Debts, expenses and income needs
Amount required to pay off the balance of the mortgage (including penalties and legal commissions and fees)
Amount required to pay off personal debts (including credit cards, personal loans, tuition loans, car loans, etc.)
Emergency reserve fund (including funding for extraordinary medical expenses and a reserve for emergency and unexpected expenses)
Final expenses (including income taxes, probate fees, lawyers' commissions and fees, accounting fees, other administrative commissions and fees and funeral costs)
Total Immediate Cash Needs
   
Post-Secondary Education Needs
 
Number of Children child/children 
Cost per Year per Child
Years Needed Per Child yrs. 
 
   
Total  (Post-Secondary Education Needs)
   
Funding for replacement of lost income
 
income
Percentage of income
required for survivors (i.e. 90%)
Number of years over which
income continuation will be required
yrs. 
Anticipated Interest expected
on investment of funds:
%
Income is to be
indexed (for inflation)
%

 

 
Total Needed to Replace Lost Income
   
TOTAL DEBTS AND EXPENSES 

 
 
Assets and Existing Insurance:
Savings and Investments: (Including bank accounts, mutual funds, certificates of deposit, stocks, bonds and cash but excluding retirement savings) 
Face (coverage) amount of all life insurance policies in force
TOTAL ASSETS & INSURANCE AVAILABLE 


Total Debts and Expenses (from above)
minus
-
Total Assets and Insurance (from above)
equals
=
Estimate of Additional Life Insurance Needs

The amount shown above is an estimate of the amount of life insurance coverage that you may need IN ADDITION to existing coverage that you have included under Face (coverage) amount of all life insurance policies in force