Insurance Review Worksheet Does your insurance fit your needs? Harbor Strategies Group provides an objective way for you to review existing policies to ensure you have the right kind of insurance, the right amount and affordable premiums.
Personal Information Print insured’s name:
DOB:
Gender:
Additional insured’s name:
DOB:
Gender:
Insured’s address: Insured’s phone:
Email:
Existing Policy Information Do YOU have existing AICPA insurance? Death Benefit Amount: $______________ Does your SPOUSE have AICPA insurance Death Benefit Amount: $______________ Other Existing Insurance:
_____ YES
_____ NO
Premium: $___________ Annually _____ YES
_____ NO
Premium: $___________ Annually
_______________________________ Insurance Company
Death Benefit Amount: $______________
Premium: $___________ Annually
Please Quote: Importance: ___ Cash Value ___ Premium (Level or Increasing) ___ Death Benefit ___ Other
FOR YOU Policy Type:
___ Permanent Life
Desired Death Benefit Amount: _____________________ Overall Health:
______YES, I am interested in learning about life products that include a Long Term Care rider. ________ YES,
I would like a comparative analysis of my existing insurance and the proposed insurance quoted by Harbor.
___ Term/ ___ Yrs.
__Excellent
___ Fair
__ Poor
FOR SPOUSE Policy Type:
___ Permanent Life
___ Term/ ___ Yrs.
Desired Death Benefit Amount: _____________________ Overall Health:
__Excellent
___ Fair
__ Poor
Please return via email to:
[email protected] or by fax to: (781) 890-5624 Harbor Strategies Group – 300 Fifth Avenue Floor 3 Waltham, MA 02451 Phone: (781) 229-2300 | www.HarborStrategiesGroup.com
