First Name *

Last Name *

Email Address *


Best Time of Day to Call

Income to be replaced if death occurred (ie. $50,000 / year) *

Estimated combined Federal & Provincial annual tax rate ((ie. 45%) *

Number of years required for income to be replaced *
(Examples: Until age 65, until age 80, until children have finished post secondary school, until mortgage is paid)

Estimated annual rate of return (ie. 4%)
(What rate of return would you expect from a conservative investment portfolio over a 30 year period?)

Estimated inflation rate (ie. 2%)
(What do you expect the average inflation rate to be over the next 30 years?)

What percentage of your net family income is spent entirely on you and not on combined family expenses (ie. 40%)
(Examples: your car payment, your car insurance, memberships, and leisure expenses)

Is there any additional info you would like to include?

Disclaimer and Notice: Results of a Needs Analyzer will only give a rough estimate of potential insurance needs. Clients should contact our office, complete a Fact Finder and discuss their particular goals with an agent.