Tell us about you and your family

	You		Your partner
First name (optional):
Age:
Gender:	Gender Male Female		Gender Male Female
Single or with a partner:	With a partner Single
Smoking status:	Non-smoker Smoker		Non-smoker Smoker
Employment status:	Select Employed Not employed Self-Employed		Select Employed Not employed Self-Employed
Annual income (before tax):	$		$
How many children do you have?
Do you have enough money to send your children to college or university?	Yes No

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How much money do you need to cover your debts and expenses?

	You		Your partner
Amount to pay off your mortgage or set up a rent fund:	$		$
Amount to pay off other debts: (Include your credit card and line of credit balances, car loans, etc.)	$		$
Amount for final expenses:	$		$
Amount to save for post-secondary education: Annual amount ($) x Years x Number of children Subtotal:	$ x x $ 0		$ x x $ 0
Amount for child/home care: Annual amount ($) x Years x Number of children Subtotal:	$ x x $ 0		$ x x $ 0
Other cash needs:	$		$
Total debts and expenses:	$ 0		$ 0

How much income will your family need if you die?

	You		Your partner
Annual household income:	$ 0		$ 0
Percentage of annual income your family will need if you die: Subtotal:	% $ 0		% $ 0
Partner’s available income:	$ 0		$ 0
Annual CPP/QPP benefits:	$		$
Annual income shortage:	$ 0		$ 0
Choose if you want to deplete or retain the capital fund:	Deplete Retain		Deplete Retain
How many years will your family need the extra income this fund provides:
What rate of return do you assume your capital fund will earn?	%		%
Total amount needed to meet income shortage:	$ 0		$ 450,000

Do you have assets and existing insurance?

	You		Your partner
Savings:	$		$
Registered investments:	$		$
Non-registered investments:	$		$
Tax free savings plans:	$		$
Principal residence:	$		$
Other assets:	$		$
Existing life insurance:	$		$
CPP/QPP death benefit:	$		$
Total assets and insurance available:	$ 0		$ 0

Amount of life insurance that may be right for you

We’ve calculated the amount of life insurance you may need to protect your family and your savings based on the following:

	You		Your partner
Debts and expenses:	$ 0		$ 0
Amount needed to meet income shortage:	$ 0		$ 0
Assets and insurance available:	$ 0		$ 0
Your life insurance need:	$ 0		$ 0

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Your current employment income

	You		Your partner
Employment status:	Select Employed Not employed Self-Employed		Select Employed Not employed Self-Employed
Monthly earned income (before tax):	$		$
Maximum disability insurance limit (based on income):	$ 0		$ 0

Your monthly expenses

	You		Your partner
Mortgage or rent payments:	$		$
Debt payments (excluding mortgage):	$		$
Savings contributions:	$		$
Other living expenses:	$		$

Do you already have disability insurance and/or other income?

	You		Your partner
Monthly non-taxable disability benefit:	$		$
Monthly taxable disability benefit:	$		$
Average tax rate:	%		%
Other monthly income: (Other income may impact your disability insurance eligibility limit)	$		$
Total monthly disability benefits and other income:	$ 0		$ 0

Amount of disability insurance that may be right for you

We’ve calculated the amount of disability insurance you may need to protect your family and your savings.

	You		Your partner
Maximum monthly disability insurance benefit available: (Adjusted for disability income)	$ 0		$ 0
Monthly expenses: (Not covered by other income)	$ 0		$ 0
Your monthly disability insurance need:	$ 0		$ 0

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Do you want to replace your income during recovery?

Consider other insurance you may have. For example, if you have disability insurance, you may not need to use critical illness insurance to replace your income.

	You		Your partner
If you suffer a critical illness, you will want to:
Replace your income: Monthly amount ($) x Months Subtotal:	$ x $ 0
Replace your partner’s income: Monthly amount ($) x Months Subtotal:	$ x $ 0
If your partner suffers a critical illness, you will want to:
Replace his/her income: Monthly amount ($) x Months Subtotal:			$ x $ 0
Replace your income: Monthly amount ($) x Months Subtotal:			$ x $ 0
Total required to replace income:	$ 0		$ 0

Do you want to pay your debts and expenses?

You can use the ‘lump sum payments’ field if you want to reduce or pay off your debt, or you can fill in the number of months you would like to cover expenses.

	You		Your partner
Mortgage or rent payments: Monthly amount x number of months Subtotal:	$ x $ 0		$ x $ 0
Debt payments (excluding mortgage): Monthly amount x number of months Subtotal:	$ x $ 0		$ x $ 0
Savings contributions: Monthly amount x number of months Subtotal:	$ x $ 0		$ x $ 0
Other living expenses: Monthly amount x number of months Subtotal:	$ x $ 0		$ x $ 0
Lump sum payments:	$		$
Additional expenses not covered by government plans:	$		$
Total debts and expenses:	$ 0		$ 0

Do you have assets and existing insurance to offset costs?

	You		Your partner
Savings and assets available to cover expenses:	$		$
Existing critical illness insurance: (Include group and personally owned critical illness insurance)	$		$
Total assets and insurance available:	$ 0		$ 0

Amount of critical illness insurance that may be right for you

We’ve calculated the amount of critical illness insurance you may need to protect your family and your savings based on the following:

	You		Your partner
Amount needed to replace income:	$ 0		$ 0
Amount needed to cover expenses:	$ 0		$ 0
Assets and insurance available:	$ 0		$ 0
Your critical illness insurance need:	$ 0		$ 0

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Your insurance needs

Based on the information you’ve provided, we’ve calculated the amount of insurance you may need and how much it may cost. You may find it helpful to discuss these results with your financial advisor. If you don’t have a financial advisor, we can help you locate someone in your area.

March 4, 2015

These results are based on:

		You Male, age 37, Smoker				Your partner Female, age 33, Non-Smoker
		Amount		Monthly cost		Amount		Monthly cost
	Life insurance (Family Term, Term - 20) Return to life needs analysis	$ 0		$ 0.00		$ 0		$ 0.00
	Disability insurance (Venture Series 3A-B) Why is there a range in monthly costs? Return to disability needs analysis	$ 0 per month		$ 0.00		$ 0 per month		$ 0.00
		$ 0 per month		$ 0.00		$ 0 per month		$ 0.00
	Critical illness insurance (Lifecheque – Term 10 with ROPD) Return to critical illness needs analysis	$ 0		$ 0.00		$ 0		$ 0.00

Life insurance - The amount of insurance has been increased to $100,000 to meet product minimums.

Life insurance - The amount of insurance has been decreased to $10,000,000. Quotes for amounts greater than $10,000,000 may be obtained from your advisor.

Life insurance - Family Term – Term-20 is available to clients age 60 and below. Your life insurance need is provided above. Your advisor can help determine which products may be right for you and provide you with a quote.

Disability insurance - The monthly benefit amount has been increased to meet product minimums.

Disability insurance - The monthly benefit amount has been decreased to meet product maximums.

Disability insurance - To be eligible for disability insurance, you must be between the ages of 18 and 60. You must also be employed with an annual income of at least $12,000.

Critical illness insurance - The amount of insurance has been increased to $25,000 to meet product minimums.

Critical illness insurance - The amount of insurance has been decreased to $2,000,000 to meet product maximums.

Critical illness insurance - To be eligible for critical illness insurance, you must be between the ages of 18 and 60.

	Combination insurance (Synergy, Term - 10 with TIR)			$ 0.00
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