Answer these questions for the person you'd like to insure.

I live in
?
The state where you, the owner of the insurance, currently live.
I am
years old
?
Your current age.
I am a
I am a
My family includes:
I make
a year
?
Your pre-tax annual income.
My mortgage is
?
Your current mortgage debt.
My other debts include
?
The amount of all other debt(s) including car loans, student loans, credit cards, etc.
I have
in assets
?
Total value of current assets including cash, CD’s, retirement accounts, savings, stocks, bond, etc. Do NOT include the value of your home.
I have
in existing life insurance
?
The amount of coverage you currently have in life insurance.
My biggest concerns:(check all that apply)