Civilian Job Survivor Benefit Program Income: Civil Service Retirement Pay - Trusts Other Total Sources of Retirement Pay Military Retirement Item Veteran Spouse, if applicable Receiving Military Retirement Pay □Yes □No (Check one) □Yes □No (Check one) Participating in Survivor Benefit Plan (SBP) or Retired Serviceman’s Family Protection Program (RSFTP)? □Yes □No (Check one) □Yes □No one) If yes to SBP or RSFTP participation, amount of monthly retirement pay prior to veteran’s death? ($/month) $_________ month $_________ month Anticipated amount of SBP or RSFTP pay after death of the veteran? ($/Month) $_________ month $_________ month If not participating in SBP or RSFTP, current military retirement pay ($/Month) $_________ month $_________ Retirement pay now being sent to: home address or bank/credit union address
Social Security Administration Payments Item Veteran Spouse, if applicable Is the veteran or spouse eligible to receive Social Security benefits? □Yes □No (Check one) □Yes □No one) Is the veteran or spouse receiving Social Security benefits? □Yes □No one) □Yes □No (Check one) If yes, how much is being received each month? ($/month)? $_________ $_________ month Should the survivor switch to spouse’s higher amount? □Yes □No (Check one) □Yes □No (Check one) Retirement Benefits for Other Government Organizations or local government organizations or agencies Item Veteran Spouse, if applicable Is the veteran or spouse receiving retirement pay or benefits from any such organizations? □Yes □No (Check one) □Yes □No (Check one) If yes, how much is being received each month? ($/month)? $_________ month $_________ month Is the Survivor eligible for survivor benefits from these organizations? □Yes □No (Check one) □Yes □No one)
What are the Survivor benefits? Survivor compensation, insurance benefits, etc.? Retirement Pay and other Benefits Non-Government Organizations or companies; i.e. Private Companies, Non-profits, etc. Item Veteran Spouse, if applicable Has the veteran or spouse work for and become eligible to receive retirement pay or survivor benefits from this type organization? □Yes □No (Check one) □Yes □No one) Is the veteran or spouse eligible to receive retirement pay and/or benefits from this type organizations? □Yes □No (Check one) □Yes □No (Check one) If yes, name of the organization and if yes, plan or company name □Yes □No (Check one) □Yes □No (Check one) Name of the organization, contact information for the organization or the benefit’s coordinator. Type of benefits received (retirement pay and the amount), survivor benefits, health insurance, etc.? and location of employment Current retirement pay ($/month) $_________ month $_________ month Is there a Survivor Benefit package for the surviving spouse? If yes, how much per month? □Yes □No (Check one) □Yes □No (Check one)
Lender: Contact Information Other Loan details:: Amount, starting date, monthly payments, end date Personal Loan debt? □Spouse □ Joint □Countersign □Spouse □ Joint □Countersign If what type? Lender: Contact Information Other Loan details:: Amount, starting date, monthly payments, end date Life Insurance – Item Veteran Spouse, if applicable A. Service members Life Insurance (SGLI) Policy □Yes □No (Check one) □Yes □No one) If Yes to SLGI, value of the policy Policy Number Policy Beneficiary Contact Number B. Veteran’s Group Life Insurance (VGLI) Policy □Yes □No (Check one) □Yes □No (Check one) If Yes to VGLI, value of the policy Policy Number
Item Veteran Spouse, if applicable Do you have Burial Insurance? □Yes □No one) □Yes □No (Check one) IF Yes, Contact Information and Policy Details If Yes, Location of policies ADVISORS Item Veteran Spouse, if applicable My Lawyer (name ) _________________________ Number: _________________________ Email Address _________________________ Address _____________________ _____________________ _____________________ _____________________ _____________________ _____________________ My Trusted Friend’s Name (relationship) _________________________ Phone Number: _________________________ Email Address _________________________ Address _____________________ _____________________ _____________________ _____________________ _____________________ _____________________