Retirement Forecast

Primary Contact

First Name *

Last Name *

Date of birth *

Retirement Goal (Age Desired) *

Employment Status *

State *

Marital Status *

Gender *

Income Sources

Current Income from Job (Annual Before Taxes) *

$

Other Income $ (Annual Before Taxes) *

$

Social Security Info can be found on SSA.Gov. Please take a moment to login for accurate numbers. This part is important for the Retirement Forecast

Age starting Social Security Income? *

Social Security Monthly Amount *

$

Will you receive a Pension? *

Yes

No

What age does Pension start

Monthly Pension Amount

$

Source of Pension

Total Monthly Expenses

Include All Expenses

Monthly Expense Amount *

$

Retirement Accounts and Assets

Total amount in CURRENT Employer Retirement Account (401k, 403b, 457, TSP, etc) *

$

Does your Employer Match? *

Yes

No

What Percentage does your Employer contribute?

What Percentage do you contribute?

Do you have Old Employer Retirement Accounts (401k, 403b, 457, TSP, etc) *

Yes

No

Total Amount in Old Employer Retirement Accounts (401k, 403b, 457, TSP, etc) *

$

Total Amount in Traditional IRAs *

$

Annual Contributions to Traditional IRAs *

$

Total Amount in Roth IRAs *

$

Annual Contributions to Roth IRAs *

$

Total amount in Brokerage Accounts NON IRA Funds (Stocks/ Bonds/ Mutual Funds) *

$

Annual Contributions to Brokerage Accounts NON IRA Funds (Stocks/ Bonds/ Mutual Funds) *

$

Total amount in Annuities *

$

Total amount in Checking/ Savings/ Bank Money Market *

$

Total amount in CD's *

$

Spouse Information

Spouse First Name

Spouse Last Name

Spouse DOB

Retirement Goal (Age Desired) (Spouse)

Spouse Employment Status

Spouse Gender

Spouse Income Sources

Current Income from Job (Annual Before Taxes)(Spouse)

$

Other Income $ (Annual Before Taxes)(Spouse)

$

Social Security Info can be found on SSA.Gov. Please take a moment to login for accurate numbers. This part is important for the Retirement Forecast

Age starting Social Security Income? (Spouse)

Social Security Income Monthly (Spouse)

$

Spouse | Will you receive a Pension?

Yes

No

Spouse | What age does Pension start

Spouse | Monthly Pension Amount

Spouse | Source of Pension

Spouse Retirement Accounts and Assets

Spouse | Total amount in CURRENT Employer Retirement Account (401k, 403b, 457, TSP, etc)

$

Spouse | Does your Employer Match?

Yes

No

Spouse | What Percentage do you contribute?

Spouse | What Percentage does your Employer contribute?

Spouse | Total Amount in Traditional IRAs

$

Spouse | Annual Contributions to Traditional IRAs

$

Spouse | Total Amount in Roth IRAs

$

Spouse | Annual Contributions to Roth IRAs

$

Spouse | Total amount in Brokerage Accounts NON IRA Funds (Stocks/ Bonds/ Mutual Funds)

$

Spouse | Annual Contributions to Brokerage Accounts NON IRA Funds (Stocks/ Bonds/ Mutual Funds)

$

Spouse | Total amount in Annuities

$

Spouse | Total amount in Checking/ Savings/ Bank Money Market

$

Spouse | Total amount in CD's

$

General Notes

Submitter

Name of Person Submitting this Form *

Email of Person Submitting this Form *