• SGLI / VGLI / FEGLI Update
• CSRS / FERS / TSP Update
• Survivors Benefit Plan Information
• Military / Civil Service Benefits Briefing
• Tax-Deferred Annuity
• Family Life Insurance Plans
• Individual Life Insurance Plans
• Child's Life Insurance Plan

Name:..............

Soc. Sec No.:.... Smoke: No Yes Sex: M F

Local Address:

City: State: ZIP:

E-Mail Address.....................................................

Agency:

Military Address: Rank:

Military City: State: ZIP:

Work Phone:... Ext.:. Home Phone:..

Room No. Sect.. Bldg. No. Date of Discharged:

Date of Birth: Single: Married:

Children............................................ Age Age Age Age Age

Spouse's Name........ | Sex F M Smoke No Yes

Spouse Birth Date......................................................................

Base Salary. Do not include overtime, bonuses, etc................$

Salary Mode:............................................................................. Bi Weekly Monthly Annual

Date of Hire:...............................................................................

Planned Retirement Age................................................................................

FEGLI Basic Enter.............................................................................. Yes Yes

FEGLI Basic Insurance will reduce by this percent after retirement 0% 50% 75%

Special Coverage.............................................................. Postal Law Enforcement Firefighter Air Traffic Control

Prev Mil Years.................................................................................................

Salary Increase Rate............ (Percent 0-15%)..............................................

Pension Increase Rate.......... (Percent 0-15%), (COLA)..............................

FERS Changeover Date
(Before 1984, Changeover Date from CSRS to FERS: Month [01-12]..

Present Monthly Social Security earnings
OTHER THAN civil service pay.................................................... $

FEGLI Option A. $10,000 Extra Benefit.............................................. Yes No

FEGLI Option B. Enter (0-5) Times Annual Salary......................................

FEGLI Option C. Spouse $5,000 / Children $2,500 Coverage........... Yes No

TSP Current Balance..................................................................$

TSP Percent (0-10%) of pay presently being contributed.............................

TSP Growth Rate (Percent 3-15%) Indicate the assumed annual growth
on TSP contributions.......................................................................................

Settlement Option TSP Payout:....................................... Life 10yr Certian/Life Lump Sum Joint 100% Joint 50%

RIF. Are you part of a Reduction In Force......................................... Yes No