Financial Planning Information Page 5

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FINANCIAL INFORMATION
Please provide information on all monthly income sources listed below.
Please enter all figures (with NO commas if using electronic form). Totals will automatically calculate.
Client
Spouse
Monthly Salary: $
Monthly Salary: $
Social Security: $
Social Security:
$
Pension:
$
Pension:
$
Investments:
$
Investments:
$
Other:
$
Other:
$
R.M.D.:
$
R.M.D.:
$
0
0
Total Monthly: $
Total Monthly:
$
What are your current monthly living expenses?
$
ECONOMIC IMPACT OF LOSING A SPOUSE
Please enter all figures (with NO commas if using electronic form). Totals will automatically calculate.
Client
Spouse
Amount at risk should ____________ die first.
Amount at risk should ___________ die first.
Social Security: $
Social Security:
$
Pension:
$
Pension:
$
Other:
$
Other:
$
0.00
0.00
Total Monthly at Risk: $
Total Monthly at Risk: $
__________________
0.00
0.00
“Total at Risk” represents a loss of $_________
“Total at Risk” represents a loss of $_________
per year and a loss of $_________ over 10 years.
per year and a loss of $_________ over 10 years.
0
0
Page 5 of 10

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