Free Planning Tool

Life Insurance Needs Analysis

Complete this form and we'll review it together — helping you understand exactly how much coverage your family needs and what fits your budget.

Planning worksheet only. Completing this form does not apply for insurance or put coverage in force. Reference: NAIC Life Insurance Consumer Guidance

Client & Household

Complete one form for each person to be insured.

Client Name *

Analysis Date *

Age *

Spouse or Partner

Phone *

Email *

Dependents & Ages

Primary Goals

Ongoing Family Support

Use annual after-tax amounts. Exclude payments for debts being paid off in Section 3.

A — Survivor household spending needed (annual)

B — Survivor income & dependable benefits available (annual)

C — Annual income gap (A minus B)

D — Number of years support is needed

E — Total support need (C × D)

Lump Sum Needs

Reflect amounts survivors would actually need to fund.

F — Mortgage or housing debt to pay off

G — Other debts to pay off

H — Funeral & final expenses

I — Education funding goal

J — Emergency or transition reserve

K — Other needs (describe)

L — Total lump sum needs (F + G + H + I + J + K)

Resources Available to Survivors

Count only resources intended and available for the needs above. Do not count the same asset twice.

Existing Life Insurance

Individual coverage — death benefit

End date or limitations

Employer or group coverage — death benefit

End date or limitations

Other coverage — death benefit

End date or limitations

M — Total existing death benefits

N — Savings & investments allocated to these needs

O — Other available resources (describe)

P — Total available resources (M + N + O)

Estimated Additional Coverage

Simplified estimate using level annual amounts. Does not adjust for inflation or investment returns.

Q — Total needs (E + L)

R — Available resources (P)

S — Additional coverage estimate (Q − R)

Coverage Discussion & Next Steps

Optional — complete if you've already spoken with an agent or have specific preferences.

Coverage amount discussed

Coverage duration

Type discussed

Monthly premium budget

Assumptions or adjustments

Next action

Preferred review date

Client initials

Your information is kept confidential and used only to prepare your personalised coverage recommendation.