Social Security Maximizer Questionnaire For Women Template
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1Women
Social Security Maximizer Questionnaire for
By completing the following questionnaire we will approximate the “Earliest Possible” and
the “Maximum” Social Security Strategies
Her Name ______________________________________
Street Address _____________________________________City: ___________________________
State ________________ ZIP _________ Email _______________________________________
Her Birth Date _______/______/_____________________
Her Marital Status (
Married__, Divorced__, Widowed__, Single__, Separated__, Domestic Partner__
Check all that apply)
Her Employment Status (Check box) Employed__, Retired__, Business Owner__, Not employed__, Homemaker__
Her Estimated Life Expectancy ____________
If left blank, we will use the age and sex in the 2006 Social Security Cohort Life Table
Has She already Elected Social Security? Yes _____ No_______
Does She have a pension from work not covered under social security? Yes _____ No_______
How should we estimate benefits for the client? ____
Using the Client’s estimated benefits from the SS Statement? (Quickest)
____
Using the Client’s earnings record from the SS Statement? (Most Accurate)
***Your client can download a copy of their Social Security Statement by setting up an account with
the Social Security Administration at
or generate a benefits estimate at
What is the Social Security Statement Date (Hers)? ______/_____/__________
How much will She receive at Full Retirement Age (FRA) as listed on the statement? ______________
At What age will She stop working? (Check one) <61___,62___, 63___, 64___, 65___, 66___, 67___, 68+___
What is Her anticipated annual income for the client (after 62)? ______________
What is the desired monthly Pre-Tax household income upon retirement? ________________
DEPENDENT CHILDREN
NAME:
RELATIONSHIP:
DATE OF BIRTH
AGE:
_______________________________
________________
____/_____/_______
_________
_______________________________
________________
____/_____/_______
_________
_______________________________
________________
____/_____/_______
_________
_______________________________
________________
____/_____/_______
_________
15701 HWY 50, Suite 204 Clermont, FL 34711
PH 352-404-5158
FAX 407-459-8746 Toll Free 877-869-9848
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