Financial Calculator Pankaj| Bhatia

Life Insurance Suitability Form

Part 1 - Client Identification

Full Name *

Date of Birth *

Age (Auto-calculated)

Marital Status

Married

Civil Union

Single

Divorced

Residence

Owner

Tenant

Smoking Status

Smoker

Non-smoker

Occupation

Annual Income

Number of Dependants

Age of Each Dependant

Total Assets

Total Liabilities (Mortgage)

Monthly Obligations

Part 2 - In-Force Insurance

Term Life Insurance Amount

Permanent Life Insurance Amount

Disability Insurance Amount

Critical Illness Insurance Amount

Other Insurance

Part 3 - Insurance Needs

Funeral Expenses Coverage

Income Replacement × Number of Years

Number of Years Required:

years ℹ️

Mortgage Repayment

Permanent Life Insurance

Leave a Legacy

Maintaining Family Lifestyle

Other Needs

Total Additional Insurance Need

Total Needs: $0 ℹ️

Minus In-Force: $0 ℹ️

Net Additional Need: $0

Part 4 - Recommendations and Decision

Life Insurance Recommendations

Term Insurance Coverage Amount ℹ️

Term (Years):

Coverage Amount:

Permanent Insurance Coverage ℹ️

Universal Life Insurance Coverage Amount

Disability Insurance Monthly Benefit ℹ️

Critical Illness Coverage ℹ️

Other Product Name

Other Product Amount

Client Decision

Accepted the recommendation

Chosen different product

Opted for higher coverage

Opted for lower coverage

For Unmet Needs Follow-up Plan

Other Notes

Client Signature

Client Signature Date

Advisor Signature

Advisor Signature Date

Part 1 - Client Identification

Full Name *

Date of Birth *

Age (Auto-calculated)

Marital Status

Married

Civil Union

Single

Divorced

Residence

Owner

Tenant

Occupation

Annual Income

Number of Dependants

Age of Each Dependant

Total Assets

Total Liabilities

Monthly Obligations

Part 3 - Recommendations

Account Types (Enter amounts for recommended accounts)

RRSP

LIRA

TFSA

RRIF

LIF

RESP

Annuities

Non-registered

Other

Guaranteed Interest Fund (GIF) - Recommended Term

Segregated Funds - Recommended Funds

Guarantees

Maturity

Death

Fee Structure

Classic Series 75/75 - Deferred Sales Charges

75/100 Series

No Sales Charge

Ecoflex Series 100/100

Front-End Load

FORLIFE Series

Why this fee structure?

Part 4 - Final Decision

Client Decision

Accepted the recommendation

Chosen another investment type

Opted for different investor profile

Follow-up Plan

Client Signature

Client Signature Date

Advisor Signature

Advisor Signature Date

Financial Calculator

Financial Needs Analysis

Part 1 - Client Identification

Part 2 - In-Force Insurance

Part 3 - Insurance Needs

Part 4 - Recommendations and Decision

Part 1 - Client Identification

Part 2 - Savings and Retirement Needs

Part 3 - Recommendations

Part 4 - Final Decision