Life Insurance Needs Analysis

1
What is your current age bracket?
Over 65
61 - 65
56 - 60
46 - 55
35 - 45
Under 35
2
What is your current financial priority?
Just getting started
Building up my savings
Growing my wealth
Retaining my wealth
3
Are you currently investing for retirement?Select that applies
401 (k)
IRA
No
4
How much income would you like your family to have?
Less than $25,000
$25,000 - $99,999
$100,000 - $249,999
$250,000 - $999,999
$1,000,000 - $4,999,999
Over $5,000,000
Other
5
Which of the following would best address your financial needs?
Higher interest on my savings account
Debt consolidation or relief
One-time financial planning session
Ongoing wealth management
6
How much other insurance do you currently have?
Under $100,000
$100,000 - $250, 000
250,000 - $500,000
Over $500, 000
Othe
None
7
When you think about the contribution your spouse makes to your family, is it...
Sizeable amount of income
Running much of the household
Both
Not significant
Other
8
Do you need life insurance for your significant other
YESNO
9
Do you need life insurance for children?
YESNO
10
Living Benefits

If you were to develop a really serious illness, that obviously wouldn't be fun. It also might cost you a lot of money. Even with medical insurance, you might need to pay a huge out-of-pocket cost.

A living benefit he policy pays out if you get one of these conditions (Not an all-inclusive list): Alzheimer's Disease, Coronary Artery Bypass Graft, Invasive Cancers, Heart Attack, Kidney Failure, Stroke, Major Organ Transplant, Lou Gehrig's Disease, Cerebral Palsy (only payable for children), Cystic Fibrosis (only payable for children), Multiple Sclerosis, Muscular Dystrophy, Sickle Cell Anemia (only payable for children), Systemic Lupus Erythematosus.
11
Do you need insurance with Living benefits?
YESNO
12
Accidental Death

This will provides an additonal financial benefit to beneficiaries if the insured person dies as a result of a covered accident.
13
Do you think you might need Accidental Death insurance?
YESNO
14
What type of insurance are you interested in?Select all that may apply
Term Life
Whole Life
IUL
Annuities
Cash Value
15
Name
First Name
Last Name
16
Email
example@example.com
17
Phone Number
Please enter a valid phone number.
18
Would you like to start comparing options online?
YESNO
19
Appointment
Should be Empty: