Principle - The objective of this needs analysis is to provide you with an accurate calculation of your life insurance needs. This model is based upon the assumption that your current assets will not be liquidated to meet your family's income requirements and that income needs will continue for children until they are fully educated and other beneficiaries until life expectancy. No social security benefits are included in this model.

Are You  Married ?	Yes No		If you are not married, how many years will  you need to provide support ?
Spouse's  Age ?
Do You Have  Children ?	Yes No		Age of Youngest Child ?

1.	Life Insurance Enforce
	Current death benefit of all your insurance.		$
2.	Other Assets
	What is the value of your other assets?  (Include any asset except the net equity in your home   that could generate an investment return to offset   the monthly income needed?)		$
3.	Rate of Return
	What is the appropriate rate of return?  (In determining your need for life insurance we must use a rate of   return assumption to be applied to both your invested assets and   the life insurance benefits paid. e.g. : 6%, 8%, 10% )		%
4.	Inflation Rate
	What inflation rate should be used?   (Life insurance benefits are paid out over many years. With such   an extended period of payments it is appropriate to include an   inflation rate to be certain that benefits keep pace with inflation.     e.g. : 2%, 3%, 4% )		%
5.	Federal Tax Rate
	What is your tax rate?   ( Life insurance benefits are not typically subject  to income taxes.   But the interest earned on those benefits is taxable. Please indicate   your approximate combined state and federal income tax rate. e.g. :   30%, 35%, 40%, 45%)		%
6.	Monthly Income
	After tax income needed by your beneficiaries !   (How much would your beneficiaries need to maintain their current    standard of living, do not include a housing cost )		$
	Amount of Insurance to support Income needs		$
7.	Housing Cost
	a.  What is the total dollar amount of your mortgage?		$
	or
	b.  What is your monthly rent?   (If you are supporting two households you will need to complete   both a & b )		$
	Subtotal of Housing Cost		$

8.	College Education
	Do you have children that you would want to provide  education funds?		Yes No
	What are the ages of the children for whom you want   to provide funds?		First    Second    Third
	Are you funding for Public or Private Education?   (For the purposes of this calculation we assume public school is    $15,000/year and private is $30,000/year for a 4 year education)		Private Public
	Subtotal of Education Requirement		$
	Total Additional Life Insurance Needed		$