New Client - Information Form

New Client - Information Form

Please complete the below ahead your meeting with Natalie, thank you!
Name

First NameLast Name
E-mail
example@example.com
Phone Number

Area CodePhone Number
Birth Date

MonthDayYear
Date
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship Status
Gender
Spouse/Partners Name
Preferred Method of Contact
Preferred Meeting Type
Current Employment
Annual Income Before Taxes from all sources
Ex : $100,000
If employed, please list who is/are your employer(s), what is/are your title(s) and when did you start working there (mm/yyyy)?
Ex : Costco, Store Manager, 06/2012
What type of debts do you currently have? Select all that apply.
What is the current amount you owe towards debts?
Do you currently have a house? Select all that apply.

Other
If you have a mortgage what is your mortgage amount?
Ex: $345,000
What is the current value of your house?
Ex: $550,000
What type of investment accounts do you currently have? Select all that apply.

Other
What type of insurance coverage do you currently have? Select all that apply.
Smoking Status, not required - can be done in person & only if applicable.
**Applicable if you would like to discuss insurance.
Health Status, not required - can be done in person & only if applicable.
**Applicable if you would like to discuss insurance.
Health History, not required - can be done in person & only if applicable.
**Applicable if you would like to discuss insurance.
How many dependents do you and your partner/spouse (if applicable) have and how old are they? If no, do you and your partner/spouse (if applicable) plan to in the future?
Ex. Three Kids aged 17, 12 and 5. My partner also has a 12 year old with an ex. or Ex. We do not have kids yet, but ideally we want 2 in the next 5 years. Ex. No kids, no plans for kids.
Do you have a will in place?
How confident are you currently when it comes to your personal finances?

1

2

3

4

5

1 is Not Good, 5 is Confident
Which topics are you most interested in. Check all that apply

Other
Feel free to outline any specific goals, ask any questions you would like addressed in our meeting, or any further information you wish to provide.
Confidentiality Statement

I understand and agree that, all information I have submitted on this form is completely correct and that all information provided is confidential and will not be used or shared outside of creating an internal client file for I, the applicant.
Should be Empty:

New Client - Information Form

Confidentiality Statement