Name
*
First Name
Last Name
Date of Birth
*
/
Month
/
Day
Year
Date
City
State
ZIP Code
*
Best Phone Number
*
No Work Numbers Please
Email
*
Personal not work
Name Spouse
Spouse Date of Birth
/
Month
/
Day
Year
Date
Federal Employee Category
*
FERS
FERS LEO
FERS ATC
FERS FIREFIGHTER
CSRS
CSRS LEO
CSRS ATC
CSRS FIREFIGHTER
CSRS OFFSET
Agency
Service Computation Date: Usually the date you started or the date used to calculate your retirement pension.
*
/
Month
/
Day
Year
Date
Annual Leave Hours
*
Estimated Retirement Age
*
Gross Pay per pay period
*
Number of pay periods
*
TSP Balance Pre Tax
TSP Contribution %
*
TSP Roth Balance
*
TSP Roth Contribution %
*
Monthly Social Security Payment @ 62
*
Monthly Social Security Payment @ Full Retirement Age
FEGLI
BASIC
Option A
FEGLI OPTION B
1X
2X
3X
4X
5X
FEGLI OPTION C
Option 1
Option 2
Option 3
Option 4
Option 5
Health Insurance Premium
Estimated Income Need
Estate Planning
*
Will
Living Trust
Power of Attorney
Living Will
Health Care Proxy
All of the Above
None of the Above
Notes and Additional Information
Securities and Advisor Services offered through Silver Oak Securities, Inc. Member FINRA / SIPCHearn Wealth Management and Silver Oak Securities Inc are not affiliated/separate entities. Martin Hearn Investment Advisor RepresentativeDBA Hearn Wealth Management LLC Call us today at:(901)473-9379
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