Financial Needs Analysis

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Writing Agent Name *

Split Agent Name

Enter details

First Name

Middle Name

Last Name

Client's Date of Birth

Phone *

Email *

Spouse's Name

Spouse's Date of Birth

Spouse's Phone Number

Spouse's Email

Do you smoke?

Smoker?

Client

Spouse

Do you have children?

Child #1

Child #1 Date of Birth

Child #2

Child #2 Date of Birth

Child #3

Child #3 Date of Birth

Other Children name and Date of Birth

Household Income

Monthly Net Income

Spouse's Monthly Net Income

Monthly Expenses

Monthly Expenses Breakdown

Mortgage/Rent

Car Insurance

Utilities

Life Insurance

Mobile Bill

Health Insurance

Auto & Transportation

Food & Groceries

Child Care

Investments

Entertainment

Subscriptions

Household Maintenance

Debt & Loans

Personal Expenses

Charity & Gifts

Shopping

Miscellaneous

Total Expenses Calculated:

Monthly total expenses

Taxable

Tax Deferred

Tax Advantage Accounts

Roth IRA

Cash Value Life Ins.

529 Plan or College

Savings Programs

Tax Advantage

Account Notes

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?

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