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Modern Architecture

FINANCIAL PROTECTION QUESTIONNAIRE

  • Do you currently have life insurance?

Select one
Yes (Personal Policy)
Yes (Through work only)
No
Not Sure

  • If your income stopped today, how long would you be financially okay?

Select one
Less than 1 month
1–3 months
3–6 months
6+ months

  • Do you have any coverage outside of your employer?

Select one
Yes
No
Not sure

  • Do you have anyone financially depending on you?

Select one
Yes
No
Planning to soon

  • How confident are you in your current coverage?

Select one
Very confident
Somewhat confident
Not confident
I do not have any coverage

  • Have you reviewed your financial protection in the last 12 months?

Select one
Yes
No
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