NCATS Client Profile -2024

SSN
Name
DOB
Age
Filing Status
Occupation
Work Phone Number
WK#
Home Phone Number
HM#
Cell Phone Number
Cell
E-Mail
example@example.com
Does your name match your SS Card
(Yes or No)
Address

Address

Street Address Line 2

CityState

Zip
Driver’s License/State ID #
Driver’s Lic. /State ID #
State
Issue Date

MonthDayYear
Date
Exp. Date

MonthDayYear
Date
Spouse(if apply)
Spouse SSN(if apply)
Spouse DOB(if apply)
Spouse Occupation(if apply)
Spouse Driver’s Lic. /State ID #(if apply)
Spouse State(if apply)
State abbreviation(ex. SC)
Spouse Issue Date(if apply)

MonthDayYear
Date
Spouse Exp. Date(if apply)

MonthDayYear
Date
At any time during 2023, did you receive, sell, send, exchange or otherwise acquire any financial interest in any virtual currency?
yesNo
If yes, what amount
At any time during 2023 did you have any interest in or authority over any foreign account or trust?

YesNo
Dependent 1
SSN
Relationship
DOB
Dependent 2
SSN
Relationship
DOB
Dependent 3
SSN
Relationship
DOB
Dependent 4
SSN
Relationship
DOB
*Note: If relationship is not your child you must be eligible to receive the earned income credit (EIC)(CTC).
Is the dependent unmarried OR married and can be claimed as your dependent?

YesNo
Could another person qualify to claim this child (children)? If No skip the next question

YesNo
Child’s relationship to the other person?
Did your dependent live with you in the U.S. for over half of the year?

YesNo
Have you provided more than half of the cost of keeping up your home for your child/children?

YesNo
Could you or your spouse if filing jointly, be a qualifying child of another person for this tax year?

YesNo
Were your main home or your spouse’s in the U.S. for more than half a year?

YesNo
Are you or your spouse eligible to be claimed as a dependent on anyone else tax return?

YesNo
Initial
Did you receive any Unemployment Compensation during 2023?

YesNo
Amount Received
Have you or anyone in your household received healthcare insurance coverage through Obama Care, or any other source during the 2023 tax year?

YesNo
Do you want a Refund Transfer?

yesNoYes, you owe any federal taxes?No, you owe any federal taxes?Yes, you in default with your student loan? yesNo, you in default with your student loan?
Do you want to apply for Republic Bank $500 to $6,000 Easy Advance Loan?

yesno
Please make sure we have a copy of IDs, SS Cards, W-2s, and a phone number and email where you can be reached.

All information given to North Charleston MBM Accounting & Tax Services, LLC is correct and true. I am responsible for any misinform information.
Print Your Name
Signature (If you complete and submit this form online type your name for your signature)

Clear
Date

MonthDayYear
Date
Please select your appointment preference.

In PersonZoom/Virtual https://us05web.zoom.us/j/6106503414?pwd=d1I0NkIxN2dnZG1LM1B2U2N4TnZVZz09
Please select a time slot and someone will contact you.

MondayTuesdayWednesdayThursdayFridaySaturday9am to 12pm1pm to 5pmAfter 5pmOther
Phone: (843) 747-1013 * Fax: (843) 302-8203 * Email: info.ncats@gmail.com
Should be Empty: