Retirement Plan
Proposal Request
Exact legal company name or individual's name:
*
Address 1:
*
Address 2:
City:
*
State:
*
Zip:
*
Contact person:
*
Title:
*
E-Mail:
*
Phone:
*
Fax:
*
Plan Trustee:
Plan Trustee:
Type of plan desired:
401(k)
Profit Sharing
Defined Benefit
412(e)(3)
Other:
Type of business:
LLC
Sole Proprietor
Partnership
C-Corp.
S-Corp.
If an LLC, how is the LLC taxed?
Corporation
Partnership
Business Inception Date:
*
Fiscal Year End:
*
Multiple Locations:
No
Yes
(If yes, attach additional information sheet)
Income reported for the Owner:
Net Schedule C
W-2
Partnership Profits
Sub S pass through
Do you own other businesses and/or does your spouse or any other family members?
Yes
No
(if yes complete a separate Client Data Sheet for each company)
Do you now or have you in the past had a Qualified plan?
Yes
No
401(k)
Profit Sharing
Money Purchase
Defined Benefit
Where are the assets held:
Exisiting Plan Year End:
If you have a qualified plan we must have copies of the following immediately:
The Adoption Agreement & Plan Document
Most recent Valuation
Most recent 5500 form filed
Do you have a
SEP IRA
or a
Simple IRA
- if so what was the last year funded:
What are the main objectives in opening the plan?
*
How much is the employer anticipating contributing annually?
*
Submitted by:
Broker/Agent name:
*
Date needed:
*
Address 1:
*
Address 2:
City:
*
State:
*
Zip:
*
Phone:
*
E-mail address:
*
Wholesaler/Referral source:
All information contained herein is for the sole purpose of preparing a qualified plan proposal.
No information will be shared and will remain strictly confidential between the parties named.
* denotes required fields
Arlene Williams
Phone: 818.593.3535
The Senex Group
Fax: 818.593.3550
Woodland Hills Financial Center
arlene@senexgroup.com
21021 Ventura Boulevard, Suite 310
Woodland Hills, CA 91364