Pershing/SEI Account - Death Claim

Pershing/SEI Account - Death Claim
Priority:
Documents Requested By:

MonthDayYear
Date
Delivery Method:
Upload Client Files:

Client Docs, Statements, License, Etc.
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New Accounts Team - Client Communication
Rep Information:
Primary Representative:
Servicing / Submitting Representative:
Will there be a Split Rep or Rep Change?
Split Rep or Rep Change Information:
Account Owner:
Is the NEW account owner an existing client?
Owner Name:

First NameMiddle NameLast Name
Owner Employment Status:
Joint Owner Name:

First NameMiddle NameLast Name
Investment Experience:
Annual Income:
Net Worth:
Liquid Net Worth:
Annual Expenses:
Range of Special Expenses:
Time frame of the Special Expenses:
Account & Investment Details:
Is the NEW investment the same as deceased owner's existing account
1 - Investment Objective:
Goal Description:
- Client Facing Account Name
Funding Amount:
Funding Source:
Risk Tolerance Questionnaire Results:
Account Type:
Non-Q Registration Type:
Qualified Registration Type:
Program:
AMP Fee Schedule:
Is the model, rebalancing and fee the same?
UMA Model (Level 1):
UMA Model (Level 2):
UMA Model (Level 3):
UMA Model (Level 4):
UMA Model (Level 5):
Investment Other:
Rebalancing Frequency:
Dollar Cost Average:
Must invest model MINIMUM $ to start account - DCA applies ONLY funds over minimum
Advisor Fee:
Fee Other:
Notes & Funding Instructions:
Please be specific regarding the funding of this account.
Does the account need to be setup for monthly distributions?
Monthly Distribution:
Are the account details the same as deceased owner's account?
2 - Investment Objective:
Goal Description:
Funding Amount:
Funding Source:
Risk Tolerance Questionnaire Results:
Account Type:
Non-Q Registration Type:
Qualified Registration Type:
Program:
AMP Fee Schedule:
Is the model, rebalancing and fee the same?
UMA Model (Level 1):
UMA Model (Level 2):
UMA Model (Level 3):
UMA Model (Level 4):
UMA Model (Level 5):
Investment Other:
Rebalancing Frequency:
Dollar Cost Average:
Must invest model MINIMUM $ to start account - DCA applies ONLY funds over minimum
Advisor Fee:
Fee Other:
Notes & Funding Instructions:
Please be specific regarding the funding of this account.
Does the account need to be setup for monthly distributions?
Monthly Distribution:
Are the account details the same as deceased owner's account?
3 - Investment Objective:
Goal Description:
Funding Amount:
Funding Source:
Risk Tolerance Questionnaire Results:
Account Type:
Non-Q Registration Type:
Qualified Registration Type:
Program:
AMP Fee Schedule:
Is the model, rebalancing and fee the same?
UMA Model (Level 1):
UMA Model (Level 2):
UMA Model (Level 3):
UMA Model (Level 4):
UMA Model (Level 5):
Investment Other:
Rebalancing Frequency:
Dollar Cost Average:
Must invest model MINIMUM $ to start account - DCA applies ONLY funds over minimum
Advisor Fee:
Fee Other:
Notes & Funding Instructions:
Please be specific regarding the funding of this account.
Does the account need to be setup for monthly distributions?
Monthly Distribution:
Beneficiaries:
Beneficiary Info:
Ex. Same as previous beneficiaries, etc.
Do you still want to add beneficiaries?
Primary Beneficiary:
Name

First NameLast Name
%
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
SS#:
Date of Birth

MonthDayYear
Will there be additional Primary Beneficiaries?
Name - 2nd Primary Beneficiary

First NameLast Name
%
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
SS#:
Date of Birth

MonthDayYear
Will there be additional Primary Beneficiaries?
Name - 3rd Primary Beneficiary

First NameLast Name
%
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
SS#:
Date of Birth

MonthDayYear
Will there be additional Primary Beneficiaries?
Name - 4th Primary Beneficiary

First NameLast Name
%
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
SS#:
Date of Birth

MonthDayYear
Contingent Beneficiary:
Name

First NameLast Name
%
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
SS#:
Date of Birth

MonthDayYear
Will there be additional Contingent Beneficiaries?
Name - 2nd Contingent Beneficiary

First NameLast Name
%
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
SS#:
Date of Birth

MonthDayYear
Will there be additional Contingent Beneficiaries?
Name - 3rd Contingent Beneficiary

First NameLast Name
%
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
SS#:
Date of Birth

MonthDayYear
Will there be additional Contingent Beneficiaries?
Name - 4th Contingent Beneficiary

First NameLast Name
%
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
SS#:
Date of Birth

MonthDayYear
Funding Instructions:
Should be Empty:

Pershing/SEI Account - Death Claim

Rep Information:

Account Owner:

Investment Experience:

Account & Investment Details:

Beneficiaries:

Primary Beneficiary:

Contingent Beneficiary: