YOU

    Name

    Email

    Your monthly salary(after tax)

    ONCE-OFF COSTS

    Mortgage

    Loans

    Other (eg. Credit Card)

    LIVING EXPENSES

    Monthly cost of family living

    RESIDUAL MONTHLY INCOME

    Your partners monthly salary(after tax)

    Spouses Death in service pension

    Social welfare payments (e.g. childrens allowance)

    Other

    DISPOSABLE ASSETS

    Bank / Credit Union deposits

    Value of other assets that can be sold

    LIFE COVER

    How much life cover do you need? (in Euros)

    For how long? (in years)

    Do you smoke?

    Date of birth:

    Existing life insurance cover (including death in service)

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