Intake Date
Client Information
Personal Details
| Detail | Client | Spouse / Partner |
|---|---|---|
| Date of Birth | ||
| Monthly Income | ||
| Tobacco Use? | ||
| Major Medical History | ||
| Desired Retirement Age |
Estimates use 2026 IRS marginal brackets after the standard deduction for the selected filing status. For Married Filing Jointly, both incomes are combined and the marginal rate / total tax shown applies to the household; the same rate is displayed for both spouses. Effective tax rate will be lower than marginal. This is a planning estimate, not tax advice.
Current Retirement & Savings
| Account Type | Client Balance | Spouse Balance | Client Monthly | Spouse Monthly | Action |
|---|
Existing Life Insurance
| Detail | Client | Spouse |
|---|---|---|
| Insurance Company | ||
| Policy Type | ||
| Coverage Amount | ||
| Monthly Premium | ||
| Cash Value |
Children
| Child's Name | Date of Birth | M / F | Action |
|---|
Three Key Questions
Why most families lack life insurance: ① Didn't think they needed it · ② Couldn't afford it · ③ Never got around to it
Q1. If we built an affordable plan that protects your family and helps you retire sooner — would you put it in place?
Q2. If you felt great about our work, would you refer 8–10 families who could benefit from what we showed you today?
Q3. If you could earn an extra $1,500/month part-time teaching families what we shared — would you want to know more?
Will: Do you currently have a Will? If one was affordable, would you like one?
Monthly Cash Flow Available: Most clients free up $200/mo. Some $500+. A few only $100. Which fits you best?
Spending Plan & Budget
Where is your money going? Fill in your current monthly amounts below. Subtotals update automatically.