Please refer
to the Final Approach Form Instructions for the specific numbers required for this form.
1.
* NAME:
SPOUSE:
* ADDRESS:
* CITY:* ST:* ZIP:
* PHONE:* BIRTHDATE:
CELL:
SPOUSE BIRTHDATE:
FAX:
EMPLOYEE NO:
BASE:
* EMAIL ADDRESS:
2. Gross
Airline Earnings History: (include
401K contributions & profit sharing)
PREVIOUS YEAR'S
EARNINGS:
2010
3. *
2ND PREV YEAR'S
EARNINGS:
2009
per month you expect
3RD PREV YEAR'S
EARNINGS:
2008
to fly:
4TH PREV YEAR'S
EARNINGS:
2007
Actual and/or projected
5TH PREV YEAR'S
EARNINGS:
2006
Equipment/Division/Seat
6TH PREV YEAR'S
EARNINGS:
2005
5.
* 2011
4.
OPTIONAL: For an estimate of your PC-3
(PBGC) benefit also include:6.
* 2012
YEARS:
2004
2003
2013
EARNINGS:
2014
2015
From
this year's Retirement Benefit Statement (posted on Jetnet
2016
in March) and your Super Saver
Statement:
2017
2018
7.
AIRCAL YEARLY FIXED ANNUITY (if appl):2019
8.
* FINAL AVERAGE SALARY: (page
1)2020
8.
* YEARS OF AA CREDITED SERVICE: (page 1)2021
AIRCAL plus AA YRS SERVICE: (if appl)
2022
8.
* COMPANY UNITS: (page 1, right column)2023
8.
OPTIONAL UNITS: (page 1, right column)2024
8.
* TOTAL UNITS: (page 1, right column)2025
8.
* BASIC ACCUMULATION: (page 1, right column)
8.
OPTNL CONTRIBUTIONS ($ AMOUNT): (p1,rt col)
12. Number of Vacation
9.
401K ACCOUNT BALANCE: (end of last year) defer to after retirement:
10. B FUND OPTIONAL CONTRIBUTION RATE:
11.
401K SUPER SAVER CONTRIBUTION RATE:
11.
401K ANNUAL CATCH-UP AMOUNT OR "MAX":
Withdrawal
Longevity Analysis Scenario Information (if uncertain, enter best estimates):
13.
Other "qualified" funds (IRA's, pensions,etc.) available for
retirement (est. value at age 60):
14. Planned gross monthly withdrawal (including taxes) from all of your
"qualified" funds:
15. Alternate gross monthly withdrawal (including taxes) from all of your
"qualified" funds:
16. Planned date after retirement of first monthly withdrawal from your
"qualified" funds:
17. Other "non-qualified" (taxable) funds available for retirement
(estimated value at age 60):
Planned gross monthly withdrawal including taxes) from all of your "non-qualified" funds:
Alternate gross monthly withdrawal (including taxes) from all your "non-qualified" funds:
Planned date after retirement of first
monthly withdrawal from your "non-qualified" funds:
18.
Option planned for your A Fund (Lump Sum, Life-Only, Survivor Annuity, Period
Certain):
If
Surv, 50%, 75%, or 100%:
If
Period Certain,10, 15, or 20 years.:
19. If you will be or are receiving a Military Retirement, estimated monthly
annuity at age 60:
If you elected a Supplemental Survivor
Benefit, enter percentage of survivor benefit:
20. Age to
begin drawing Social Security benefits:Retiree:
Spouse:
21.
Estimated marginal tax rate in retirement:Federal:
State:
Comments or Additional
Information:
Representative:
