Life Insurance Needs Analysis

Which of the following will require life insurance benefits?
*Final Expenses *Income Replacement *Mortgage pay-off *College education
What Life Insurance benefit are in place at this time?
*Company employee benefits Life $________________
*Personal policies:_________________  Death Benefit $___________ Company Name___________
  $_______________________ _______________________
  $_______________________ _______________________
  $_______________________ _______________________
Final Expenses
How much money would you require to clear up short-term obligations, funeral expenses and other final
arrangements? $__________________
Mortgage Payoff Loan balance $________________________
Income Replacement
Amount Required for family income each year after
Mortgage and other debts are paid? Annual Income $_____________________
How many years would you like income to continue?
Number of years_______________________
Total Income Replacement $_________________
College Education Expenses
Do you want tuition expenses for your children's formal education in public/private colleges?
  Annual $___________________
  Number of Children___________
  Number of Years_____________
Total For Education  
Expenses $__________________
Total Life Insurance Benefit require $____________________
Full Name_____________________________________
Day Phone Number_________________Date Completed_________________
Tabacco Use? Yes______ No_______
Please Fax to (504) 486-4290 or (985_ 674-0971
Or mail to 5557 Canal Blvd, New Orleans, LA. 70124 or 2020 N. Causeway Ste. 1A, Mandeville, La. 70471
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