Life Insurance Review Form - Spencer Insurance Agency Inc.

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Life Insurance Review

Life Changes And So Do Your Life Insurance Needs. Let's Keep Everything Up To Date!

Name(Required)

First Last

Email(Required)

Address

Street Address Address Line 2 City State ZIP Code

Home Phone

Cell Phone

Please take a few moments to complete our questionnaire. A positive answer to any of these questions may indicate a need to revise your life insurance plans. Please check the statements you agree with.

Change of Residence

I have recently moved.

I have recently purchased my first home.

I have increased the amount of my mortgage since our last review

Wealth Variations

The value of my home has decreased or increased during the past year

Either I, or my spouse, have received an inheritance during the past year

Family Status

A member of our family has married since our last review

A new baby has joined our family since our last review

A child in our family has special needs that will need support in years to come

A member of our family has separated or divorced since our last review

A member of our family has died since our last review

Employment and Business Interests

My employment situation has significantly changed during the past year

I have established a new business during the last year

Either I, or my spouse, have become disabled

Life Insurance and Annuities

My group insurance benefits have changed during the past year

I would like to change the beneficiary designation on an existing life insurance policy

I feel I need additional insurance

I would like to learn more about the new types of life insurance policies being offered and how they might fit into my plans

I would like to change the beneficiary designation on an existing annuity

I would like information about annuities

Survivor Income Life Insurance

I would like to leave a guaranteed stream of income to my surviving family members

Amount of annualized income I would like to leave my surviving family members

I would like the income paid:

Monthly

Quarterly

Annually

Number of Years I Would Like The Income Paid

Please enter a number from 5 to 30.

(Min - 5 years; Max - 30 years)

Retirement

I would like to start my own individualized private retirement program

My IRA is funded with certificates of deposit. I would like information about alternative strategies

My spouse and I are concerned about the reduction in Social Security benefits at the first death

I would like more information on the following:

Tax savings available by use of tax-qualified retirement plans

Increased protection for my family

Debt protection for loans, cars, boats, vacation homes, etc.

Final expense protection

Converting term life insurance or term rider to permanent coverage

Insurance for children or grandchildren

Providing college education to my children or grandchildren

Insurance for my spouse

Group insurance

Key person insurance

Business by-sell agreements

Leaving funds to charities

Spencer Insurance Agency, Inc., an independent insurance agency, provides life insurance, disability insurance, auto insurance, home insurance, business insurance, and umbrella coverage.

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115 West Ave, Suite 108
PO Box 54
Jenkintown, PA 19046-0054
(215) 885-2200
info@spencerinsurance.com
(215) 887-9538