Life Insurance

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First name: Last name: Address:

City: State: Zip:

Email: Home phone: work phone:

Applicant Information:

Gender: Birth date: mm/dd/yyyy Height

Weight: Smoker: Any Medical Condition:

If any, list your current life coverage: Any family Heart disease history: Any family Cancer disease history:

Insurance Requested:

Terms requested: Coverage amount: Policy type:

Occupation: Years employed: Monthly income:

$

Driver's license ever been suspended: If yes, when to when date? (mm/yy to mm/yy) Will you include other's in this policy?

If yes, Gender: Birth date: mm/dd/yyyy Smoker:

Comments:

Why you need Life Insurance.

Life and Disability insurance helps protect the people who depend on you for financial support by replacing some or all of your lost income when you die or disable. It can help pay expenses that your income normally would have covered, including mortgage payments, bills, and a dependent’s child cares or college tuition. Some types of life and disability insurance also accumulate cash value during the policyholder’s lifetime that can be withdrawn or borrowed against. Requesting term life insurance online is the easiest way to shop for life insurance. Broker’s Corner provides the best quotes from top notched companies. Start your life insurance quote online simply fill out the above form, it’s that easy!

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How Much life Insurance Is Enough?

An adequate amount of term insurance to support surviving family members is that which replaces income, or at least that portion of current income that you would want your family to continue to receive. That income figure would need to grow from year to year to keep up with inflation, so the amount of capital producing replacement income would need to grow as well.

For example, with an 6 percent pre-tax rate of return and a 2 percent inflation rate, only 4 percent of capital before taxes would be available for spending, because 2 percent would need to be reinvested in order for future income to keep pace with inflation. Assume that there is a need for $100,000 of replacement income before taxes, increasing with inflation. At a 4 percent rate of return, $2 million would be required in the form of insurance and other liquid assets. The capital need for replacement income, using the 4 percent income rate of return assumption, is therefore calculated by multiplying the pre-tax replacement income need by 20. Consider also whether this stream of replacement income will be adequate to provide for education costs or other special needs. For example, a private education at one of the most expensive colleges requires almost $140,000 in today's after-tax dollars.

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