| Assets |
| Liquid: Cash, shares, bonds, unit trusts etc. |
$
|
| Other: jewellery, antiques etc. |
$
|
| Liabilities |
| Short term: personal loans, credit cards, leases
etc. |
$
|
| Long term: mortgages, other |
$
|
| Existing Insurances |
| Amount |
$
|
| In the event of your premature death or total disablement, would
you like your dependants to receive: |
| An income to replace your lost income? |
Yes
No |
| If yes, |
|
| Annual level of income before tax |
$
|
| Income to continue for |
years |
| Return on lump sum to produce above income |
% |
| Annual increase in income to cover inflation
etc. |
% |
| And/or, |
|
| A lump sum to repay debts? |
Yes
No |
