Online Pension Evaluation Form

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

REQUESTING ATTORNEY INFORMATION
If you are a Party in this action and requesting the report yourself please complete this section with your information.
Order Request Date: / MM / DD YYYY
Name: First Last
Firm Name:
Address:
Street Address

Address Line 2

City

State
Postal / Zip Code
Email:
Phone Number: * - (###) - ### ####
Fax Number: - (###) - ### ####
Party you Represent: Husband Wife Both
CASE DATA
Pensioner's Name:
Plan Name:
Gender: Male Female
Date of Birth: / MM / DD YYYY
Date of Marriage: / MM / DD YYYY
End of Marriage / Cutoff Date: / MM / DD YYYY
Date of Plan Entry: / MM / DD YYYY
Breaks in Service Dates - Total Time:
or Start Date: / MM / DD YYYY
Return Date:
/ MM / DD YYYY
Normal Retirement Age:
EVALUATION DATA
CORPORATE/UNION

Pensioner Active. Accrued Benefit $ Normal Retirement Age Pensioner Terminated. Deferred Benefit $ Normal Retirement Age Pensioner Disabled $ Date of Disablement If RAILROAD provide the Pensioner's Tier II Monthly Benefit or
Submit T-25 Form $

This firm at no additional cost shall decipher the plan's retirement benefit statement. (If available) You may scan/copy & paste in your email to us such benefit statement for interpretation.

Required annual pensionable salary
*Required for federal, state, and municipal plans unless pensioner is in pay status. If pensioner is in pay status, check and complete pensioner retired section just below.

Kindly supply the annual pensionable salary for the two years prior plus for the year of your jurisdictional cutoff date.

Kindly note if your plan's formula requires a five-year average, (i.e. Florida retirement system) kindly supply applicable five-year pensionable salaries.
Year:

Supply the Average Pensionable Salaries Required as per your Plan's Benefit Formula. (ie 1 Year, 3 Years (Standard) or 5 Years.)
STATE / GOVERNMENT
Annual Salary: Year 1 $
Year 2 $
Year 3 $
Year 4 $
Year 5 $
MILITARY REGULAR / RESERVIST
Regular: Supply Rank:

*Complete this Section Only for Military, Reserve and Regular Component Service Members: Regular
Base Pay: $ Dollars
Total Service:
Reservist: Supply Rank:
Base Pay: $ Dollars
Total Points:
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 $75.00
(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 Report $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.
EasyCharge® MasterCard American Express Visa Discover Card
Charge Credit/Debit Card in the Amount of: $ . Dollars Cents
Credit Card Number:
Expiration Date: / MM YYYY
Name as it appears on Credit Card:
Billing Address:
Street Address

Address Line 2

City

State
Postal / Zip Code

Online Pension Evaluation Form

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

CASE DATA

EVALUATION DATA
CORPORATE/UNION

PENSION EVALUATION SERVICES/FEES

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

Online Pension Evaluation Form

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

CASE DATA

EVALUATION DATA CORPORATE/UNION

PENSION EVALUATION SERVICES/FEES

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

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

EVALUATION DATA
CORPORATE/UNION

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