General Information
First Name
Last Name
Nickname or Preferred Name
SSN
 -
Month
 -
Day
Year
Date of Birth
Place of Birth (City and State)
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Email
example@example.com
Cell Phone
Format: (000) 000-0000.
Legal Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Prior Address (if at current address less than 3 years)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address
Same as legal address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Occupation
Name of Business
Do you have a spouse?
Yes
No
First Name
Last Name
SSN
 -
Month
 -
Day
Year
Date of Birth
Place of birth
Email (example@example.com)
Cellphone
Format: (000) 000-0000.
Legal Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Name of Business
 -
Month
 -
Day
Year
Date of Marriage
Location of Marriage
Do you have a dependent?
Yes
No
*
Dependent address
Same
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Estimated Net Worth
Under $5M
$5M-$10M
$10M-$24M
$25M-$49M
$50M-$99M
$100M+
Current Tax Accountant and Firm
Would you like us to recommend a tax accountant within our network?
Yes
No
Current Estate Attorney and Firm
Would you like us to recommend an attorney within our network?
Yes
No
Notes
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Which service(s) would you like us to provide?
*
Investing
Life Insurance Review
Personal Lines Insurance Review
Tax Review
Estate/Legal Review
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What type of account(s) are you interested in opening?
Single
Joint
Trust
LLC/Partnership
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Trust Information
Trust Name
Tax ID
 -
Month
 -
Day
Year
Date of Trust
Trustee Information
First Name
Last Name
SSN
 -
Month
 -
Day
Year
Date of Birth
Email (example@example.com)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer
Occupation
Grantor/Settlor Information
First Name
Last Name
 -
Month
 -
Day
Year
Date of Birth
 -
Month
 -
Day
Year
Date of Death (if applicable)
SSN
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
Format: (000) 000-0000.
Upload All Trust Documents
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Would you like to add another trust?
Yes
No
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Trust Information
Trust Name
Tax ID
 -
Month
 -
Day
Year
Date of Trust
Trustee Information
Name
First Name
Last Name
SSN
 -
Month
 -
Day
Year
Date of Birth
Email (example@example.com)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer
Occupation
Grantor/Settlor Information
First Name
Last Name
 -
Month
 -
Day
Year
Date of Birth
 -
Month
 -
Day
Year
Date of Death (if applicable)
SSN
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
Format: (000) 000-0000.
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Yes
No
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Trust Information
Trust Name
Tax ID
 -
Month
 -
Day
Year
Date of Trust
Trustee Information
First Name
Last Name
SSN
 -
Month
 -
Day
Year
Date of Birth
Email (example@example.com)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employer
Occupation
Grantor/Settlor Information
First Name
Last Name
 -
Month
 -
Day
Year
Date of Birth
 -
Month
 -
Day
Year
Date of Death (if applicable)
SSN
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
Format: (000) 000-0000.
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Articles of Incorporation
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Operating/Partnership Agreement
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Estate Planning
Beneficiaries (Including desired charitable gifts)
Name
First Name
Last Name
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to you (if any)
Charitable gift amount
Please upload a personal balance sheet if available. We can assist in creating one if needed.
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Would you like to add another beneficiary?
Yes
No
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Estate Planning
Beneficiaries (Including desired charitable gifts)
Name
First Name
Last Name
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to you (if any)
Charitable gift amount
Please upload a personal balance sheet if available. We can assist in creating one if needed.
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Would you like to add another beneficiary?
Yes
No
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Estate Planning
Beneficiaries (Including desired charitable gifts)
Name
First Name
Last Name
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Relationship to you (if any)
Charitable gift amount
Please upload a personal balance sheet if available. We can assist in creating one if needed.
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Would you like to add another beneficiary?
Yes
No
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Do you have any prior marriages?
Yes
No
Describe any continuing obligations under the divorce decree.
Supply copy (if available)
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Community Property? (Generally all property acquired by a husband and wife during their marriage from earnings of either spouse, while domiciled in a community property state, as well as property located in a community property state and acquired during marriage, is owned equally by them and is called community property.)
Yes
No
I'm not sure.
