Survivor Life Insurance 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
+ Income Detail
Client Info Spouse Info
Annual Income ($)
Pay Increases (%)
Desired Retirement Age
+ Assets
Description Estimated Value ($) Ownership Type
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+ Pension
Client Info Spouse Info
Future annual benefit ($)
Lump sum ($)
Annual (spouse) pension if you were to die ($)
Adjust pension for inflation?
Pension Begin Age
+ Dependent Information
Name Birthdate (mm-dd-yyyy) Description Annual Cost Set Aside (taxable) Set Aside (tax advantaged) % You Pay College Start Age How Many Years
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+ Life Insurance
Company Annual premium ($) Cash value ($) Face amount ($) Insured party Policy type Policy owner Beneficiary
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+ Liabilities
Description Liability type Balance ($) Rate (%) Payment ($) Min payment ($) Responsible party
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+ Long-Term Survivor Income Needs
Initial spending ($) For how long? (years) Subsequent spending ($) For how long? (years)
Annual spending for survivors of client
Annual spending for survivors of spouse
+ Cash Needs
Estimated funeral and related expenses ($)
Estimated estate / administrative expenses ($)
+ Rate Assumptions
Portfolio before-tax return pre-retirement
Average tax bracket pre-retirement
Estimated Inflation Rate (%)
If client were to die, how much (if any) would the spouse's personal earned income change from the current level? (allow for negative (-) values)
If spouse were to die, how much (if any) would the client's personal earned income change from the current level? (allow for negative (-) values)