What happens if your income is no longer there?

You and your family depend on your Earnings for food, clothing and a home. In fact, just about everything you have or hope to have in the future depends on your income.

What happens if your income is no longer there or is drastically reduced because of an injury or sickness?

How will you meet your normal living expenses plus pay for possible added medical expense? Even if you eliminate some of the less crucial expenditures such as entertainment, recreation, savings plans and even education, you are still faced with the continual need to provide a home, food, clothing...

Where will this money come from?

• Savings?
• Loans?
• Social Security Benefits?

Are these realistic solutions?

• Social Security Benefits usually are difficult to qualify for. And, oftentimes, the amount you receive is not enough to meet your needs.
• Most lending institutions want concrete evidence that you would have the ability to make prompt and timely repayment on any loans.
• If you were unable to work for an extended period of time, how long would your savings last?
* =Required Fields
* Full Name		Zip Code
* Address		Phone
City		Fax
State		* Email
Name of Proposed Insured
Gender
Birthdate
Height	ft/inch
Weight	Lbs.
Age
Tobacco	Yes No
Medications/Conditions:
1.  2.  3.
Job Title
Exact Duties
Employee Status		Employee Sole Prop Partner S. Corp C. Corp
If Self-Employed, Covered by SDI?		Yes No
% of work at home		%
Premium to be paid by:		Self Employer
Other DI Coverage to Remain in Force		$
If Group, % Of Salary		%
Who pays premium		Employee Employer
Coverage Request
Personal DI
Business Overhead Expense
Monthly Benefit Amount	$
Elimination Period	30 Days 60 Days 90 Days 120 Days 180 Days 365 Days
Benifit Period	2 years 3 years 4 years 5 years 6 years 65 years 67 years
Disability Buy-Out
Buy-Out Amount
Lump Sum	$
Monthly	$
Benifit Period	24 months 36 months 60 months
Elimination Period	12 months 18 months 24 months
Additional Information

Thank you and I look forward to talking to you soon
Maraletos Insurance