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FINANCIAL NEEDSANALYSIS WORKSHEET
PREPARED FOR:
Name
Address
Phone #
At what age do you plan to retire?
In today’s dollars, how much income on a monthly basis would you like during retirement? $
For how many years?
PERSONAL INFORMATION
Client 1
First Name Last Name DOB
Mobile Phone Home Phone Work Phone
Address City State/ZIP
Email 1 Email 2
Employer Title Years
Annual Gross Income $ Other Income Sources
Martial Status Highest Education Level
Dependent Children
1. Name Age DOB
2. Name Age DOB
3. Name Age DOB
4. Name Age DOB
Client 2
First Name Last Name DOB
Mobile Phone Home Phone Work Phone
Address City State/ZIP
Email 1 Email 2
Employer Title Years
Annual Gross Income $ Other Income Sources
Highest Education Level
1
Y N Do you have a will? Last updated?
Do you have a trust? If yes what kind?
Purpose of trust?
Have you reviewed your finances with a financial professional?
Do you have an established budget?
CHECK ALL THAT ARE IMPORTANT TO YOU
Liquidity Safety Taxation Transferability
GOALS (1-3 yrs) (3-7 yrs) (7+ yrs)Reduce Debt/Pay Off MortgageMaximize Retirement AccountsAchieve Financial IndependenceMaximize Tax AdvantageFund CollegeBuy New Home/Mortgage PurchaseOwn a BusinessExplore Investment OptionsSell Your HomeOther GoalsOther GoalsOther Goals
EMERGENCY FUND
Number of months to provide for Emergency Fund
How much do you need monthly in case of an emergency?
How much do you currently have dedicated to your Emergency Fund?
ASSET ACCUMULATION
Short-Term Mid-Term Long-Term
2
DEBT Total Student Loans $Car Loans $ Credit Cards $ Personal Loans $
Total Debt $
INCOME Amount needed to replace your income $ /month # years
Total Income Replacement Need $
MORTGAGE What is your current balance on your home mortgage? 1. $ 2. $
Total Mortgage Balance Needed $
EDUCATION Would you like to provide for your children’s education? ALL or PART Approximate Cost for Education $ Amount Saved $
Total Education Fund Needed $
SUBTOTAL OF DIME NEED $(Debt, Income, Mortgage, Education)
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ASSETS
TotalSavings $Money Market $CDs $Mutual Funds $Stocks $Bonds $Tax Deferred Annuities $Total $
CURRENT INSURANCE
Type Death Benefit Premium Carrier
Type Death Benefit Premium Carrier
Current Death Benefit to Apply to Need $
TotalIRAs $Roth IRAs $401(k), 403(b) Pension Plan $ 529 Plan $Life Insurance with Cash Value $Other $Total $
Transamerica Agency Network and its affiliated companies do not provide tax or legal advice. This material and the concepts presented here are for informational purposes only and should not be construed as tax or legal advice. Any tax and/or legal advice you may require or rely on regarding this material should be based on your particular circumstances and should be obtained from an independent professional advisor.
Assets to Apply to Need $
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SUBTOTAL DIME NEED $
- CURRENT INSURANCE $
- APPLIED ASSETS $
CURRENT TOTAL NEED $
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NOTES
ACTION ITEMS
REFERRALS
This worksheet is a tool to assist you in estimating your basic life insurance needs. It is not intended to provide a thorough and comprehensive analysis of your life insurance needs or to recommend a specific amount of type of coverage. The actual amount of life insurance you need will depend on several factors that you need to consider carefully. Your insurance professional can assist you with analysis of your personal circumstances.
Transamerica Agency Network (TAN) is a marketing group of Transamerica. Insurance products are sold through United Financial Services, Inc. and affiliated Transamerica companies.
Life Insurance products issued by Transamerica Premier Life Insurance Company or Transamerica Life Insurance Company, Cedar Rapids, IA.
117977 TAN 3/19
