Life Insurance Needs Worksheet (D.I.M.E.)

Your information

So Jim and Katie know whose worksheet this is and how to reach you.

First name *

Last name *

Email *

Cell phone *

Date of birth (optional)

Best way to reach you

Height (optional)

Weight (optional)

Height and weight are completely optional — they just help Jim price your coverage accurately, since every life insurer asks about build.

D Debt

Debts other than your mortgage — credit cards, auto loans, student loans, or other personal debt.

I Income

Income replacement — how much income your family would need each year, and for how many years.

Annual income to provide

Years to provide income

Income need (annual × years)$0

M Mortgage

Real estate debt — tell us how many properties you owe on, then pick the type and balance for each.

How many properties do you have mortgage debt on?

Total mortgage balances$0

E Expenses

Estimates of specific expenses — best guesses are fine.

Final expenses

Funeral and burial costs.

Immediate cash needs

A cushion for bills right after a loss.

Educational costs

College or schooling for the kids.

Child care / long-term care

Other expenses

Total expenses$0

Life insurance you already own

Death benefit of life insurance you own personally — not counting insurance through an employer or owned by others.

Total needs (D + I + M + E)$0

Remaining estimated need$0

This worksheet is an estimate to start a conversation — it is not a quote, a recommendation, or a guarantee of coverage or price. Life insurance issued by Farmers New World Life Insurance Company, 12822 SE 32nd St., Ste. 2, Bellevue, WA 98005. Products and features, including same-day coverage, may not be available to all applicants or in all states and may vary by state. Restrictions, exclusions, limits, and conditions apply. Any product guarantees are subject to the financial strength and claims-paying ability of Farmers New World Life Insurance Company, which is solely responsible for the obligations under its own policies. Farmers New World Life Insurance Company is not licensed and does not solicit or sell in the state of New York.

Jim Wilkinson Agency · 5626 134th Pl SE, Ste D, Everett, WA 98208 · (206) 363-1503

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Worksheet received

Thank you — your D.I.M.E. worksheet is on its way to Jim Wilkinson and Katie at the Jim Wilkinson Agency. One of them will reach out shortly to walk through your numbers. Need us sooner? Call (206) 363-1503.