1. What is your annual income?
2. For how many years do you want to protect it?
3. Against what annual inflation factor do you want to protect?
4. At what annual interest rate can the proceeds be invested?

5. What is your current investment income (Rental Properties, Dividends, Annuities, etc.)? $
6. What are your existing liquid assets - All assets that can be turned into cash within 3 months (We recommend you not liquidate retirement accounts due to tax penalties)? $
7. What is the amount of your existing life insurance coverage? $
8. What is your outstanding mortgage balance? $
9. What are your outstanding loans? $
10. How much are your final expenses: (Medical, Funeral, Taxes)? $

Face Amount:          $