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UB Advisor Long Core Form

Include with documentation: Pay Stub, TSP Statement, Social Security Statement, Employee Benefits Statement, DD214 (record of military service).

Step 1 of 20

5%
This field is for validation purposes and should be left unchanged.

Employee & Spouse Information

MM slash DD slash YYYY
Please provide 3 days for processing and ensure that due date is at least 1 day before customer appointment.
MM slash DD slash YYYY
Please enter a number from 0 to 100.
Is the employee married?(Required)
MM slash DD slash YYYY
Please enter a number from 0 to 100.
Was (is) the spouse a Federal Employee?
Address

Retirement System & Employee Type

Retirement System(Required)
Employment Type(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY

Pension and Eligibility

Retirement Type

When does employee want to retire? (Select One)(Required)
Please enter a number from 50 to 75.
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY

Current Leave Hours

Does the employee intend to receive a lump sum payout for their annual leave hours?
Does the employee intend to use their sick leave hours towards their pension?

Income and Pension Values

Will the employee’s High-3 be based on their CURRENT salary?

Survivor Benefit

Is the employee’s Spouse and/or Former Spouse be entitled to the Survivor Benefit?

Social Security Income and Special Retirement Supplement (SRS)

Is the employee ELIGIBLE for Social Security at age 62?

Part Time Service

elect Yes or No and fill in the rest of the information)
Has the employee worked Part-Time while contributing to CSRS or FERS?(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY

Non-Deduction Service

Has the employee ever worked in a Non-Deduction Status when contributions were NOT taken from their pay?(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY
Was a deposit paid?
Please enter a number greater than or equal to 0.

BREAK IN SERVICE / REFUNDED SERVICE

Did the employee ever have a Break in Service of more than 3 days?(Required)
MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY
During break: Did the employee take a Refund of retirement contributions?
Was a Redeposit made after returning to federal service?

Military Service Details

Fill in below if Military service = Yes.
Has the employee ever had Military service?(Required)
If yes, what type of service was it?
MM slash DD slash YYYY
MM slash DD slash YYYY
Active-Duty: Deposit paid?
Please enter a number greater than or equal to 0.
MM slash DD slash YYYY
MM slash DD slash YYYY
Reserve: Deposit paid?
Please enter a number greater than or equal to 0.
MM slash DD slash YYYY
MM slash DD slash YYYY
Reserve: Deposit paid?
MM slash DD slash YYYY
MM slash DD slash YYYY
Reserve Academy (only if yes + academy)
If the employee Retired from Military service, which type was it? (if yes to military service)
Is the employee collecting VA pay? (only yes to military service)

THRIFT SAVINGS PLAN (TSP)

WHILE WORKING
Does the employee contribute to Traditional TSP?
Does the employee contribute to Roth TSP?
Does the employee have any TSP loan(s)?
If yes, which type of TSP loan?
How much does the employee pay for their loan(s)?
$ /PP
% /PP
 
How much is owed for each loan?
Loan #1
Loan #2
 
What is the estimated pay off dates(s)?
Estimated Payoff Date #1
Estimated Payoff Date #2
 

IN RETIREMENT

When does the employee need access to the TSP?
Is protecting their $$ from market loss important?
Will the TSP be the only source of additional income?
List other accounts and their balances
Fund Choices
Current Balance ($)
Future Allocation (%)
G
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
F
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
C
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
S
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
I
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
L INCOME
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
L 2030
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
L 2035
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
L 2040
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
L 2045
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
L 2050
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
L 2055
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
L 2060
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
L 2065
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
L 2070
Please enter a number greater than or equal to 0.
Please enter a number from 0 to 100.
Total
Total current balance dollar amount
Total future allocation percentage

GOALS

Does the employee feel on track to reach their retirement goals?

Federal Employee Group Life Insurance (FEGLI) MetLife

Does the employee currently have FEGLI coverage?(Required)
Will the employee have coverage 5 years preceding retirement?
Will the employee keep FEGLI in retirement?
Does the employee want to reduce FEGLI by 75%?
What coverage does the employee have?(Required)
Have you ever had a needs analysis completed?

Federal Employee Health Benefits (FEHB) various plans

Does the employee have FEHB coverage?(Required)
Will the employee have FEHB coverage for at least 5 years immediately preceding retirement?
Will the employee keep FEHB in retirement?(Required)
Will any family members be dependent on FEHB in retirement?
If yes, who?

Federal Dental and Vision Insurance Plan (FEDVIP) various plans

Does the employee have Dental coverage?(Required)
Keeping in retirement?
Does the employee have Vision coverage?(Required)
Keeping in retirement?

Federal Long Term Care Insurance Program (FLTCIP) John Hancock

Does the employee have FLTCIP?(Required)
Does the employee plan on keeping their FLTCIP coverage in retirement?
Per day

File Upload

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Max. file size: 50 MB.

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