If you or your spouse have resided, during marriage, in any community property law state(s) such as Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington, or Wisconsin, specify the name of the state(s) and dates of residence.
If your employment, vacation or other demands require that you spend more than a nominal amount of time in another state or country you may be deemed a domiciliary of that jurisdiction for estate tax purposes. If you feel that the question may apply to you, select yes and set forth immediately below the name of the state or country, dates you were or will be present in such jurisdiction, where you vote, register your automobile and property owned in such jurisdiction.
Yes
No
I'm not sure.
Date you were or will be present in such jurisdiction
Where you vote, register your automobile and property owned in such jurisdiction
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Have you or your spouse made any gifts exceeding the annual gift tax exemption (currently $15,000) per year to any person or created any trusts?
Yes
No
I'm not sure.
Supply copies of gift tax returns and trusts, if available.
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Do you or your spouse have a power of appointment or other interests under a Will or Trust of another person?
Yes
No
I'm not sure.
Supply copy of document, if available
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If you or your spouse have any prospective inheritances, give source and estimated amount.
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If you or your spouse are or were employed, give details of any pension plans or other employee benefits to which you are or may be entitled.
If you or your spouse are self-employed or a member of a partnership, give details of any contracts or commitments to sell such interest at death or retirement, as well as any retirement plans or other benefits that will be payable by reason of your death.
If you or your spouse own stock in a closely-held corporation, give details of any stock redemption agreements, stock options, salary continuation, or other deferred compensation plans that may be applicable to you.
Indicate the person(s) or institution you wish to appoint (if applicable) as your:
Estate Executor
Trustee
Guardian of Minors
Are you and your spouse both citizens of the United States?
Yes
No
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Personal Lines Insurance
Do you or any household members participate in a non-profit organization as a board member or director?
Yes
No
Do you have anyone helping you maintain your lifestyle?
Yes
No
Do you travel outside of the country?
Yes
No
Do you own an aircraft?
Yes
No
Do you have any animals?
Yes
No
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Do you see your public profile changing in the next year?
Yes
No
Do you own any property in a name other than your personal name?
Yes
No
Do you plan to complete any remodeling in the next 12 months?
Yes
No
Do you host parties or other gatherings at your home?
Yes
No
Do you rent your home(s) or other structure(s) to others?
Yes
No
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Do you regularly drive vehicles not owned by you?
Yes
No
Do you own any recreational vehicles?
Yes
No
Do you or any members of the household participate in vehicle ride sharing?
Yes
No
Do you own any watercraft?
Yes
No
Do you have any type of collection?
Yes
No
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Anything you really like about your current insurance?
Yes
No
Any concerns with your current insurance program?
Yes
No
Any home or auto claims in the last 5 years?
Yes
No
Insurance coverage policy document
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If you answered "Yes" in the above questions, please provide more details:
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Market Analysis
Years with current insurance company?
Any bankruptcies?
Yes
No
Bankruptcies description
Pending litigations?
Yes
No
Pending litigations description
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Property
*
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Collectibles
Jewelry?
Yes
No
Value of Jewelry?
Art?
Yes
No
Value of Art?
Wine?
Yes
No
Value of Wine?
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Spirits?
Yes
No
Value of Spirits?
Musical Instruments?
Yes
No
Value of Musical Instruments?
Coins?
Yes
No
Value of Coins?
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Stamps?
Yes
No
Value of Stamps?
Sports Memorabilia?
Yes
No
Value of Sports Memorabilia?
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Auto
Driver's License Number
State Issued
Are you under Age 25?
Yes
No
Over 3.0 GPA?
Yes
No
Away over 100 miles without a vehicle?
Yes
No
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Vehicle Make:
Vehicle Year:
Who will primarily drive this vehicle?
Vehicle Model
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Annual Miles
What will this vehicle primarily be used for?
Distance to office?
Where the vehicle is regularly garaged matters. Please confirm garaging state:
Add another vehicle
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Life Insurance
Supply copy of term policies: declaration page from original policy
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Supply copy of other policies: annual statement
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Tax Accounting and Consultancy
Supply copy of last 2 Tax Returns
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