Please provide the following information:

Name:
Your date of birth:
Spouse's name and date of birth:
Please list any children:	And their date of birth:
Are you currently living in the USA? Yes No            State of Residence?
Current assignment entity?
Will you be moving oversea/returning to the US soon? Going Coming Home No Change When?
When is your next furlough and for how long?
Are you currently claiming the Foreign Earned Income exclusion? Yes No
Does Either spouse work outside of Wycliffe? Yes No
How long have you been with Wycliffe?   In missions?
How is your overall health given your age?
Do you have any pending inheritances? Yes No
Do you anticipate any major expenses over the next five years? Yes No
Do you own a home? Yes No     How much is it worth?   How much do you owe?
Are you paying into Social Security? Yes No
Are you claiming a housing allowance? Yes No If yes, amount
List investments that are not a part of your Wycliffe retirement plan: Investment name Type of Account* Registration Name Dollar Value
Income from Wycliffe?
Income from interest & dividends?
Income from other (or spouse) employment?     Please explain
Indicate the best way to communicate  E-mail address
Phone Number
Other Comments Please upload a copy of your taxes in PDF format on this page: upload . You may also mail a copy to our office.