ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
2
CALCULATOR
3
Main Applicant's InformationTotal Income $ -
4
Date of BirthAnnual Salary $ -
5
AgeOther Income $ -
6
Years to Replace Income
7
Final Expense $ 25,000.00
8
Spouse/ Partner's Information (if applies)
Total Income $ -
9
Date of BirthAnnual Salary $ -
10
AgeOther Income $ -
11
Years to Replace Income
12
Final Expense $ 25,000.00
13
Total Monthly Expenses (enter data using a lump sum or itemized expenses)
 $ -
14
Lump Sum $ - ORHousing $ -
15
Transport $ -
16
Food $ -
17
Other expenses $ -
18
19
Total Liabilities/ Loans (enter data using a lump sum or itemized loans)
 $ -
20
Lump Sum $ - ORMortgage $ -
21
Car $ -
22
Credit Card/s $ -
23
Other loans $ -
24
25
Total Savings and Investments (Do you have any savings or investments? (Yes/ No)
 $ -
26
Savings $ - OREmergency Funds $ -
27
FHSA $ -
28
Investments $ - RESP $ -
29
RRSP $ -
30
TFSA $ -
31
Other investments/ savings
 $ -
32
33
Other Info
34
Do you have any dependent/s? (Yes/ No)
35
How many dependent/s will need education funds? (e.g. 1, 2, 3 etc.)
0
36
Do you or your spouse/ partner have any type of insurance? (Yes/ No)
37
If yes, please add your insurance coverage that applies.
38
Main Applicant
Spouse/ Partner
Total/ Combined Coverage
39
Personal - Life $ -
40
Personal - Critical Illness
41
Personal - Accidental Death & Disability
42
Personal - Others
43
Employer/ Business (Optional)
44
45
Calculator
46
Computed Insurance Needs (inclusive of final expenses and education funds)Main Applicant needsSpouse/ Partner needsCombined, they need
47
-$25,000.00-$25,000.00-$50,000.00
48
Less Current Coverage$0.00$0.00$0.00
49
Remarks-$25,000.00-$25,000.00-$50,000.00
50
Under InsuredUnder InsuredUnder Insured
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100