Pension Evaluation Form

• To purchase this Basic Pension Evaluation from an experienced Pension Appraiser, please enter your information on the form below.

• REQUESTING ATTORNEY / PARTY INFORMATION

  If you are a Party in this action and requesting the report yourself please complete this section with your information.

• Order Request Date:
• Name:
  
  First*
  
  Last*
• Firm Name:
• Address:
  Street Address
  Address Line 2
  City
  Select AL AK AZ AR CA CO CT DE FL GA GU HI ID IL IN IT IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA DC WV WI WY State
  Postal / Zip Code
• Email: *
• Phone Number: *

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• Fax Number:

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• Party you Represent:

  Husband

  Wife

  Both

  If you Represent Both Parties Select one:

  Joint Retainer

  Court Appointment

  Mediator

  Collaborator

• CASE DATA

• Pensioner's Name: *
  
  
• Plan Name: *
  
  
• Gender:

  Male

  Female

• Date of Birth:
• Date of Marriage:
• End of Marriage / Cutoff Date:
  (Jurisdictional End of Marriage Date), (Date of Last Acquisition of marital benefit. If there is none filed use Current Date. [State Specific Statutes apply]).
• Date of Plan Entry: (Federal/Civil is SCD Date. Military is Enlistment Date)
• Breaks in Service Dates - Total Time:
• or Start Date:
• Return Date:
  
• Normal Retirement Age:

• EVALUATION DATA

• Present Value (typically the Standard). Choose State of Action/Divorce Select AL AK AZ AR CA CO CT DE FL GA GU HI ID IL IN IT IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA DC WV WI WY
  Valuation Date (if other than the standard of present day value, specify date)
• Pensioner Active. Accrued Benefit $ Normal Retirement Age
  Pensioner Terminated. Deferred Benefit $ Normal Retirement Age
  Pensioner Retired. Monthly Benefit $ Benefit Commencement Date:
  Pensioner Disabled $ Date of Disablement
  *If you are unable to provide the Accrued Monthly Benefit, requested above, our firm at no additional cost shall decipher the Plan's Retirement Benefit Statement, (if available), provided that we are supplied the Specific Plan details relevant to this Pensioner. You may scan/copy & paste your benefit statement for interpretation email to us
  If RAILROAD provide the Pensioner's Tier II Monthly Benefit or Submit T-25 Form $
• **Complete ONLY ONE of the following sections, as applicable to the Pensioner’s Type of Employment.**
• PUBLIC / CITY / STATE / GOVERNMENT
• ANNUAL PENSIONABLE SALARY:
  *Required for Federal, State and Municipal plans unless pensioner is in pay status.
• SUPPLY THE ANNUAL PENSIONABLE SALARY FOR THE TWO YEARS PRIOR PLUS FOR THE YEAR OF YOUR JURISDICTIONAL CUTOFF DATE. As per your Plan’s Benefit Formula (i.e. 1 Year, 3 Years (Standard), or 5 Years). Note if your Plan's formula requires a Five-Year Average (i.e. Florida retirement system), supply applicable Five-Year Pensionable Salaries.”
• Year 1 $
• Year 2 $
• Year 3 $
• Year 4 $
• Year 5 $
• MILITARY REGULAR / RESERVIST
• *Complete this Section Only for Military, Reserve and Regular Component Service Members
• Regular: Supply Rank: Base Pay: Dollars
  Submit Statement (If Available)

  *Complete this Section Only for Military, Reserve and Regular Component Service Members: Regular

• Total Service:
• Reservist: Supply Rank: Base Pay: Dollars
  Submit Statement (If Available)
• Total Points:
• UNION MEMBERS
• *Complete this Section Only for Union Members: Please note the Pension Fund is the Pension Plan with a Monthly Annuity and the Annuity Fund is a Cash Account. To value the Pension Fund simply provide the Monthly Accrued Benefit as of the End of Marriage Date. Simply attach the Benefit Statement indicating such Monthly Accrued Benefit or fill-in same.
• Monthly Accrued Benefit as of Cutoff Date: $
  Normal Retirement Age:
  If the Annuity Fund Requires Evaluation, Simply Provide the Statement Indicating the Cash Balance for the Quarter Closest to the End of Marriage Date, and the date of plan entry (only if different from the pension fund/plan)
• COMPANY / CORPORATE / PRIVATE / CLOSELY HELD CORPORATIONS
• Supply the Benefit Statement indicating an ACCRUED MONTHLY BENEFIT, for the year or date subject to this evaluation. You may scan/copy & paste your benefit statement for interpretation email to us (Generally supplied to employee, annually or quarterly)
• Year:

  Supply the Average Pensionable Salaries Required as per your Plan's Benefit Formula. (ie 1 Year, 3 Years (Standard) or 5 Years.)

• PENSION EVALUATION SERVICES/FEES

• (Check appropriate box(s) based on the services required and remit payment accordingly) ACCUCALC® Pension Evaluation $200.00
  (1 Defined Benefit Annuity or Cash Balance Pension Plan) Add QUICKCALC® Rush Service $100.00
  (For one plan. Call for multiple plans or reports are extra call for rates)
  (24-hour business day turn-around via fax or e-mail) Each Additional Plan$75.00
  (On same Pensioner spouse requires completion of a 2nd form)

  Call for Additional Services or Executives with a Full Deferred Pay Program or Authorization Forms for Independent Discovery Services

• (Check appropriate box(s) based on the services required and remit payment accordingly) Each Additional Report $50.00
  (Supply Alternate Valuation Date on Same Plan)
  Additional Date:
  Add Social Security Offset Report $95.00
  (On Same Pensioner for States with this Methodology)
  (Requires salary on pensioner if not already submitted)
  Year: Annual Salary: Present Value Prior Report $75.00

  ACCUCALC® PenEval Report Immediate Offset Settlements New ACCUQDRO™ services also available Deferred Distribution Settlements

• (Check appropriate box(s) based on the services required and remit payment accordingly) Each Additional Calculation $50.00
  (Supply Alternate Retirement Age on Same Plan)
  Additional Retirement Age:
  Add Social Security Offset Report $95.00
  (On Spouse who contributes to social security for States with this Methodology)
  Supply Spouse's Date of Birth:
  & indicate salaries or supply social security statement
  
  Update Prior Report New Data $75.00
  (i.e. salary, date of plan entry, etc.)

  COURT TESTIMONY: We will provide expert testimony regarding our Pension Evaluations. We provide expert testimony telephonically or in person at the courthouse. Request our Expert Testimony pack

• PENSION EVALUATION EASYPAY

  For further details contact Pension Evaluators® at Troyan, Inc.
  

  Total: $
  
  Payment Method:

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  Select AL AK AZ AR CA CO CT DE FL GA GU HI ID IL IN IT IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA DC WV WI WY *State

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