0   
B1                       Needs Analysis Fact Finder
B0
Agent Name ________________________________        Date ____/____/____

           B1 Client                                 SpouseB0

Name ___________________________      Name ___________________________

Age ____  Birth Date ___/___/___      Age ____  Birth Date ___/___/___

Life Expectancy ______                Life Expectancy ______

Current Annual Income $_________      Current Annual Income $_________

Covered by Social Security?  Y N      Covered by Social Security?  Y N
Civil Service Employee?    C F N      Civil Service Employee?    C F N
Military Service?            Y N      Military Service?            Y N

         B1Education Needs                       MiscellaneousB0

Education Costs Inflation _____%      Miscellaneous
Education Fund Interest   _____%      Annual Income       $___________

    Child      Age   Educ. Fund
                                       For How Many Years?      _______
_____________  ___  $___________

_____________  ___  $___________               B1AssumptionsB0

_____________  ___  $___________       Annual Interest Rate        ____%

_____________  ___  $___________       Annual Inflation Rate       ____%

_____________  ___  $___________       Social Security Adjustment  ____%

                         B1Capital AnalysisB0
           Assets                              Liabilities

Cash (checking)         $__________    Mortgage          $___________

Cash (savings)          $__________    Auto Loans        $___________

Investments             $__________    Consumer Loans    $___________

Life Ins. Death Benefit $__________    Business Debt     $___________

Business Assets         $__________    Final Expenses    $___________

Other Assets            $__________    Emergency Fund    $___________

Non-Income Producing    $__________    Other Liabilities $___________

IRA Curr. Value(client) $__________

Retirement Fund(client) $__________

Pension Fund (client)   $__________

    (Circle any of the above assets the client wants to conserve)


                             B1Cash (Savings)B0

                         Conserve/Liquidate (C/L): ___

                                                 Int.         Maturity
                               Amount            Rate           Date

Savings Account             $__________       ______%  

Money Markets               $__________       ______%  

Certificate of Deposit      $__________       ______%      ___________

Certificate of Deposit      $__________       ______%      ___________

Certificate of Deposit      $__________       ______%      ___________

Certificate of Deposit      $__________       ______%      ___________

Other                       $__________       ______%  

                Total       $__________



                            B1IRA Current ValueB0

                         Conserve/Liquidate (C/L): ____

     Description                        Value           Owner

     ________________________     $___________       __________

     ________________________     $___________       __________ 

     ________________________     $___________       __________

     ________________________     $___________       __________

     ________________________     $___________       __________

     ________________________     $___________       __________

     ________________________     $___________       __________

     ________________________     $___________       __________

           Total (Client)    $___________  

           Total (Spouse)    $___________  



                             B1Retirement FundsB0

                     Conserve/Liquidate (C/L):     ______

                     Client Retirement Fund...  $________ 

                     Spouse Retirement Fund...  $________ 


                     B1Survivor Needs (Monthly)B0
Family With Children at Home                           $_____________

Spouse Before Retirement (No children at home)         $_____________

Spouse During Retirement (No children at home)         $_____________

Special Immediate Need      $____________   For ______ Years

               Spouse's Monthly Earnings Potential
Number of Years of Readjustment Period                  _______

Income During Readjustment Period                      $_____________

Family With Children at Home                           $_____________

Before Retirement (no children at home)                $_____________

Spouse's Retirement Age                                 _______

Spouse Retirement Assets                               $_____________

Spouse's Monthly Pension at Retirement                 $_____________

                    B1Disability Needs (Monthly)B0
Family With Children at Home                           $_____________

Lifetime (No children under 18)                        $_____________

Disability Insurance Income per Month    $__________  for  ____ years

Additional Dis. Ins. Income per Month    $__________  for  ____ years

               Spouse's Monthly Earnings Potential
Family With Children at Home                           $_____________

Before Retirement (no children at home)                $_____________

                     B1Retirement Income NeedsB0
Desired Monthly Income                       $___________
                                      Client             Spouse
Retirement Age                     ______              ______

Monthly Pension Income            $______________     $______________

Life Ins. Cash Value at Ret.      $______________     $______________

IRA Value at Retirement           $______________     $______________

Retirement Fund Value at Ret.     $______________     $______________

Pension Fund Value at Ret.        $______________     $______________

Preretirement Investment Rate            ________%             

                        B1Options for OutputB0
Cover Sheet  Y  N   Graphs/Tables/Both  G  T  B    Survivor Needs    Y  N
Summary      Y  N   New Insurance      $________   Disability Needs  Y  N
Detail Inf.  Y  N   Print Page Numbers   Y   N     Retirement Needs  Y  N

1
                       B1Civil Service InformationB0

                                          Client              Spouse

Years of Service                       ____________        ____________

Retirement Age                         ____________        ____________

Special Occupation                        Y    N              Y    N

Current Grade / Step                   ____ / _____        ____ / _____

Expected Retirement Grade / Step       ____ / _____        ____ / _____

Current Annual Salary                 $____________       $____________

High-3 Salary Average                 $____________       $____________

Survivor's Annuity Base               $____________       $____________

Post Civil Service Salary             $____________       $____________

Covered by FEGLI                          Y    N              Y    N

    FEGLI Option A                        Y    N              Y    N
    FEGLI Option B  (0-5)                 ______              ______
    FEGLI Option C                        Y    N              Y    N

                       B1Military Service InformationB0

                                          Client              Spouse

Active Now?                               Y    N              Y    N

   If non-active, only answer the questions with an '*'.

*Date Entered Service                  ___/___/____        ___/___/____

Current Years of Service               ____________        ____________

Current Military Rank                  ____________        ____________

Full SGLI Benefits?                       Y    N              Y    N

  If not, number of units (0-4)        ____________        ____________

Annual Post Military Salary           $____________       $____________

Anticipated Retirement Rank            ____________        ____________

Military Retirement Age                ____________        ____________

*Years of Service at Retirement        ____________        ____________

*Survivor's Benefit Plan?              ____________        ____________

*Current Monthly Retirement Pay       $____________       $____________


