TEST | Tower Wealth

Know your client information form

You are an existing client
You are a new client

Has Your Personal Information Changed?

Yes
No

(Address/Contact Details/Email/Photo ID)

PERSONAL INFORMATION

Client Name *

First

Last

Client Birthdate *

Client Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Email *

Client Home Phone

Client Cell Phone

Client Work Phone

Drivers License/Passport # *

Drivers License/Passport Expiry Date *

Attach Photo ID *

Click or drag a file to this area to upload.

Drivers License/Passport

SIN Number *

Social Insurance Number

Void Cheque *

Click or drag a file to this area to upload.

Number of Dependants *

Dependant(s) Information

First Name / Last Name / D.O.B / SIN # / Relationship / Male or Female

Employment Status

Has Your Employment Status Changed?

Yes
No

Employer's Name: *

(If retired or unemployed, must list past employment)

Job Type: *

Position: *

Employment Address: *

Annual Income *

Your Personal Net Worth

Has Your Personal Net Worth Changed?

Yes
No

a. Cash and Cash Equivalents *

b. Fixed Income Securities *

c. Equities *

d. Alternative Securities *

e. Net Liquid Assets *

+ Fixed Assets and Real Estate *

+ Net Fixed Assets *

(Fixed assets less liabilites against Fixed Assets)

- Personal Loans & Credit Card Balances *

- Lines of Credit *

- Mortgages *

- Other (specify) *

Estimated Total Net Worth *

Liquidity Requirements *

None, (No funds Required in the Short Term)
Funds May Be Required on Short Notice

If required, notes regarding amount and approximate date(s) when money required: *

Trusted Contact

Would you like to add a trusted contact to the account?

Yes
No

If yes, include the 'Trusted Contact Form'

Download the Trusted Contact Form

Spousal Information

Is your spouse a current client

Yes
No

Has your spouse information changed?

Yes
No

Spouse Name *

First

Last

Spouse Birthdate:

Employers Name:

(If retired or unemployed, must list past employment)

Employers Address:

Spouse Job Type:

Occupation:

Spouse Annual Income

Spouse Liquid Fixed Assets ($)

Spouse Fixed Assets ($)

Spouse Drivers License/Passport #

Spouse Drivers License/Passport Expiry Date

Attach ID (Spouse)

Click or drag a file to this area to upload.

PERSONAL INFORMATION

Employment Status

Your Personal Net Worth

Trusted Contact

Spousal Information

Passion, Preservation, Prosperity

Our Solutions

Contact Us

[email protected]

1524 91 St SW., Suite 212 Edmonton, Alberta T6X 1M5