EFS Advisors - Secure Data Form

The Stillwater Group:

Jim Johnson, Jay Higgins CFP®, and Charles Mylrea CRES®

This confidential, personal data allows us to organize and effectively setup your 403b. Please complete the following information:

District or Employer *

First Name *

Last Name *

Phone Number *

Email Address *

Street Address

Address Line 2

City

State

Zip Code

Drivers License Number

Drivers License State

Drivers License Expiration Date +

Date of Birth +

Social Security Number

Marital Status

Approximate Annual Salary

Beneficiary Name

Relationship

Beneficiary Date of Birth +

Do you have other investment or retirement accounts (403b, 457, 401k, IRA, Roth, IRA, etc.) that you would like to discuss?

Yes

Completing this form will allow us to quickly help you set up your 403b electronically so that you do not have to spend any more of your precious time on your investment accounts during this hectic time of year. You will be receiving an email from us with your completed 403b documents requiring an electronic signature to complete this process.

We will be following up with you later in the fall to have a personal one on one sit down to discuss this account and any other financial questions you might have. Personal financial planning is our main goal and will always be the focal point of our practice. Our hope with this process is to be respectful of your time during this exciting time of year.

Please understand that all of your information is strictly confidential. All of the information we request is necessary per SEC and FINRA regulation and is solely used to help expedite the setup of your 403b.