Personal Profile

Complete this Personal Profile to start your Free Benefit Analysis. We would also like a copy of your most recent:

   1. Leave and Earnings Statement
   2. Thrift Savings Plan Statement and Loan Statement (www.TSP.gov)
   3. Social Security Statement (www.SSA.gov)

Client Information

First Name *

Last Name *

Male

Female

Date of Birth (mm/dd/yyyy) *

Street Address *

Phone Number

Address Line 2

Cell Number

City *

State *

Zip Code *

Email Address *

Employer *

Position

Street Address

Phone Number

Address Line 2

Email Address

City *

State *

Zip Code

Family Information

Marital Status *

Spouse/Life Partner's Name

Spouse/Life Partner's Date of Birth (mm/dd/yyyy)

Male

Female

Child's Name

Child's Date of Birth (mm/dd/yyyy)

Male

Female

Child's Name

Child's Date of Birth (mm/dd/yyyy)

Male

Female

Child's Name

Child's Date of Birth (mm/dd/yyyy)

Male

Female

Child's Name

Child's Date of Birth (mm/dd/yyyy)

Male

Female

Income

Annual Income

	Client	Spouse/Life Partner
Salary (Base and Locality)	Client	Spouse/Life Partner
Bonus/Commissions	Client	Spouse/Life Partner
Interest/Dividends	Client	Spouse/Life Partner
Rental Income	Client	Spouse/Life Partner
Child Support	Client	Spouse/Life Partner
Other	Client	Spouse/Life Partner

Leave and Earnings Data (pay stub)

	Dollar Amount
Retirement Deduction	Dollar Amount
Federal Tax	Dollar Amount
FEGLI - Regular	Dollar Amount
Health - Pretax	Dollar Amount
TSP Contribution	Dollar Amount
Allotment Deduction	Dollar Amount
OASDI Tax	Dollar Amount
State Tax	Dollar Amount
FEGLI - Optional	Dollar Amount

(continued)

	Dollar Amount
Dental & Vison	Dollar Amount
TSP Catch Up	Dollar Amount
Union Dues	Dollar Amount
Medicare Tax	Dollar Amount
FSA	Dollar Amount
Charity	Dollar Amount
Association	Dollar Amount
TSP Loan	Dollar Amount
Other	Dollar Amount

Creditable Service

Service Computation Date (SCD) *

*

Have you ever taken leave without pay?
Were you ever on worker's compensation?
Do you have any part time work?
Did you ever have intermittent (WAE) work?
Did you ever have a break in service?
Are you retired from the military?
Have you made a deposit for your military service?
Do you have any non-deduction (temporary time) service?
Did you ever have a break in service and withdraw your contributions?

If you answered yes to any of the previous questions, please explain and include dates.

Retirement

At what age would you like to retire? *

At what age would your spouse/life partner like to retire?

Retirement System *

CSRS

FERS

CSRS Offset

FERS Transfer

Employment Type *

Retirement Type *

Regular

Optional

Mandatory

If you are a CSRS Employee, how much of a survivor benefit would you like?
(You can choose any amount from 0% to 100% in 1% increments)

If you are a FERS employee, what survivor benefit would you like?

0%

25%

50%

Sick leave hours you have saved to date.

Federal Employee Group Life Insurance (FEGLI)

Do you have basic FEGLI coverage?

Yes

No

If yes, what reduction option do you want at age 65?

0%

50%

75%

Option A?

Yes

No

Option B?

Yes

No

If yes, how many multiples?

Reduce after 65?

Yes

No

Option C?

Yes

No

If yes, how many multiples?

Reduce after 65?

Yes

No

If you have Option C, will any of your children be dependent on you after age 22?

Yes

No

Do you have other life insurance?

Yes

No

Amount

Type

Thrift Savings Plan (TSP)

Do you participate in the Thrift Savings Plan? *

Yes

No

Total amount currently in your TSP

Current Savings in your TSP

	C Fund	F Fund	G Fund	I Fund	S Fund	L Fund
Dollar Amount ($)	C Fund	F Fund	G Fund	I Fund	S Fund	L Fund

If using the L Funds, which L fund are you in?

What percent are you investing into each of the funds in your TSP?

	C Fund	F Fund	G Fund	I Fund	S Fund	L Fund
Percentage (%)	C Fund	F Fund	G Fund	I Fund	S Fund	L Fund

If using the L Funds, which L fund are you in?

Percent of Salary invested in your TSP this year.

or

Bi-weekly contribution ($).

Do you have any TSP loans?

Yes

No

If yes, what is the total amount of the loan ($)?

Other Assets

Primary Residence

Do you own your primary residence?

Yes

No

Current Value of Home.

Current Loan Amount

Loan Term (Years)

Years Paid

Monthly Payment

Does this payment include taxes and insurance?

Yes

No

Other Assets

	Value ($)	Location	Current Interest/Return Rate
Savings	Value ($)	Location	Current Interest/Return Rate
CD's / Money Market	Value ($)	Location	Current Interest/Return Rate
Rental Properties	Value ($)	Location	Current Interest/Return Rate
Stock/Bonds/Mutual Funds	Value ($)	Location	Current Interest/Return Rate
Retirement Accounts	Value ($)	Location	Current Interest/Return Rate
Other	Value ($)	Location	Current Interest/Return Rate
Other	Value ($)	Location	Current Interest/Return Rate

Social Security

	You	Spouse/Life Partner
Social Security Benefit At Age 62	You	Spouse/Life Partner
Social Security Beneft at Full Retirement Age	You	Spouse/Life Partner

Other Information

Please list all major debts that you have (i.e. - Credit Cards, Car Loans, Student Loans, etc.)

When you retire from the Government, what do you see yourself doing and what are some of your goals?

	You	Spouse/Life Partner
Retirement Picture	You	Spouse/Life Partner

Please let us know anything else that you think would be important for us to know to complete your analysis.

If you would like to include a copy of your Leave and Earnings Statement, you can upload it here.

If you would like to include a copy of your Thrift Savings Plan, please upload it here.

If you would us to review any other paperwork, please upload it here.

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