Confidential Client Questionnaire Step 1 of 9 - Instructions 0% FacebookThis field is for validation purposes and should be left unchanged.For Your Convenience We want to make forms as convenient for you as possible! By submitting this secure on-line questionnaire, we can pre-fill your account forms for you and your spouse/partner. Thank you for your time and effort! Before You Begin Please have the following items ready for you and your spouse/partner if applicable. Driver's license or passport Work address and phone number Approximate household income and net worth Trust document if applicable Optional: latest tax return Instructions Please answer only those questions which apply to you or your spouse/partner. Leave the rest blank. Required fields are denoted with an asterisk (*) next to the field name. NAMES: Consider entering the name you typically use such as on bank accounts, investment accounts, and driver's license. Let's Begin!Your answers on this first page will customize the rest of the form, showing only applicable questions.Marital Status* Single Married Life Partner Separated Divorced Widowed Your Employment Status* Employed Self-employed Unemployed Retired Homemaker Student Spouse/Partner Employment Status* Employed Self-employed Unemployed Retired Homemaker Student The form will be limited to those areas which apply to you.Which of these apply to you?Check all which apply to you and your spouse/partner. My mailing address is DIFFERENT than my primary residence I have a SECOND residence (vacation, summer/winter) I have a home phone (land line) I have a personal mobile phone I have a personal email address I have a Trust I have a Trusted Contact Person I have children who live with me About YouThe questions on this page are about YOU. Consider entering the name you typically use such as on bank accounts, investment accounts, and driver's license.First Name*Middle NameLast Name*SuffixDesignationsNick Name*Maiden NameSocial Security #*Date of Birth* MM slash DD slash YYYY Personal Mobile*Personal Primary Email* Citizenship Status* U.S. Citizen Permanent Resident Not U.S. Citizen Wedding Anniversary MM slash DD slash YYYY Driver's License InformationDriver's Licence #*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDate Issued* MM slash DD slash YYYY Date Expires* MM slash DD slash YYYY About Where You LiveThe primary address must be a physical location (your home) and not a post-office box. Primary Residence Address*Primary address must be a physical location (your home) and not a post-office box. Street Address Address Line 2 City State StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Primary Residence Phone*If you have a land-line.Primary Residence FaxIf you have a land-line.Your Mailing Address...because you indicated it's different than primary address.Mailing Address* Street Address Address Line 2 City State StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Your Second ResidenceFor example a vacation home, or a summer or winter home where you live part of the year.Second Residence Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Second Residence PhoneIf you have a land-line. About Where You WorkThis section also applies if you are self-employed. Company Name*Job Title*Work Address* Street Address Address Line 2 City State State/ProvinceAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Work Phone Number* About Your Spouse / Life PartnerThese questions apply to your spouse or life partner. Consider entering the name they typically use such as on bank accounts, investment accounts, and driver's license. First Name*Middle NameLast Name*SuffixDesignationsNick Name*Maiden NameSocial Security #*Date of Birth* MM slash DD slash YYYY Citizenship Status* U.S. Citizen Permanent Resident Not U.S. Citizen Personal Mobile*Personal Primary Email* Driver's License InformationDriver's Licence #*State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDate Issued* MM slash DD slash YYYY Date Expires* MM slash DD slash YYYY About Where Your Spouse / Partner WorksCompany Name*Job Title*Work Address* Street Address Address Line 2 City State StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Work Phone Number* About Your Trust Note: When we open your account, we will include the title, trustee(s), and effective date in the account registration. If you are unsure of the proper title of your trust, you should consult with your attorney. Example of a proper Trust title: The Doe Family Trust, John A. Doe OR Jane B. Doe TTEES, UA 1/1/2001 Trust Title*Effective Date* MM slash DD slash YYYY Trust SSN/Tax ID*Trustee #1 Name* First Middle Last Suffix Trustee #2 NameIf there is a second trustee listed. First Middle Last Suffix About Your Financial InformationAnnual Household Income*Select the range which best describes your household's total annual income. Under $15,000 $15,000 to $24,999 $25,000 to $49,999 $50,000 to $99,999 $100,000 to $249,999 $250,000 or more Approximate Household Net Worth*Select the range which best describes your household's total net worth, excluding your primary residence. Under $15,000 $15,000 to $24,999 $25,000 to $49,999 $50,000 to $99,999 $100,000 to $249,999 $250,000 to $499,999 $500,000 to $999,999 $1,000,000 to $1,999,999 $2,000,000 or more Do you have your latest tax return handy?*This is optional, but the information will help us incorporate your personal tax considerations during real-time portfolio management operations. Yes No Tax Year*The calendar year to which your tax return applies. For example, a tax return filed in 2024 applies to tax year 2024.Please enter a number from 2022 to 2099.Filing Status*Filing status shown on Form 1040, page-1, "Filing status" Individual Married Filing Jointly Head of Household Married Filing Separately Taxable IncomeTaxable Income is typically shown on Form 1040, line 15.Please enter a number from 0 to 9999999.Capital Loss CarryoverTotal Capital Loss Carryover is typically shown on schedule D, line 16.Please enter a number from 0 to 9999999. Trusted Contact Person 1 A Trusted Contact Person is a resource whom we at Coherent, or your custodian (e.g. Schwab) may contact on your behalf if necessary, to attempt to address issues related to your accounts. Trusted Contact information provided on this form will replace all those currently on file. For multiple-party (e.g. joint) accounts, each party can name separate Trusted Contacts. If this applies to you, please let us know. Otherwise the Trusted Contact information on this form will apply to all parties. A Trusted Contact will not be able to view your account information, execute transactions, or inquire about account activity, unless that person has authority through another role on the account, such as a trustee or power of attorney. A Trusted Contact must be at least 18 years old. Trusted Contact Name* First Middle Last Suffix Relationship* Spouse Partner Child Parent Sibling Friend Other AddressPlease provide at least one method of contact: address, phone, or email. Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneEmail Add Second Trusted ContactThis is optional. Yes No Trusted Contact Person 2Trusted Contact Name* First Middle Last Suffix Relationship* Spouse Partner Child Parent Sibling Friend Other AddressPlease provide at least one method of contact: address, phone, or email. Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code PhoneEmail Children who live with youList only those children or step-children who reside with you at your primary residence. List each child on a separate line. Include their full name and date of birth (SSN-optional).
