Sheffler Consulting Actuaries, Inc.


Proposal Form

Please fill out the following and click "Submit"

Business Name:
Email:
Address:
Phone number: Fax number:
Business Form: Corp S Corp Partner LLC LLP Sole Proprietor
Date business started: Fiscal year ends: Number of Employees:
Was there a predecessor entity Yes No
If yes, when did it start?
Nature of income pattern: (i.e. steady, seasonal, varies, etc.)

Name of Principals Ownership % Position if employed in business
%
%
%

Related Business

Do the principals own or control other businesses? Yes No
Is this business affiliated with any other businesses? Yes No
Is this business a subsidiary of any other business? Yes No
For any "yes" answers, please provide information, including business relationship and ownership percentages.

Plan Design Considerations

Has this business ever had a qualified plan? If yes, please provide details.
Yes No

What is the motivation for this plan? Please number preference 1 to 4, with 1 being primary motivation.
  Retirement savings for principals
  Employee benefit
  Remain competitive with similar employers
  Other:

Employee Information

Please complete the employee census request. If you have this information in another format, you do not need to complete this form. We simply need the data. For a Defined Benefit Plan illustration, please complete the SALARY HISTORY request.

*See note below

Name
(Indicate if Family Member*)		 Date of
Birth		 Date of
Hire		 Annual Salary Part
Time**		 % owner Officer
%
%
%
%
%
%
Note:   *>Family Member means Spouse, Children or Parents of Owners
         **>Part time means less than 1,000 hours per year

Salary History

For a Defined Benefit Pension Plan illustration, complete the following for principals for the prior three years.

Name Year Salary or Schedule C income

Principal

Principal

Principal

Principal

Principal

Principal

 

 

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