Personal Insurance - Financial Planning
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Full Name *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Phone Number *
County of Birth *
Residency status *
Smoker Status *
Smoker is defined as:
Regularly use tobacco or nicotine in any form. This includes the following products: Cigarettes, cigars and cigarillos. Chewing tobacco. Smoking cessation products like nicotine gum and patches
LIFE INSURANCE
In order to determine the right amount of life Insurance, you may want to consider:
Liabilities – Mortgage, Loans, Credit Cards
Income – 8 to 10 Times your salary depending on the age of your children
Funeral Expenses - $25,000 for funeral and legal expenses
Education Savings - $40,000 per young child set aside for education
Term 10 is the most economical method of protecting your family however if you are healthy, a non-smoker and have young children, you may want to consider the longer term benefits of a Term 20 policy.
Mortgage Amount (If applicable)
Home Equity (If applicable)
Savings and Investment (if applicable)
Other Assets (If applicable)
Other Liabilities (If applicable)
Dependents - The age of number of dependent help determine the amount insurance coverage required.
Do you have or any dependents, If so, how many?
How old are your dependents
In the past year, have you practiced aviation (other than as a passenger), scuba diving, parachuting, heli-skiing, a winter sport in avalanche risk areas, hang gliding, paragliding, mountaineering, climbing, combat sport, car or motorcycle racing or plan to do so in the next year?
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Please list the sport(s) in question and frequency.
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