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Social Security Maximization
Data Intake Form


Client Section: Fill out the following information fields for yourself, the client. The subsequent section will pertain to your spouse's information. Please be sure to complete all fields so we can best serve you.


First Name: *
Last Name: *
Daytime Phone (no dashes): *
Evening Phone (no dashes): *
Date of Birth: *
Gender: Male Female
SS Primary Insurance Amount
(at full retirement age):
*
Already taking SS? Yes No
If you answered "Yes"
to the previous question,
when did you start?
*
Annual Salary: *
Age you would like to retire: *


SPOUSE SECTION:
Fill out the following information
for your spouse.



First Name: *
Last Name: *
Date of Birth: *
Gender: Male Female
SS Primary Insurance Amount
(at full retirement age):
*


Already taking SS? Yes No
If you answered "Yes"
to the previous question,
when did you start?
*
Annual Salary: *
Age you would like to retire: *




 
Which of the following reports
would you like to receive?
Check all that apply.

Social Security Taxation
Working in Retirement
Individual Breakeven Analysis
How to Fill the Income Gap





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