Client Profile Questionnaire

Client Information

Co-client / Spouse Information

• Salutation --None-- Mr. Ms. Mrs. Dr. Prof. Judge Sir
•  
• First Name
• Middle Name
• Last Name
•  
•  
• Home Address
• City
• State/Province
• Zip
• Country
•  
• Home Phone
• Home Fax
• Mobile Phone
• Personal Email
• Client Employment Status --None-- Employed Self-Employed Retired Unemployed
• Business Name
• Type of Business
• Title/Position
• Business Address
• City
• State
• Zip Code
•  
• Business Telephone Number
• Business Fax Number
• Business Email

• Co-client / Spouse Salutation --None-- Mrs. Miss Ms. Dr. Mr. Prof. Judge Sir
•  
• Co-Client / Spouse First Name
• Co-client / Spouse Middle Name
• Co-Client/Spouse Last Name
• Is Co-client / Spouse home address different from your own?
• Yes No
• Co-client/Spouse Address
• City
• State / Province
• Zip
• Country
•  
• Co-client/Spouse Home Phone
• Co-client/Spouse Home Fax
• Co-Client / Spouse Cell Phone
• Co-client / Spouse Personal Email
• Co-client / Spouse Employment Status --None-- Employed Self-Employed Retired Unemployed
• Co-client / Spouse Type of Business
• Co-client / Spouse Title / Position
  
• Business Address
• City
• State
• Zip
•  
• Business Telephone Number
• Business Fax Number
• Business Email

Preferred Methods of Contact

• Preferred Email --None-- Business Personal
• Preferred Mailing Address --None-- Home Business Other
• Preferred Telephone --None-- Business Home Cell
• Preferred Fax --None-- Business Home

• Co-client / Spouse Preferred Email --None-- Business Personal
• Co-client / Spouse Preferred Address --None-- Home Business Other
• Co-client / Spouse Preferred Telephone --None-- Business Home Cell
• Co-client / Spouse Preferred Fax --None-- Business Home

Personal Information

• Client Date of Birth
• Client Driver's License
  Expiration Date
• Client Driver's License
  Place of Issuance
• Client Country of Citizenship
• Client Marital Status --None-- Single Married
• Client Number of Dependents

• Co-Client / Spouse Date of Birth
• Co-client / Spouse
  Driver's License Expiration Date
• Co-client / Spouse
  Driver's License Place of Issuance
• Co-Client / Spouse Country of Citizenship
• Co-client / Spouse Marital Status --None-- SIngle Married
• Co-client / Spouse Number of Dependents

Financial Information

• Client Annual Income
• Estimated Household Net Worth
• Value of Household Liquid Assets
• Household Estimated Austerra Assets

• Co-Client / Spouse Annual Income
• Value of Household Illiquid Assets (excluding primary residence)
• List of Household Illiquid Assets

Mortgage Information

• 
  Primary Residence Value
• Primary Residence
  Mortgage Balance
• Primary Residence
  Mortgage Interest Rate
• Primary Residence
  Mortgage Term
• Primary Residence Mortgage Type --None-- Fixed rate Variable rate

• 
  Secondary Residence Value
• Secondary Residence
  Mortgage Balance
• Secondary Residence
  Mortgage Interest Rate
• Secondary Residence
  Mortgage Term
• Secondary Residence Mortgage Type --None-- Fixed rate Variable rate