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MMT Financial & Insurance

Educate • Protect • Wealth

Marc Merritt — NYS Life, Health, FIA Licensed since 2001, LA # 1010090
Marylene Teopengco-Merritt — NYS Life & FIA Licensed since 2017, LA # 1298496

📞 Marc Merritt, RVP: 1-646-645-2453
📞 Marylene Teopengco-Merritt, RVP: 1-631-579-1904

Tip: On mobile, the policy and retirement tables can be scrolled left/right.

Client & Household Information

Address

Health & Lifestyle Information

Existing Insurance Policies & Carriers

Life, Term, Whole Life, IUL, Annuities, Disability, LTC, etc.
Policy Type Carrier Policy # Coverage ($) Monthly Premium ($) Remove
Total Monthly Premiums

401(k), 403(b), IRA, Roth, Pension & Other Retirement Accounts

Account Type Provider / Custodian Employer Current Value ($) Monthly Contribution ($) Remove
Totals

Life Insurance Needs Analysis

Monthly Retirement Budget

Calculated from Client + Spouse annual salaries ÷ 12.
Sum of premiums + contributions + tax refund + other monthly savings.
Household Monthly Income − Living Expenses − Total Current Monthly Retirement Savings

Signature Acknowledgement