthdate (mm-dd-yyyy)
Occupation
Employer
Street Address
Street Address - additional
City
State
Zip Code
Phone
Email Address
Marital Status
+ Assets
Description Estimated Value ($) Ownership Type
1
2
3
4
5
6
7
8
9
10
+ Long-Term Care
Client Info Spouse Info
Age To Begin Long-Term Care
Number Of Years Needed
Annual Amount Needed OR Daily Benefit x 365
Estimated Annual LTC Premium
Annual Increase in LTC Costs
+ Rate Assumptions
Portfolio before-tax return pre-retirement
Average tax bracket pre-retirement