Your Social Security Timing Questionnaire

Social Security Timing

Your Questionnaire & Customized Report Order Form

PURPOSE

The purpose of this questionnaire is to allow our Social Security Team to gather important information unique to you and your spouse. Your valuable customized report is not one-size-fits-all. Your accuracy and thoroughness here will enable our team to determine your best possible timing choices, claiming combinations and strategies, enabling you to MAXIMIZE your family's lifetime Social Security income benefits.

PLEASE NOTE

Your privacy and the safety of your personal information is critical to us and held with strict confidence. As a professional Wealth Management firm we deal with this type of information with every client.

To Protect Your Interests:

1) You are connected to this form via a secure encrypted web link.

2) We NEVER collect your Social Security Number (SSN).

3) Your Social Security statement does NOT contain your full SSN.

4) We ONLY collect necessary information to produce the most accurate, optimal report for your family.

5) This process enables our team to identify your best options resulting in the maximum income for your family.

ANY questions? If you'd like to call for any reason, our main phone number is:

610-945-1837

Do you have a recent Social Security Statement for both you and your spouse? *

YES NO

IMPORTANT NOTE:

In order to proceed, you must download a FREE copy of your Social Security Reports (one for each spouse) from the official SSA web site. This is quick and easy and should take less than 5 minutes. Here is the web address:

http://www.socialsecurity.gov/mystatement/

After you've downloaded your reports (in PDF format), just upload the PDF files - one file for each spouse. Click on the BROWSE buttons below to locate and upload each spouse's report from your computer. It is as simple as that...

Send/Upload HUSBAND's Social Security Report *

Send/Upload WIFE's Social Security Report *

Enter the estimated Social Security income amounts at each age, for both spouses, in the table below. This information is available on page 2 of your recent Social Security Report. *

	Husband's Social Security Income	Wife's Social Security Income
Age 62 - Monthly Income Estimate
Age 66 - Monthly Income Estimate
Age 70 - Monthly Income Estimate

Full Name *

First Name Last Name

Birth Date *

Month Day Year

Life Expectency Estimate - (Husband's Age at Death) Make your best estimate here based on your health and your family health history...

Current Annual Gross Income

Last year's taxed Social Security income - if any?

Has HUSBAND already elected Social Security? *

Yes No

Current Social Security Monthly Income Amount *

Social Security Income Benefit Start Date *

Month Day Year

What age does HUSBAND intend to stop working? *

	Anticipated Annual Earnings
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028

	Anticipated Annual Earnings
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038

What age does HUSBAND currently plan to start drawing Social Security Income? *

The date your most recent Social Security statement was issued. *

Month Day Year

Does HUSBAND now, or will he in the future receive any pension income from earnings not covered under Social Security? *

Yes No

Monthly Pension Amount ($) *

Pension Cost of Living Adjustment as an annual percentage *

Pension Start Date *

Month Day Year

IMPORTANT NOTE:

Receipt of pension funds not covered under Social Security likely means you will be impacted by the Government Pension Offset or the Windfall Elimination Provision. For this reason, you'll need to submit a copy of your official Social Secuirty Earnings Statement to ensure your most accurate SST Report.

You can easily and quickly download a FREE PDF COPY of your report from the official SSA web site at:

http://www.socialsecurity.gov/mystatement/

Once you've downloaded your earnings report (in PDF format) from the official SSA web site, just upload the PDF file to us with the upload field below, by clicking the BROWSE button and locating the PDF file on your computer.

Send Us (Upload ) Your Detailed SSA Earnings History Report *

Full Name

First Name Last Name

Birth Date

Month Day Year

Life Expectency Estimate - (Wife's Age at Death) Make your best estimate here based on your health and your family health history.

Current Annual Gross Income

Last year's taxed Social Security income - if any?

Has WIFE already elected Social Security? *

Yes No

Current Social Security Monthly Income Amount *

Social Security Income Benefit Start Date *

Month Day Year

What age does WIFE intend to stop working? *

	Anticipated Annual Earnings
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028

	Anticipated Annual Earnings
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038

What age does WIFE currently plan to start drawing Social Security Income? *

The date your most recent Social Security statement was issued. *

Month Day Year

Does WIFE now, or will she in the future receive any pension income from earnings not covered under Social Security? *

Yes No

Monthly Pension Amount ($) *

Pension Cost of Living Adjustment as an annual percentage *

Pension Start Date *

Month Day Year

IMPORTANT NOTE:

Receipt of pension funds not covered under Social Security likely means you will be impacted by the Government Pension Offset or the Windfall Elimination Provision. For this reason, you'll need to submit a copy of your official Social Security Earnings Statement to ensure your most accurate SST Report.

You can easily and quickly download a FREE PDF COPY of your report from the official SSA web site at:

http://www.socialsecurity.gov/mystatement/

Once you've downloaded your earnings report (in PDF format) from the official SSA web site, just upload the PDF file to us with the upload field below, by clicking the BROWSE button and locating the PDF file on your computer.

Send Us (Upload ) Your Detailed SSA Earnings History Report *

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Preferred Phone # *

Area Code Phone Number

Alternate Phone #

Area Code Phone Number

Best Days & Times to reach you via telephone?

Preferred E-mail Address *

Alternate E-mail Address

In the table below, enter combined estimated balances and annual savings amounts for each type of account owned by you and/or your spouse.

	Estimated Balance	Annual Savings Amount
401(k)s, 403(b)s, 457s etc.
IRAs, SEPs
Roth IRAs
Annuities
CDs
Brokerage Acounts
Savings, Cash Money Market Accts.
Other

NO UP-FRONT COST TO ORDER

Your Personalized Social Security Timing Report

When you submit your questionnaire, our team will perform your analysis and generate your customized report.

If we can NOT show you how to increase your lifetime Social Security income by $15,000 or more (than your plan) then your report is ABSOLUTELY FREE.

You only pay for the report IF we can show you how to increase your lifetime income by $15,000 or more, THEN AND ONLY THEN, your report will cost just...

$249 - less discount code below

We're so confident in the tremendous PROVEN VALUE of this service, that you only pay, IF AND ONLY IF, your report increases your income by $15,000 OR MORE. You simply can not get a better deal.

DON'T FORGET to Enter Your $100 Discount Code...

Before You Get Started...

Husband's Information

Anticipated Earnings - Husband

Wife's Information

Anticipated Earnings - Wife

Family Contact Information

Sources of Savings

ORDER NOW