Notes l(I) Enter the total monthly household income, in today's amounts, that you wish your survivor(s) to have if you and/or spouse, if applicable, are deceased.

Monthly Income

Notes:
I(2) Enter the number of the years into the future that you wish to provide for survivors or the number of years it would take for your youngest child to complete there education. This number can vary depending on your family needs. The typical range is from 7 to 18 years.

I3) Enter the monthly income from wages and salaries that would be earned by your spouse if you were deceased, and the monthly income that you would earn if your spouse was deceased. If you are single, leave this entry blank.
 

Use This worksheet if benefits will end prior to I(2) Years

Notes:
 I(4) Enter the monthly income that you expect to receive from government sources such as Social Security and/or Veterans Survivor's programs. The Social Security benefit is approximately $600 per month for each dependent child. To get more details for your particular situation, call your local Social Security office or the Social Security Administration at (800) 772-1213. If you are a veteran, check with the Department of Veterans Affairs (VA). You should also check with your financial advisor.

:I(5) Enter the monthly amount expected from any other sources such as rental income, royalties, annuities, dividends, interest, etc., not included in another category, which would continue after you or your spouse were deceased.

Notes:

I(6) Enter an estimate of the immediate expenses that would be incurred if there were a death today. This amount should include Federal and State estate taxes, probate costs and attorney fees, funeral expenses and anticipated unreimbursed medical costs for the deceased.

I(7) Enter the amount you wish to provide as an emergency fund. Financial analysis guidelines typically recommended that 3-6 months of living expenses be kept in a safe and liquid account. This amount is usually held in reserve for unexpected and/or non-recurring expenses such as job loss, legal fees, auto repair, emergency travel, etc. You may want to consider available credit as part of this fund.

I(8) Enter the amount necessary to provide the desired level of funding for children's' education. Include tuition, books, fees, room and board, etc. Reduce this amount by grants and scholarships. For help in estimating these costs, consult with your financial advisor.

I(9) Enter the current balance of any mortgage or mortgages that you wish to repay. You may choose to pay the entire mortgage or only a portion. Check with your bank or mortgage company for the current mortgage balance.

I(I 0) Enter the total amount of any other debts that you desire to be repaid which are not included in another category Include any insurance loans which would reduce your death benefit and other debts such as auto loans, business liabilities, credit cards, etc.

Notes:
I(11) Enter the total current death benefit amount of any life insurance policies
on which you and/or your spouse pays the premium.

,I( l 2) Enter the total current death benefit amount of any life insurance policies where you and/or your spouse do not pay the premium such as insurance provided by an employer.

I(13) Enter the total death benefit amount of all life insurance policies that are specifically designated to pay off mortgage balance in case of death. This amount may vary depending upon your mortgage balance. Check that up-to-date information is being used

I( l4) Enter the total death benefit amount of any other life insurance policies not included in another category. Do not include specific illness or accident policies.

I( l 5) Another source of capital for the survivors if the market value of financial assets such as savings, investments in stocks, bonds, mutual funds, and retirement accounts, In addition, if there were to be a death, a survivor may choose to sell non-income earning personal assets such as automobiles and furniture which may be no longer necessary. These assets are often converted to financial assets such as cash and investments. Enter the amount of assets which would be converted (sold) to cash.
 

Comments:

I will contact Security Insurance Brokers at 914-244-4400 to discuss my results

I would like Security Insurance Brokers to contact me at the phone number and time indicated below.

Contact Name*

Phone Number

Weekday         

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