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Financial Needs Analysis
Full Name

First NameLast Name
Spouse Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Spouse's Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.
Email Address
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child 1 Name

First NameLast Name
Child 2 Name

First NameLast Name
Child 1 Date of Birth

MonthDayYear
Date
Child 2 Date of Birth

MonthDayYear
Date
Child 3 Name

First NameLast Name
Child 4 Name

First NameLast Name
Child 3 Date of Birth

MonthDayYear
Date
Child 4 Date of Birth

MonthDayYear
Date

Let's calculate your monthly expenses
Auto & Transportation
Fuel, Insurance, Lease payments, Repairs or Public Transportation
Food
Dining out & Groceries
Mortgage or Rent
Including - Home Insurance & Property Taxes
Utilities
Hydro, Gas, Internet, Phone, Water
Debt Payments
LOC, Credit Cards & Student Loans
Household expenses
Child Care, Classes, Gifts, Misc expenses
Entertainment
Subscriptions, Trips, Parties etc
Health / Medical
Gym, Prescription medicines, supplements etc.
Total expenses
Total Monthly Expenses

Debts / Liabilities
What type of debt(s) do you have?

MortgageCar LoanCredit Card LoanLine of CreditPersonal LoanStudent DebtNone

Mortgage
What is Market Value of your primary house
When is the mortgage Renewal
Interest Rate
Mortgage Balance

Car Loan
Car Loan Outstanding Balance
Interest Rate %
# of years left before car loan is paid off

Line of Credit
Line of Credit - Outstanding Balance
Interest Rate %
Target Date to Payoff
Additional LOCs (if more than one)

Credit Cards
Outstanding Balance
Interest Rate %
Target Date to pay off
Additional Credit Cards (If more than one)

Student Loans/ Personal Loans
Outstanding Balance
Interest Rate %
Target Date to pay off
Additional Credit Cards (If more than one)

Employment & Income Details
Occupation
Occupation Type?
Spouse Occupation
Spouse Occupation Type?

Income
Primary earner - Yearly Income(Gross)
Secondary earner - Yearly Income (Gross)
How much Child Care Benefit (CCB) do you receive yearly ?
Monthly
Rental & other income (yearly)

Protection
Do you have any Protection Plan, to protect your family income in case of Death, injury or illness?

Life InsuranceCritical Illness InsuranceDisability InsuranceMortgage InsuranceGroup Insurance (from Employer)None

Life Insurance Details
Insurance Type
Insured Name
Type of Life Insurance
Insurance Amount
Insurance Premium (Monthly)
Issue Year
Company Name
Additional Family Member Insurance Details (Note all details as above)

Critical Illness Insurance
Insurance Type
Insured Name
Type of CI Plan
Insurance Amount
Insurance Premium (Monthly)
Issue Year
Company Name
Additional Family Member Insurance Details (Note same details as above)

Mortgage Insurance
Insurance Type
Type of Insurance
Premium
Company Name

Disability Insurance
Insurance Type
Insured Name
Are you covered with WSIB or EI ?
Monthly Benefit Amount
Insurance Premium (Monthly)
Issue Year
Company Name
Additional Family Member Insurance Details (Note same details as above)

Group Insurance
Insurance Type
Insured Name
Premiums you pay (per paycheque)
CI Benefit
Disability Benefit
Life Insurance Benefit
Company Name
Any Investment Account Statements

Cancelof

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Recommendations & Next Steps
Advisor Name
Advisor Email ID (Use Official Email ID)
WFG Email ID
Advisor Phone Number
Please enter a valid phone number.
SMD Name
We are looking for individuals who would like to have additional source of income. Would you like to look into ways to generate income with us?

Sure, I can look into itMay beI am not currently looking for additional income
I acknowledge that I have shared my basic financial data with my advisor for the purpose of analysis & preparing a financial plan
Neither World Financial Group Insurance Agency of Canada Inc. (WFGIA) nor its agents may provide tax or legal advice. Anyone to whom this material is promoted, marketed, or recommended should consult with and rely on their own independent tax and legal professionals regarding their particular situation and the concepts presented herein. This intake form shows expenses, savings and income, and investments based solely on the data collected from sources believed to be reliable and accurate.Your information is being collected to identify your current investments and any potential future insurance needs. Only information required for these purposes is being collected. By filling this form, you acknowledge the collection of information policies and provide express consent to be contacted, by either email or telephone, whether you are an existing client or a prospective client. For more information on WFGIA privacy policies, please see the website: www.worldfinancialgroup.com.

Financial Needs Analysis

Let's calculate your monthly expenses

Debts / Liabilities

Employment & Income Details

Assets

Protection

Rate yourself as an investor

Part 2 - Meeting Confirmation for Solutions

AGENT DISCLOSURE