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Financial Inventory FEx .pdf


Original filename: Financial Inventory - FEx.pdf

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FINAL
EXPENSE
WORKSHEET

1) No Burial Life Insurance
2) Need More Life Insurance
3) Leave behind money for legacy

Name and Age:

Name and Age:

Retired / Employed:
Social Security / Pension / Both:
Medicare / Med Sup:
Life Ins / Annuity:
401K/IRA/Stock/SEP/TSP/MF/CD:
Burial / Cremation

Retired / Employed:
Social Security / Pension / Both:
Medicare / Med Sup:
Life Ins / Annuity:
401K/IRA/Stock/SEP/TSP/MF/CD:
Burial / Cremation

QUALIFIED DISCOUNTS Tobacco: Yes / No
Credit Union / Financial Institution / Dex

QUALIFIED DISCOUNTS Tobacco: Yes / No
Credit Union / Financial Institution / Dex

Heart Attack / Stroke / TIA / Stents / Cancer / Diabetes (Pills vs Insulin) / Pain Meds / HBP / Cholesterol
Asthma & COPD (Albuterol vs Corticosteroid) / Thyroid / Anxiety & Depression / Alzheimers / Dementia
Medical Conditions/Hospitalizations/Surgeries:

Medical Conditions/Hospitalizations/Surgeries:

Prescription List (Name, Dosage, Frequency):

Prescription List (Name, Dosage, Frequency):

OPTION #1

Name of Beneficiary:
DOB:
Relationship to Insured:

OPTION #2

Name of Beneficiary:
DOB:
Relationship to Insured:

OPTION #3


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