Financial Needs Analysis

Important Notice: Your privacy is our top priority. We never sell or share your information, except when required by insurers for processing. Submitting this application does not ensure approval

Writing Agent Name *

Client's Date of Birth

Spouse's Date of Birth

Spouse's Phone Number

Do you smoke?

Smoker?

Client

Spouse

Do you have children?

Child #1 Date of Birth

Child #2 Date of Birth

Child #3 Date of Birth

Other Children name and Date of Birth

Monthly Net Income

Spouse's Monthly Net Income

Monthly Expenses Breakdown

Auto & Transportation

Household Maintenance

Miscellaneous

Total

Total Expenses Calculated:

Monthly total expenses

Taxable Accounts

Tax Deferred Accounts

Tax Advantage Accounts

Roth IRA

Cash Value Life Ins.

529 Plan or College

Savings Programs

At what age would you like to be in a position to retire?

Spouse: At what age would you like to be in a position to retire?

How much money would you need to have saved up in order to retire?

What would you need as a monthly income in order to be able to retire?

Let's do the math real quick to figure out how much you’d need saved total based on that monthly amount
For example, let’s say you live up to age of 90.
So $__each month X 12, for the whole year you’ll need $___. I'm going to multiply that $__ by the amount of years you’ll be retired___.
That's a total of ___million dollars.

Let’s say you were at a place where you get $/month in retirement, what would your retirement look like for you?

With what you currently have in place or have saved now, would you say you are on track to hitting that goal?

If we could create a plan that would help you confidently retire at age ___ with $___ saved and a monthly income of $____, and we didn’t charge you a single penny to do so, is that something you would allow us to look into for you?

By checking this box, I consent to receive transactional messages from Epic Agency related to my account, orders, or services I have requested. These messages may include appointment reminders, order confirmations, service updates, and account notifications. Message frequency may vary. Message and data rates may apply. Reply HELP for assistance or STOP to opt out at any time.