YES	NO
1	Added to your family?	( )	( )
2	Decided to review how your life cover may help meet any estate settlement costs you may have?	( )	( )
3	Consider increasing your life assurance?	( )	( )
4	Consider converting any term assurance?	( )	( )
5	Consider increasing your disability insurance?	( )	( )
6	Consider insurance on children or grandchildren?	( )	( )
7	Started or changed your pension plan at work?	( )	( )
8	Increase estimate of monthly income needed for retirement?	( )	( )
9	Any need to change beneficiaries?	( )	( )
10	Any need for other policy changes?	( )	( )
11	Would you like to discuss the tax advantages of trusts?	( )	( )
12	Acquired any new group insurance?	( )	( )
13	Acquired any new disability (loss of income) policies?	( )	( )
14	Acquired any additional personal assets?	( )	( )
15	Acquired additional real estate?	( )	( )
16	Received any inheritance (you or your spouse)?	( )	( )
17	Entered into a new business venture?	( )	( )
18	Changed your occupation?	( )	( )
19	Changed attorneys, banks, accountants etc?	( )	( )
20	Changed your mailing address?	( )	( )
21	Changed your will or need to change your will?	( )	( )