Roadmap for Retirement℠ Form Step 1 of 5 20% Your Full Name(Required) First Last Your date of birth (mm/dd/yyyy)(Required) MM slash DD slash YYYY Your Spouse's full name (if applicable) First Last Your spouse's date of birth (mm/dd/yyyy) MM slash DD slash YYYY Tell us about your retirement statusAre you retired or employed?(Required) Retired Employed When did or do you expect to retire? (mm/dd/yyyy)(Required) MM slash DD slash YYYY Where did/do you work?(Required)Is your spouse retired or employed? Retired Employed Not applicable When did or does your spouse expect to retire? (dd/mm/yyyy)Where does/did your spouse work? A couple questions about your estate plansDo you have a will?(Required) Yes No Not sure Does your spouse have a will? Yes No Not sure Do you have a trust?(Required) Yes No Not sure Does your spouse have a trust? Yes No Not sure Your Financial Picture Your Roadmap for RetirementSM is your personal plan for how to avoid the biggest risks in retirement. To build your plan, we need to understand your financial situation. Estimates are okay at this point if you aren’t sure of the exact details. Household Monthly Income & ExpensesMonthly Income(Required)Monthly Social Security benefitMonthly pensionMonthly rental incomeOther monthly incomeEstimated monthly expenses Approximate Asset ValuesBank accounts, CDs, money market accounts (Examples: Chase CD: $25,000: Chase savings $50,000) If not applicable, enter “none”(Required)List all retirement account values (401k, 403b, IRA, Roth IRA) If not applicable, enter “none”(Required)Other Investments (other than retirement accounts – stocks, bonds, mutual funds, annuities, etc.) If not applicable, enter “none”(Required)Insurance (Life, term, universal, long-term care, etc.) If not applicable enter “none”(Required)Value of real estate, farm land, vehicles, boats, business interests, etc. If not applicable, enter “none”(Required)Total estimated value of your debt Δ
