Client Information Questionnaire
Name
*
First Name
Last Name
Date Of Birth
*
Employment Status
*
Please Select
Employed
Self-Employed
Retired
Homemaker
Student
Not Employed
Employer
Preferred Email
*
example@example.com
Preferred Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Primary Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address If Different From Primary Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Primary Beneficiary #1 Information
At least ONE primary is required, however, you can add more than one. You will also have a chance to add contingent beneficiaries next.
Name Of Primary #1
*
First Name
Last Name
Relationship To You
*
Please Select
Spouse
Child
Sibling
Grandchild
Parent
Trust
Other Individual
Organization
Estate
Percentage #1
*
Phone Number Of Primary Beneficiary #1
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Of Primary Beneficiary #1
example@example.com
Can we contact this beneficiary?
*
Please Select
Yes, please do.
No, I prefer you didn't
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Primary Beneficiary #2 Information
At least ONE primary is required, however, you can add more than one. You will also have a chance to add contingent beneficiaries next.
Name Of Primary #2 (if applicable)
First Name
Last Name
Relationship To You
Please Select
Spouse
Child
Sibling
Grandchild
Parent
Trust
Other Individual
Organization
Estate
Percentage #2 (if applicable)
Phone Number Of Primary Beneficiary #2 (if applicable)
Please enter a valid phone number.
Format: (000) 000-0000.
Email Of Primary Beneficiary #2 (if applicable)
example@example.com
May we contact this beneficiary?
Please Select
Yes, please do.
No, I prefer you didn't
Please list any additional primary beneficiaries below (ie: name, relationship to you, percentage, and contact information)
Please include if we may contact each additional beneficiary listed
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Contingent Beneficiary #1
A contingent is always recommended, but not required. A contingent beneficiary is the person that will receive your assets should you primary beneficiaries pass away before you can update your profile.
Name Of Contingent #1 (if applicable)
First Name
Last Name
Relationship To You
Please Select
Spouse
Child
Sibling
Grandchild
Parent
Trust
Other Individual
Organization
Estate
Percentage #1 (if applicable)
Phone Number Of Contingent Beneficiary #1 (if applicable)
Please enter a valid phone number.
Format: (000) 000-0000.
Email Of Contingent Beneficiary #1 (if applicable)
example@example.com
May we contact this beneficiary?
Please Select
Yes, please do.
No, I prefer you didn't
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Contingent Beneficiary #2
A contingent is always recommended, but not required. A contingent beneficiary is the person that will receive your assets should you primary beneficiaries pass away before you can update your profile.
Name Of Contingent #2 (if applicable)
First Name
Last Name
Relationship To You
Please Select
Spouse
Child
Sibling
Grandchild
Parent
Trust
Other Individual
Organization
Estate
Percentage #2 (if applicable)
Phone Number Of Contingent Beneficiary #2 (if applicable)
Please enter a valid phone number.
Format: (000) 000-0000.
Email Of Contingent Beneficiary #2 (if applicable)
example@example.com
May we contact this beneficiary?
Please Select
Yes, please do.
No, I prefer you didn't
Please list any additional primary beneficiaries below (ie: name, relationship to you, percentage, and contact information)
Please include if we may contact each additional beneficiary listed
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Optional Survey For PFS
Please share with us any areas you would like to know more about, concerns you might have or any feedback for our team
Would you like more information on any of the following?
RMDs (Required Minimum Distributions)
QCDs (Qualified Charitable Distributions)
Running/Updating A Financial Plan
Risk Assessments
Insurance
401k Management
Rolling Over An Account/Opening A New Account
Estate Planning/Trusts and Wills
Please rate below how satisfied you are with our team on the following areas:
Rows
Not Satisfied
Somewhat Satisfied
Very Satisfied
How satisfied are you with access to our financial
professionals [our team]?
How satisfied are you with the frequency of our
meetings? (virtual or in-person meetings)
How satisfied are you with the frequency of our
client communications? (outreach via emails,
newsletters, updates, etc.)
How satisfied have you been in the response time
to your questions?
How satisfied are you in the format of our
meetings? (virtual or in-person meetings)
How satisfied are you with the technology offered
to communicate with our team?
Are there any concerns you have regarding your portfolio and/or the PFS team?
How can we make our services better and/or any general feedback:
Submit
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