US Expat Client Intake Form (new account opening)

Client Intake Form (Expats)

Opening a new account
Name *

Prefix First Name Middle Name Last Name Suffix
Home Address (in the USA if you have one)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Mailing Address USA (if different from home address)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Overseas Address (including Country)
US Phone Number (if you have one)

Area Code Phone Number
Overseas phone number (including country code)
Email
example@example.com
Birthdate

Month Day Year
Date
Social Security Number
Marital Status
Number of Dependents
Country of Citizenship
Drivers License Number (USA)
Drivers License State (USA)
Drivers License Issue Date

Month Day Year
Date
Drivers License Expiration Date

Month Day Year
Date
If you don't have a non-expired US drivers license any longer, you can use your current passport information for identification as well.
Passport (Nationality)
Passport Number
Passport Issue Date

Month Day Year
Date
Passport Expiration Date

Month Day Year
Date
Attach a picture or scan of your driver's license or passport bio page.

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If you are on your phone or tablet, you can take a photo of your Driver's License or Passport here!
How would you rate your Risk Tolerance for Investing?

Conservative - Protecting my principal is more important than growth. Conservative / Moderate - Low Risk with a little growth. Moderate - Balance of protection and growth. Moderate / Aggressive - More Risk than protection designed for growth. Aggressive - All growth for max returns with possibility of large fluctuation in value.
Years of experience investing in Mutual Funds?
Years of experience investing in Stocks / ETF's?
Years of experience investing in Bonds?
Years of experience investing in Annuities?
Years of experience investing in Options / Futures / Margin / Hedge Funds?
Employment Status
Are you or anyone in your immediate family employed by the securities industry?
Are you or any one of your immediate family members an officer, director or 10% (or more) shareholder in a publicly traded company?
Employer Name
Occupation
Employer Address
Annual Income (Just you)
Household Income
Household Net Worth (Guesstimate is OK)
Beneficiary 1 (Primary)

First Name Last Name
Beneficiary 1 Relationship to You?
Beneficiary 1 Address (if different than yours)
Beneficiary 1 phone number
Beneficiary 1 Social Security
Beneficiary 1 Birthdate

Month Day Year
Date
Beneficiary 1 Email
example@example.com
Beneficiary 2

First Name Last Name
Beneficiary 2 Relationship to You?
Is this a Primary or Continent Beneficiary?

Primary Contingent
Beneficiary 2 Address (if different than yours)
Beneficiary 2 Phone number
Beneficiary 2 Social Security
Beneficiary 2 Birthdate

Month Day Year
Date
Beneficiary 2 Email
example@example.com
Beneficiary 3 Info (if you have a third beneficiary or contingent beneficiary info)
Beneficiary 4 Info (or contingent beneficiary info)
Are you interested in learning more or purchasing...

Life Insurance Disability Insurance Long Term Care Insurance Portfolio Insurance Lifetime Income Insurance
Would you like to sign up for e-delivery of statements?
Questions or Comments?
If you want to link your accounts to your checking account or do a monthly bank draft for your investments, please attach a picture of a voided check for the account you would like to link. This is a free service.

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If you are on your phone or tablet, you can take a photo here of the voided check!
Attach your most recent statement(s), including bank, 401(k), life insurances, mortgage & other investments. (If we are transferring an account or working on a financial plan).

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Want to Chat? Schedule a call now...

Appointment Times
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Client Intake Form (Expats)