Personalized Life Insurance Analysis Worksheet

When you make the decision to purchase life insurance, or coverage in addition to what you have already, a couple of key factors should be considered:

What will the immediate obligations be at the time of my death?

This can include (estimates of):

Funeral expenses, estate-settlement costs¹ (both taxes and attorney’s fees), outstanding medical bills, and financial needs/wants you see as “non-negotiable”.

What income is required for my household to be able to sustain itself?

A simple starting point for estimating this would be:

You make a certain amount of money (e.g. $75,000/year) as your yearly earnings.  Assume that you work until age 65, how many years of working do you have left²?  Wages multiplied by years of working is known as human life value; in other words, the economic value of you as a working person.  This can provide a framework for arriving at a life insurance figure (just like the multiple of income calculator above).

What other financial needs, wants, and goals do I want to see fulfilled?

What is “needed” and what is “wanted” varies by individual and household.  The choice to provide for certain financial items after you pass away is entirely yours, but here are some items to consider:

College tuition costs for children and/or grandchildren (present or future costs)

Paying off the mortgage, cars, and/or other debts

Gifting – to charities, foundations, alma mater

Paying off business debts (if you own a business) and/or creating a means to smoothly exit your business

By completing the form below (should take 3-5 minutes at the most) you will enable a member of the Insuring Income team, who specializes in life insurance, to provide you with a more customized analysis of your life insurance goals.  This is not an obligation to buy insurance or even complete an application, but quotes will be provided for your consideration.  Ultimately, the decision to proceed with securing life insurance, as well as what amount you want to secure, is a decision for you and your family.

Required Information

First Name *

Last Name *

Email Address *

State of Residence *

Date of birth (MM/DD/YYYY) *

Sex *

Male

Female

Have you used tobacco in the past 5 years?

No

Yes

Do you still use tobacco products?

Yes

No

Date of last use?

Personal opinion of health?

Very Good

Good

Average

Less than average

Not such a great health history

Marital Status

Married

Domestic partnership

Divorced

Widowed

Engaged

Other

Marital Status - Other (Details)

How many children do you have?

0

1

2

3

4

5

More than 5

Age of Child #1

Age of Child #2

Age of Child #3

Age of Child #4

Age of Child #5

How many children do you have?

Age of children (separate with commas)

Expenses at the time of death

Burial and Funeral Expenses

A common response for this questions is $12,500.

Outstanding Mortgage Principal Balance ($)

Other outstanding debt (not including mortgage) ($)

Sum of above expenses

If you were to pass away today

Your Current Annual Income ($)

Number of Working Year Remaining

This is auto-calculated as 67 minus current age. Feel free to modify this.

Current value of assets? ($)

Savings, investments, retirement accounts, properties, and other “hard” assets.

Face value (total death benefit) of all life insurance you currently have?

Will your spouse or partner work after your death

Yes

No

Spouse's gender

Male

Female

Current age of spouse or partner

Annual income of spouse or partner

Additional Considerations

Here you will input values for things that are important to you (examples could be: “charity, $25,000”, “gifts to siblings, $50,000”, “payoff rental property mortgages, $300,000”, “overall additional wants, $500,000”, etc.)

Purpose of Funds #1

Amount ($)

Purpose of Funds #2

Amount ($)

Purpose of Funds #3

Amount ($)

Purpose of Funds #4

Amount ($)

Total Calculated Amount Needed for Additional Considerations

Please feel free to add any comments that you believe will be helpful as we analyze the best options for you.

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1. Consult your tax professional and/or your estate planning attorney regarding these matters.  Insuring Income does not provide tax or legal advice.
2. General guidelines; 30x income for ages 20-29  ·  20x income for ages 30-39  ·  15x income for ages 40-49  ·  10x income for ages 50-59  ·  1x assets for ages 60+.  Amounts may vary by carrier and state and additional circumstances, but the factors in this guideline are a good starting point.