Mortgage Mart — Insurance Needs Analysis

We take a different approach to insurance.

Rather than starting with products, we start with you. This questionnaire helps us understand your financial situation so we can identify the real cost of life's unexpected events — what would actually happen financially if you couldn't work, became seriously ill, or weren't here. Once we understand those costs, we find the best way to protect against them.

This is a needs assessment, not an offer of insurance. It helps us build a recommendation tailored to what you can afford and what matters most. A full application will require additional information including health, weight, and medical history.

It takes about 5 minutes, and you only need to fill in what applies to you — skip anything that doesn’t. There are no wrong answers.

Short on time? Tick here, add your name, email and mobile below, and we’ll call you to finish it together — no need to complete the rest now.

1. Your Details ▼

Client 1

Title

First name

Surname

Date of birth

Gender

Smoker?

Non smoker

Smoker

Occupation

Planned retirement age

Self-employed or business owner?

Yes

Mobile

Income sources — add each job / income stream, each with its own KiwiSaver

Source / employer

Gross $ pa

KiwiSaver basis

KS value

Each source can carry its own KiwiSaver — e.g. 3.5% PAYE, or a fixed $ amount if self-employed.

Client 2 (partner, if applicable)

Do you have a partner to include?

Family & Financial

Number of dependent children

Mortgages

Mortgage balance ($)

Payment amount ($)

Payment frequency

Do you have an investment property?

Other Loans & Commitments

Description

Balance

Payment

Frequency

Credit Cards

Provider / Card

Limit

Current balance

2. Income & Mortgage Repayment Protection ▼

If you couldn't work due to illness or injury, income protection replaces your income so the mortgage and living costs stay covered. Just answer the one question below — we’ll set the technical details (waiting period, how long payments run) as part of your advice.

If you couldn’t work, how long could you and your family cope before insurance payments would need to start?

4 weeks

8 weeks

13 weeks

6 months

1 year

A longer wait period reduces your premium but means a longer gap before payments start.

3. If the Worst Happened ▼

Nobody likes thinking about this, but putting a number on the financial impact is how we work out what cover actually makes sense — and avoid paying for cover you don't need.

If you died — what would your family need?

We'll include your mortgage balance and lost income automatically. These are the additional costs.

Would your partner need to buy a house?

Funeral and immediate costs

Child raising — total lump sum needed

Rule of thumb: ~$75,000 per child from birth to 18.

Education fund, bucket list, or other legacy

Special bequests (family, charity)

If you were diagnosed with a serious illness

Cancer, heart attack, stroke — trauma cover pays a lump sum on diagnosis. Think about costs beyond lost income.

How many years would you want to focus on recovery without financial pressure?

1 year

2 years

3 years

Partner taking time off work to care for you?

Extra expenses during recovery (travel, childcare, home help)

Medical costs — overseas treatment or non-funded drugs?

Pharmac doesn't fund everything. Some cancer drugs cost $5,000–$15,000/month.

Recovery and rehabilitation

Anything else?

If you were permanently unable to work ever again

Total Permanent Disablement — your income stops permanently and costs often increase.

Extra weekly living costs due to disability (care, transport, equipment)

Per week. Even $100/week = $200,000+ over a lifetime.

Home modifications (wheelchair access, bathroom, etc.)

Debt repayment not covered elsewhere

Leave at $0 if your mortgage is covered by mortgage repayment insurance.

4. Health Insurance ▼

Health insurance covers medical costs the public system doesn't — or covers them faster.

Client 1

Client 2

Private hospital & surgery
Skip public waiting lists

Specialists & diagnostic tests
MRI, CT scans, specialist consultations

Optical & dental

GP visits & prescriptions

All Medsafe-approved drugs
Including drugs not funded by Pharmac

Contract guarantee
Insurer can't change your terms or exclude conditions later

Preferred excess (amount you pay per claim)

$250

$500

$1,000

$5,000

$10,000

Higher excess = lower premium. $5k–$10k works well if you only want cover for the big stuff.

5. Your Current Insurance Policies ▼

If you have existing personal insurance, list it here so we can check it's still fit for purpose. Don’t know your premiums? Skip this and email your latest policy schedules to advice@mortgagemart.co.nz — we’ll read them for you.

Type

Provider & Details

Cover amount

Premium

Frequency

6. Business Insurance (if applicable) ▼

Are you a business owner, partner, or shareholder?

Business insurance protects the business — and your family’s investment in it — if a key person can’t work or dies. We only need the essentials here; we’ll get the financial detail from your accountant’s statements.

Business name

Who the business depends on

List the people the business couldn’t easily run without — owners, partners or key staff. A rough idea of how much of the income depends on each is plenty.

Name	Role	Rough % of income	Owner / shareholder?

“Rough % of income” = how much of the business income depends on that person being there. A ballpark is fine.

Ownership

Is there a buy-sell (shareholder protection) agreement in place?

Yes

Not sure

If something happened to an owner, who should their share pass to?

We’ll pull revenue, profit, shareholder current accounts and any wind-up figures straight from your financial statements — no need to key them here.

7. Your Priorities ▼

What's your biggest financial worry if something happened to you or your partner?

How much could you comfortably spend on insurance per month (total, both clients)?

Under $100

$100–$200

$200–$400

$400–$600

$600+

Whatever it takes

This helps us prioritise the most important cover first if we can't do everything.

Anything else we should know?

What happens next: We'll use this information to calculate your actual financial exposure and produce a personal recommendation. We'll present options at different price points so you can see the trade-offs. Nothing is committed until you're comfortable.