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 3–5 minutes. There are no wrong answers — just be as accurate as you can.

1. Your Details ▼

Client 1

Title

First name

Surname

Date of birth

Gender

Smoker?

Non smoker

Smoker

Occupation

Annual gross income ($)

Planned retirement age

Mobile

Self-employed or business owner?

Yes

KiwiSaver contribution

% of gross

Default 3.5%. Self-employed may pay a fixed $ amount instead — just note it below.

Client 2 (partner, if applicable)

Do you have a partner to include?

Family & Financial

Number of dependent children

Mortgages

Home mortgage balance ($)

Payment amount ($)

Payment frequency

Investment mortgage balance ($)

Payment amount ($)

Payment frequency

Investment income from rental 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 pays you a regular amount to cover your mortgage and living costs. These options affect the cost and level of cover.

How long could you manage without income before needing help?

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.

Would you want payments to start immediately after the wait period?

Yes — immediately (in advance)

No — end of month (in arrears)

How long should the policy cover you?

To age 65

To age 70

If you make a claim, how long should payments continue?

2 years

5 years

To age 65

To age 70

Longer payment periods cost more but protect you better for serious illness or injury.

Continue KiwiSaver contributions while off work?

% — some policies will continue your KiwiSaver contributions while you're unable to work

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.

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.

Business Revenue & Key Person Impact

If you were out of action, what would happen to the business income?

Business name

Financial year end

Annual gross revenue ($)

Gross profit margin (%)

Fixed costs excl. shareholder salaries ($pa)

Rent, power, insurance, admin staff — costs that continue whether you're there or not.

Annual cost of goods sold / COGS ($)

Direct costs of producing goods/services. Leave at 0 if unsure — we can calculate from GP margin.

Key People

Who are the people the business depends on most? They might be owners, partners, or key employees.

Name	Position / Role	Revenue contribution %	Shareholder?

Revenue contribution = how much of the business income depends on this person being there.

Shareholders

Anyone marked as a shareholder above will appear here automatically. Add any other shareholders who aren't key people.

Estimated company value ($)

Buy-sell agreement in place?

Yes

Not sure

If something happened to a shareholder, who should the shares pass to?

Shareholder name	Share %	Salary drawn ($pa)	Source

Business Wind-Up

If the business had to close, what's the gap between assets and liabilities? Approximate figures are fine.

Assets (what you could sell)

Item	Book value	Realise %
Cash on hand
Accounts receivable
Inventory / Stock
Plant & equipment
Vehicles
Property / Land
Goodwill

Liabilities & Wind-up Costs

Item	Amount
Accounts payable
Shareholder current accounts
Tax owing (GST/PAYE)
Bank loans
Hire purchase
Unexpired lease
Redundancy / holiday pay
Legal, accounting & other

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.