Secure New Client Information Form 2026-04

First Authorized Individual

All fields in this section are required unless otherwise noted.
Full Name*

First NameMiddle InitialLast Name
Social Security Number*
Date of Birth*

MonthDayYear
Date
Legal Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have a separate Mailing Address?

YesNo
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Email Address (Secondary)
example@example.com
Employment Status*
Occupation/Title*
Marital Status*
Additional Authorized Individual
Is there an additional Authorized Individual (Joint, Co-Trustee, etc.)?

YesNo
Full Name*

First NameMiddle InitialLast Name
Social Security Number*
Date of Birth*

MonthDayYear
Date
Legal Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have a separate Mailing Address?

YesNo
Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
Email Address (Secondary)
example@example.com
Employment Status*
Occupation/Title*
Marital Status*
Document Uploads & Attachments

Please upload any documents below.
DOCUMENT UPLOADS

Please upload your Statements, Trust or Estate Documents, Proof of Identity, Voided Check, etc.
Cancelof
Beneficiary Designations (Optional)

Please reach out if you have questions completing this section.
Are you setting up Retirement accounts or adding a Beneficiary to a taxable account?

YesNo

Primary - First person or entity you choose to receive your assets.

Contingent - Only receive assets if the Primary is unable to accept the distribution.

Per Stirpes - Ensures that if a beneficiary passes away before you, their share of the assets automatically passes down to their children (your direct descendants).
If applicable, would you like to designate your spouse/partner as your primary beneficiary?

YesNo

Primary - First person or entity you choose to receive your assets.

Contingent - Only receive assets if the Primary is unable to accept the distribution.

Per Stirpes - Ensures that if a beneficiary passes away before you, their share of the assets automatically passes down to their children (your direct descendants).
Additional Contact (Optional)
Would you like to add additional contact (children, siblings, etc.)?

YesNo

Compliance

All fields below are required.
Are you related to any employee of Atwood & Palmer, Inc.?*

YesNo
Name the Employee
Are you a control person or have access to insider information of a publicly traded company?*

YesNo
Enter Company Name
Are you associated with a financial institution?*

YesNo
Enter Institution Name
Would you like to have duplicate statements sent to a third party?*

YesNo

Contact Authorization

List persons/entities approved for Atwood & Palmer to contact on your behalf:

Rows	Name	Address	Email	Phone Number
Attorney
CPA
Other
Other

Disclosures & Acknowledgments
Please review the following from the Atwood & Palmer website: Client Relationship Summary (Form CRS), Firm Brochure (Form ADV2a/2b), Privacy Policy.
I/we have reviewed the Disclosures & Acknowledgements.*

YesNo
By checking this box, I/We authorize Atwood & Palmer, Inc. to communicate via a secure portal or other encrypted electronic means. I/We understand that email transmissions cannot be guaranteed to be secure or error-free. Therefore, A&P does not accept liability for any errors or omissions in the contents of emails received.*

YesNo
Should be Empty:

Rows	Name	Birthdate	Social Security #	% to Receive	Relationship	Beneficiary Designation	Per Stirpes
1.
2.
3.
4.

Rows	Name*	Birthdate*	Social Security #	% to Receive*	Relationship	Beneficiary Designation	Per Stirpes
1.
2.
3.
4.

Rows	Name*	Birthdate	Social Security #	Relationship*
1.
2.
3.
4.

Rows	Name	Address	Email	Mobile Phone #
1.
2.
3.
4.

First Authorized Individual

Additional Authorized Individual

Document Uploads & Attachments

Beneficiary Designations (Optional)

Additional Contact (Optional)

Compliance

Contact Authorization

Disclosures & Acknowledgments