Insurance Planner – Personal Profile

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Personal Profile

Date * :

Advisor:

First Name * :

Last Name * :

Middle Name:

Address:

City * :

Province * :

Postal Code:

Email Address * :

Date Of Birth * :

Place Of Birth:

Occupation:

Employer:

Marital Status * :

Spouse Income:

Smoking Status * :

Earned Income * :

Children:

Own:

Rent:

Monthly Commute Cost:

Other Income * :

Assets Not Available to Produce Income

Cash Bank Chequing * :

Residence Value * :

Household Furnishings * :

Automobiles * :

Recreation Equipment * :

Other * :

Assets Available to Produce Income

Cash Bank Savings * :

Real Estate * :

Stocks Securities * :

RRSP TFSA * :

RESP * :

Company Pension * :

Business Interest * :

Other * :

Loans Lines Of Credit And Mortages

Mortgage * :

Loans * :

Credit Balances * :

Other * :

Office Overhead Expenses

Monthly Overhead * :

Personal Insuarance

Personal Life Insurance Term * :

Personal Life Insurance Permanent * :

Group Life Insurance * :

Credit Insurance Mortgage * :

Critical Illness Insurance * :

Personal Disability Insurance * :

Group Disability Insurance * :

Overhead Disability Insurance * :

Anticipated Rate Of Inflation * :

Anticipated Rate Of Interest * :

Anticipated Rate Of Investment Return * :

% of Income to Replace at Death or Disability * :

Include In Calculation * :

Priorities to Discuss

Life Insurance * :

Critical Illness * :

Disability Insurance:

To Discuss

Personal Life Insurance:

Spousal Life Insurance:

Childrens Protection:

Disability Insurance:

Critical Illness Recovery Insurance:

Mortgage Insurance:

Updating Of Current Policies:

Partnership Business Insurance:

Estate Planning:

Ability To Qualify For Insurance:

All That Apply

Smoker:

Non Smoker:

Health Concerns:

Maritial Status:

Family Status:

Career Job Change:

Plans To Move:

Hazardous Activities: