Social Security Strategy Session
Name
First Name
Last Name
Spouse Name
First Name
Last Name
Your DOB
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Spouse DOB
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Have you (and spouse if applicable) registered for an online account at
Marital Status (please check all that apply now and in the past)
Single, never been married
Married
Separated
Divorced
Widow
Back
Next
Have you and/or your spouse started collecting Social Security?
Yes (both of us)
Yes (spouse only)
Yes (self)
No not currently
No, never had
If either of you are collecting or have collected, please explain and include dates
Are you (or your spouse) disabled?
Yes (spouse only)
Yes (self)
No, not currently
No, never
Do you have any disabled children former spouse, or other family members drawing off of your Social Security record? (if yes please explain)
What questions do you have about Social Security planning or about the SSA program?
What are your goals for your Social Security planning session?
What is your estimated Social Security benefit from your most recent Social Security Earnings Statement?
What is your estimated Social Security benefit from YOUR SPOUSE's most recent Social Security Earnings Statement?
How long do you (and spouse) expect to live?
Additional Questions/Concerns
If married prior, how long was the marriage?
Anticipated Household Gross Income for Current year?
Types of Income (check all that apply)
W2 Employment
Self Employment
Investments
Retirement
Alimony
Other
Tell me about your assets and liquidity
What is your estimated net worth (from a monetary prospective)?
What are your financial objectives and personal goals?
I have additional questions/concerns or need to review my policy for:
Health Insurance
Medicare
Life Insurance
Annuities
Cancer Insurance
Dental/Vision Insurance
Long Term Care
Recovering at home Insurance
Critical Illness
Are you still working?
Yes
No
Is your spouse still working?
Yes
No
Tell me about you (and spouse if applicable's) current health insurance?
Submit
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