FI Insurance — layout mock

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Only open this form from www.financialinternational.com. Financial International will never email or text you a link asking you to enter your SSN or bank details. If you get one, do not respond; call us at (213) 487-0587.
If you print it, keep the completed form in a safe place and shred spare copies.
Your information is kept confidential and used only to provide the services you asked us for.

Client:

Insurance Worksheet (Husband / Wife)

Cross-refs: Education L14, Retirement L17, Emergency Fund L3. Table One external. Live totals for 1D, 8, 12.

Pre-Retirement / Needs

Husband

Wife

1A. Replacement Income Needed After Death

1B. # of Years Until Retirement

1C. Capital Needed to Replace $1,000 in Income (Table One)

1D. Capital Needed to Replace Client's Income (1A/1,000 × 1C)

2. Final Expenses

3. Educational Fund Gap (From Education Worksheet Line 14)

4. Survivor Retirement Gap (From Retirement Worksheet Line 17)

5. Child Care Fund

6. Emergency Fund Gap (From Emergency Fund Worksheet Line 3)

7. Miscellaneous Fund Gap

8. Total Protection Needed (1D + Lines 2–7)

9. Non-Committed Assets

10. Present Life Insurance

11. Social Security Benefits

12. Additional Insurance Need (Line 8 − (9+10+11))

This form may ask for sensitive information, such as Social Security numbers, account numbers, income, and health or family details.
DO NOT email your completed form or financial documents. Email is not secure. Send this form with the Submit button below, send documents only through the secure Upload button (Financial International’s SharePoint), or deliver them in person.
This online form sends your answers over an encrypted (HTTPS) connection directly to Financial International.
Only open this form from www.financialinternational.com. Financial International will never email or text you a link asking you to enter your SSN or bank details. If you get one, do not respond; call us at (213) 487-0587.
If you print it, keep the completed form in a safe place and shred spare copies.
Your information is kept confidential and used only to provide the services you asked us for.

Fillable HTML worksheet with live math where applicable. Click Submit to send to the FI FORMS Teams channel (SQL when webhook is configured).