FINANCIAL NEEDS

ANALYSIS WORKSHEET

PREPARED FOR:
Name

Address

Phone #

Email

1
PERSONAL INFORMATION

Client 1

First Name Last Name DOB

Mobile Phone Home Phone Work Phone

Address City State/ZIP

Email 1 Email 2

Employer Title Years

Annual Gross Income $ Other Income Sources

Martial Status Highest Education Level

Client 2

First Name Last Name DOB

Mobile Phone Home Phone Work Phone

Address City State/ZIP

Email 1 Email 2

Employer Title Years

Annual Gross Income $ Other Income Sources

Highest Education Level

Dependent Children

1. Name Age DOB

2. Name Age DOB

3. Name Age DOB

4. Name Age DOB

At what age do you plan to retire?

In today’s dollars, how much income on a monthly basis would you like during retirement? $

For how many years?

Y N
Do you have a will? Last updated?

Do you have a trust? If yes what kind?

Purpose of trust?

Have you reviewed your finances with a financial professional?

Do you have an established budget?

CHECK ALL THAT ARE IMPORTANT TO YOU

Liquidity Safety Taxation Transferability

GOALS

Short-Term Mid-Term Long-Term
(1-3 yrs) (3-7 yrs) (7+ yrs)
Reduce Debt/Pay Off Mortgage
Maximize Retirement Accounts
Achieve Financial Independence
Maximize Tax Advantage
Fund College
Buy New Home/Mortgage Purchase
Own a Business
Explore Investment Options
Sell Your Home
Other Goals
Other Goals
Other Goals

EMERGENCY FUND

Number of months to provide for Emergency Fund

How much do you need monthly in case of an emergency?

How much do you currently have dedicated to your Emergency Fund?

1
DEBT
Total
Student Loans $
Car Loans $
Credit Cards $
Personal Loans $

Total Debt $

INCOME

Amount needed to replace your income $ /month # years

Total Income Replacement Need $

MORTGAGE

What is your current balance on your home mortgage? 1. $ 2. $

Total Mortgage Balance Needed $

EDUCATION

Would you like to provide for your children’s education? ALL or PART
Approximate Cost for Education $
Amount Saved $

Total Education Fund Needed $

SUBTOTAL OF DIME NEED $

2
CURRENT INSURANCE

Type Death Benefit Premium Carrier

Type Death Benefit Premium Carrier

Current Death Benefit to Apply to Need $

ASSETS

Total Total
Savings $ IRAs $
Money Market $ Roth IRAs $
CDs $ 401(k), 403(b) Pension Plan $
Mutual Funds $ 529 Plan $
Stocks $ Life Insurance with Cash Value $
Bonds $ Other $
Tax Deferred Annuities $ Total $
Total $

Assets to Apply to Need $

Transamerica Agency Network and its affiliated companies do not provide tax or legal advice. This material and the concepts presented here
are for informational purposes only and should not be construed as tax or legal advice. Any tax and/or legal advice you may require or rely on
regarding this material should be based on your particular circumstances and should be obtained from an independent professional advisor.
3
 SUBTOTAL DIME NEED $

- CURRENT INSURANCE $

- APPLIED ASSETS $

CURRENT TOTAL NEED $

4
NOTES

ACTION ITEMS

REFERRALS

5
This worksheet is a tool to assist you in estimating your basic life insurance needs. It is not
intended to provide a thorough and comprehensive analysis of your life insurance needs or
to recommend a specific amount of type of coverage. The actual amount of life insurance
you need will depend on several factors that you need to consider carefully. Your insurance
professional can assist you with analysis of your personal circumstances.
Transamerica Agency Network (TAN) is a marketing group of Transamerica. Insurance
products are sold through United Financial Services, Inc. and affiliated Transamerica
companies.
Life Insurance products issued by Transamerica Premier Life Insurance Company or
Transamerica Life Insurance Company, Cedar Rapids, IA.
117977 TAN 3/19