CURRENT LIFE INSURANCE Client _____________________________ Type: _____________ Carrier: _____________

Spouse ____________________________ Type: _____________ Carrier: _____________

When we get back together, if I can offer recommendations that, in your opinion, are better for you and your family in every way, is there any reason we couldn’t do business?

Would you be kind enough to refer our services to 8-10 other people like you?

Date of our next meeting: Time: BPM

World Financial Group, Inc. (WFG) is a financial services marketing company whose affiliates offer a broad array of financial products and services.

Insurance products offered through World Financial Group Insurance Agency, Inc., World Financial Group Insurance Agency of Hawaii, Inc., World Financial Group Insurance Agency of Massachusetts, Inc., World Financial Group Insurance Agency of Wyoming, Inc., World Financial Insurance Agency, Inc. and/or WFG Insurance Agency of Puerto Rico, Inc. - collectively WFGIA.

WFG and WFGIA are affiliated companies.

World Financial Group and the WFG logo are registered trademarks of World Financial Group, Inc.

Headquarters: 11315 Johns Creek Parkway, Johns Creek, GA 30097-1517. Phone: 770.453.9300. WorldFinancialGroup.com

©2014 World Financial Group, Inc. 0900/5.16

Total Monthly

Debts Student Loans $ ___________ $ ___________

Car Loans $ ___________ $ ___________

Credit Cards $ ___________ $ ___________

Income If you or your spouse could not work again, how much income would you need to sustain your current lifestyle? $ ___________/month

Mortgage What do you think your house is worth? $ _____________ What is your current balance on your home mortgage?

1. $ ___________ 2. $ ___________

Monthly payment: $ ___________

Type of Loan: ____ Fixed ____ Adjustable

Number of Years: _____________

Interest Rate: ________________%

Education Would you like to provide for your children’s education? _______

____ ALL or ____ PART

Approximate Cost for Education: $ ___________

Amount Saved: $ ___________

WFG’s MissionTo help families achieve financial independence

Notes

Current Life Insurance

Financial Checkup

A Transamerica Company

Client: Date:

//

Associate: Code #:

Spouse:

Co-Associate: Code #:

Personal Statistics

Taxable Tax Deferred Tax Advantaged

CF = College Funding Ret = Retirement Pass = Pass on to Heirs

Check Up What do you intend to do with these assets?

Please note the following about these products:

*Variable Life Insurance: Both principal and yield of investment securities will fluctuate with changes in the market conditions, and may be worth more or less than the original investment. If tax-free loans are taken from a variable life insurance policy and the policy lapses, a taxable event may occur. Loans and withdrawals from the life insurance policies that are classified endowment contracts may be subject to tax at the time the loan or withdrawal is made. Early withdrawal may be subject to surrender charges, and if taken prior to age 59 1/2 a 10% IRS penalty may apply. Withdrawals and loans have the effect of reducing the death benefit and cash surrender value of a policy.Variable life insurance is sold by prospectus, which contains complete information on charges, expenses and tax consequences in relation to the policy. The prospectus should be read carefully before investing or sending money.

** This product is offered through securities registered representatives. An investor should consider the investment objectives, risk, and charges and expenses associated with municipal fund securities before investing. More Information about municipal fund securities is available in the issuer’s official statement

Total CF Ret Pass

Savings $

Checking $

CDs $

Mutual funds $

Stocks $

Bonds $

Treasuries $

Other $

Total $

Total CF Ret Pass

IRAs $

401(k), 403(b)s and $ other pension plan assets

Variable Annuities $

Fixed Annuities $

Savings Bonds $

Other $

Total $

Total CF Ret Pass

Roth IRAs $

Single Premium $ Variable Life Insurance* Cash Value

529 Plan** College $ Savings Programs

Single Premium $ Whole Life Insurance Cash Value

Annual Pay VUL Cash Value $

Annual Pay $ Whole Life Insurance and/orUniversal Insurance Cash Value

Total $

Tax Advantaged assets are positioned for the future since they receive preferential tax treatment during accumulation and at distribution.

NOTE: Certain events and distributions may be subject to taxation and individuals would be responsible for the appropriate liability. This piece provides general information regarding the Internal Revenue Code and does not take into consideration specific state laws. World Financial Group, Inc. and its associates do not provide tax advice and strongly recommend that clients consult a compe-tent tax advisor concerning any tax issues relating to their investments.

Tax Deferred assets are earmarked for long-term needs, such as college funding and retirement. These assets are invested into less-liquid investments where any growth or interest is ultimately taxable at distribution.

Taxable assets are generally positioned for current or short-term needs that can be best served with highly liquid investment instruments.

Last Name First DOB

Spouse Name DOB Home Phone Work Phone

Address City State Zip

Employer (C) Yrs. Annual Gross Income $

Employer (S) Yrs. Annual Gross Income $

Other Income Sources

Children/Age 1. / 2. / 3. / 4. /

At what age do you plan to retire?

In today’s dollars, how much income on a monthly basis would you like during retirement?

And for how many years?