Plan Proposal Request
Please provide the following information and submit.
General Company Information:































Other Information:
Employee Information:
Please provide the following data or submit separately in any other format.

* Family member = Spouse, Children or Parents of Owners **Part-time = less than 1,000 hours per year.

Business Name:
Business Type:
What is your ideal contribution amount for this plan year?
Is there any retirement plan/account in effect?
Business Start Date:
Name of Employee
  Family Member*
Date of Birth
Date of Hire
Annual Salary   
Part-** Time
Percentage of       
Actuarial Consulting Group, Inc.

Do the Owners control or own any other businesses?
Is the Business affiliated with any other businesses?
Is the Business a subsidiary of any other business?

10 Pointe Drive, Suite 155, Brea, CA 92821
Tel: (626) 581-8210 Fax: (626) 581-8310 Email:

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