Retirement Road Map

Collection Date:

Simple Entry Client A Male Married First Name Last Name Female Date of Birth Client B Male First Name Last Name Female Date of Birth

1. When do you plan to retire?

Already retired

Plan to retire at age

2. How much monthly retirement income do you need?

Estimate based on current monthly earnings of $

Specify monthly income needs of $

3. What is the current value of your retirement plans (401(k), IRA)?

Current Value of Retirement Plans

Client A $ Client B $

4. What is the current value of other assets you have specifically set aside for your retirement?

$

5. Would you like to illustrate Social Security retirement benefits?

Do not illustrate benefits

Estimate

Enter benefits

Yours $ per month Your spouse’s $ per month

6. Do you know of any other retirement income? Other Retirement Income

Yours $ per month Your spouse’s $ per month