Page 16 - Financial House222

5. Life Insurance

Existing Life Insurance Information
Death Monthly
Owner Company Type Cash Value Policy End Date
Benefit Premium
□Term $ $ $ □ Life or
□Permanent
□Term
□Permanent $ $ $ □ Life or
□Term $ $ $ □ Life or
□Permanent

Health Information
Client Smoker Health Concerns
Yes or No
Yes or No

6. Long-Term Care

Existing Long-Term Care Coverage Information
Daily Inflation Inflation Monthly
Owner Company Type Start Date Years
Benefit Type % Premium
□Cash / / $ □Simple % $
□Reimbursement □Compound
□Cash / / $ □Simple % $
□Reimbursement □Compound

*To be filled out by a Financial Professional