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Life InsurancePolicy Review Fact FinderPOLICY REVIEW DATA FOR:Name: Advisor:INCLUDES: CURRENT POLICY DATA WORKSHEETS NEEDS ANALYSIS WORKSHEET CURRENT HEALTH QUESTIONNAIRE
WHAT IS A POLICY REVIEW?A Policy Review is an opportunity for you to review your existing life insurance policiesagainst your current needs and objectives. It involves a thorough evaluation of yourcurrent life insurance policies, your current life insurance and planning needs, andyour health.Why is it important for you to have your life insurance policies reviewed?Because your life insurance needs are dynamic and the economic value of your lifechanges over time. Revisiting financial objectives at different life stages ensures thatyour coverage always reflects your current priorities.OBJECTIVEThe ultimate goal of Policy Review is to ensure that your life insurance policy is: Protecting your beneficiaries in the way that you intended Performing appropriately to meet your planning objectives Accomplishing your goals at the best price available to youLIFE EVENTS THAT MAY AFFECT YOUR INSURANCE NEEDS Marriage/WeddingDivorceBirth/AdoptionBecome legal guardian forsomeoneGraduationMove/Relocate/Sell your houseHome refinancing/Pay offmortgageTaking an equity line of creditNew jobJob layoff Financial setbackInheritance/Financial windfall Retirement Death in family Critical illness/injury/disability Enter a nursing home Start your own business Sell or close your business Win/lose a lawsuitPolicy Review Fact Finder2
CURRENT INSURANCE COVERAGEPolicy #2Policy #3Policy #4 Term UL Whole Life Variable Indexed Term UL Whole Life Variable Indexed Term UL Whole Life Variable Indexed Term UL Whole Life Variable Indexed No Yes No Yes No Yes No Yes Level Increasing Level Increasing Level Increasing Level Increasing Annual Semi-Annual Quarterly Monthly Annual Semi-Annual Quarterly Monthly Annual Semi-Annual Quarterly Monthly Annual Semi-Annual Quarterly Monthly Never Year: Never Year: Never Year: Never Year:Policy #1InsuranceCompanyPolicy TypePolicy OwnerBeneficiariesCollaterallyAssigned?Policy IssueDateDeath BenefitOptionHow long do youwant to keep thispolicy?UnderwritingClass *PREMIUM INFORMATIONCurrentPremiumPremiumModeCurrent CashValuePaid to DatePaymentsEndingPolicy Review Fact Finder3
CURRENT INSURANCE COVERAGE (CONT.)In the space below, please explain the initial objective of the policy. For example, “theobjective was to build enough cash value for us to be able to take 50,000 per year inpolicy loans to supplement our retirement income beginning at age 70 and provideadequate insurance protection in the meantime.” Or, “the objective was to provide payfor estate taxes and leave an inheritance to our children. At the time our estate wasvalued at 5mm at the federal estate tax exemption was 1mm.”NOTES, COMMENTS, AND DETAILSPolicy #1Policy #2Policy #3Policy #4* Please include a copy of the most current annual statement for each of these policies.Policy Review Fact Finder4
This worksheet can help you get a general sense of how much life insurance you needto protect your family. This worksheet assumes you died today.INCOME1. Total annual income your family would need if you died todayWhat your family needs, before taxes, to maintain its currentstandard of living (Typically between 60% - 75% of total income) 2. Annual income your family would receive from other sourcesFor example, spouse’s earnings or a fixed pension.1 (Do not includeincome earned on your assets, as it is addressed later in the calculation) TABLE A3. Income to be replacedSubtract line 2 from line 1 4. Capital needed for incomeMultiply line 3 by appropriate factor in Table A. Factor . EXPENSESYearsIncomeNeeded Factor101520253035408.812.415.418.120.422.424.15. Funeral and other final expensesTypically the greater of 15,000 or 4% of your estate) TABLE B6. Mortgage and other outstanding debtsInclude mortgage balance, credit card balance, car loans, etc. YearsBeforeCollege Factor7. Capital needed for college(2007-2008 average 4-year cost: Private 181,480; Public 80,360)Estimated Appropriate Factor NPV 4-Year Cost in Table BChild 1 X Child 2 X Child 3 X 8. Total capital requiredAdd items 4, 5, 6 and 7 5101520.87.75.65.55 INCOME9. Savings and investments Bank accounts, money market accounts,CDs, stocks, bonds, mutual funds, annuities, etc. 10. Retirement savings IRAs, 401(k)s, SEP plans, SIMPLE IRA plans,Keoghs, pension and profit sharing plans 11. Present amount of life insuranceIncluding group insurance as well as insurance purchased on your own 12. Total income producing assetsAdd lines 9, 10 and 11 13. Life insurance neededSubtract line 12 from line 8 Note: These tableshelp you determineNet Present Value(NPV), the amount ofcapital required todayto satisfy futureincome or college costneeds, given anassumed investmentreturn of 6%, inflationof 3% for living costsand 5% for collegecosts.1. Social Security benefits, which may be available, have not been factored into this calculation. 2. Trends inCollege Pricing, 2007, The College Board. Costs reflect total charges, which includes tuition, fees, room andboard. 3. Distributions from most retirement savings plans are subject to ordinary income tax rates.Life Insurance Needs Analysis5
LIFE INSURANCE PRELIMINARY HEALTH QUESTIONNAIRE1.Name:3.Have you used ANY form of Tobacco/Nicotine (cigarettes, nicotine patch, pipe, electroniccigarettes, cigars, dip/chew, nicotine gum, patches) in the past:5 years:Yes No 2.12 months: Yes Date of Birth:No If yes, what type and how much?4.Height:5.Have you ever been treated for:Blood PressureDiabetesCancerWeight:Yes Yes Yes No No No Weight change in last 12 months:CholesterolYes Heart Disease Yes Stroke/TIAYes No No No Latest ReadingsB.P.Total Chol.HDLA1CIf yes, please provide details including when diagnosed, date and type of treatment, etc.6.Has any member of your family (siblings and/or parents) been treated for OR died fromCancer, Heart Disease (including heart attack), or stroke prior to age 60? If so:Family:Family:Age of Onset/Death:Age of Onset/Death:7.Are you currently taking, or have been prescribed to take any prescription medication in thelast 5 ndition:Condition:Medication:Medication:8.In the past 12 months have you traveled or resided in a foreign ngth:Reason:9.Do you have current plans to travel or reside in a foreign country in the next 12-24 gth:Reason:10.Do you participate in any avocations/hazardous activities (scuba diving, hang gliding,racing, private pilot, parachuting, etc.)Activity:Details:11.Have you had any moving violations in the past 5 years including speeding tickets, DWI/DUI orhas your license been suspended? Yes No If yes, please provide details including date and type of violation.12.Is there anything else you can think of that an insurance company may be concerned aboutregarding your insurability? Yes No If yes, please explain:E: marketing@bordenhamman.comP: (800) 420-9190Fax: (214) 302-81986
Life Insurance Needs Analysis 5 This worksheet can help you get a general sense of how much life insurance you need to protect your family. This worksheet assumes you died today. IN OME 1. Total annual income your family would need if you died today 35 EXPENSES Factor _ IN OME help you to satisfy future
