New Client Data Sheet
Client Information Per Household
Name
*
First Name
Last Name
Marital Status
*
Please Select
Married
Single
Divorced
Separated
Domestic Partner
Widowed
Spouse's Name
First Name
Last Name
Physical Address (NO PO Box)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different from Physical, i.e. PO Box)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Spouse's Phone Number
Please enter a valid phone number.
Email
*
example@example.com
Spouse's Email
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Spouse's Date of Birth
-
Month
-
Day
Year
Date
Social Security Number
*
Are you a U.S. Citizen?
*
Yes
No
If you are not a U.S. Citizen, what is your nation of birth?
Driver's License Number
*
Issuing State
*
Issued Date
*
-
Month
-
Day
Year
Date
Expiration Date
*
-
Month
-
Day
Year
Date
Spouse's Driver's License Number
Spouse's Issuing State
Issued Date
*
-
Month
-
Day
Year
Date
Spouse's Expiration Date
-
Month
-
Day
Year
Date
Date of Marriage
-
Month
-
Day
Year
Date
Retired?
*
Please Select
Yes
No
Spouse Retired?
Please Select
Yes
No
Occupation (If Not Retired)
Spouse Occupation (If Not Retired)
Employer's Name (If Changed Within Last 2 Years)
Spouse Employer's Name (If Changed Within Last 2 Years)
Employer's Address
Street Address
City/State/Zip Code
City
State / Province
Employer's Phone Number
Spouse Employer's Address
Street Address
City/State/Zip Code
City
State / Province
Employer's Phone Number
Primary Bank Name
*
Trust Name (If You Currently Have a Trust in Place)
Date of Trust
Beneficiary Name (If Changed In Last 2 Years)
*
First Name
Last Name
Beneficiary Name (If Changed In Last 2 Years)
First Name
Last Name
Trusted Contact Name (Contact Only No Account Info Shared)
*
First Name
Last Name
Trusted Contact Phone Number
*
Please enter a valid phone number.
Trusted Contact Relationship
*
Trusted Contact Email
*
example@example.com
Trusted Contact Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Suitability - Finances & Tax Status
Estimated Annual Income
*
Estimated Net Worth (Excluding Primary Residence)
*
Total Estimated Liquid Net Worth (Excluding Primary Residence)
*
Assets Held Away
*
Annual Expenses (Est)
*
Special Expenses (Est)
*
Special Expenses Time Frame
*
Less than 1 Year
1-2 Years
2-5 Years
5+ Years
Federal Tax Bracket
*
Please Select
15% and Below
15.1% - 20%
21% - 25%
26% - 30%
31% - 35%
Over 36%
Investment Purpose(s) - Select All That Apply
*
Save for Education
Generate Income
Preserve Wealth
Retirement Purposes
Accumulate Wealth
Market Speculation
Save for Short-Term Goals
Investment Objective
*
Please Select
Current Income
Growth & Income
Growth
Investment Time Horizon
*
Please Select
0 - 2 Years
2 - 5 Years
5 - 10 Years
Over 10 Years
Investment Knowledge
*
Please Select
None
Limited
Good
Excellent
Liquidity Needs
*
Please Select
Very Important
Somewhat Important
Not Important
Does Not Matter
What is your priority as it relates to liquidity and guarantees?
*
Please Select
Willing to give up guarantees for liquidity
Prefer liquidity over guarantees
Desire a balance between guarantees & liquidity
Prefer guarantees over liquidity
Willing to give up liquidity for guarantees
What is your attitude about the level of advice that you would like and feel you need?
*
Please Select
Would like to make your own decisions
Will make your own decisions, but you would like suggestions
Would like help managing your own assets
Would like someone to manage your assets, but you wish to implement your ideas
Would like someone to manage your assets for you
What is your general attitude and sensitivity toward fees?
*
Please Select
Favor lower fees over features
Lean toward lower fees
Have no strong opinion regarding fees
Lean toward features over fees
Favor features over fees
What is your situation regarding insurance coverage?
*
Please Select
Have a need for products with death benefits
Do not need products with death benefits
Outside of AWA Investments
*
Current Balance
Mutual Funds
Stocks
Bonds
Limited Partnerships
Variable Annuities
Options
Alternative Investments
Employer Plans
Managed Accounts
Cash/Checking/Savings
Submit
Should be Empty: