US Client Intake Form (new account opening)

Client Intake Form

Hello! This form is for new clients who wish to open an account at Baobab Wealth Management.
Let's start with the basics...
Name*

PrefixFirst NameMiddle NameLast NameSuffix
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from home address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number
Mobile Phone Number
Work Phone Number
Email
example@example.com

Your Investment Experience

Please let us know about your investment experience.
How would you rate your Risk Tolerance for Investing?

Conservative - Protecting my principal is more important than growth.Conservative / Moderate - Low Risk with a little growth. Middle of the road.Moderate - Balance of protection and growth.Moderate / Aggressive - More Risk than protection, designed for growth.Aggressive - All growth for max returns with possibility of large fluctuation in value.Other
Years of experience investing in Mutual Funds?
Years of experience investing in Stocks / ETF's?
Years of experience investing in Bonds?
Years of experience investing in Annuities?
Years of experience investing in Options / Futures / Margin / Hedge Funds?

Work Information

Please tell us about your work.
Employment Status
Employer Name
Occupation
Employer Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you been with your current employer?
Annual Income (Just you)
Household Income
Household Net Worth
Are you or anyone in your immediate family employed by the securities industry?
Are you or any one of your immediate family members an officer, director or 10% (or more) shareholder in a publicly traded company?

About your Spouse

Now let's get a little more detailed about your spouse...
Your Spouse's Birthdate

MonthDayYear
Date
Your Spouse's Social Security Number
Your Spouse's Country of Citizenship
Your Spouse's Country of Birth
Maiden Name of Your Spouse's Mother
For security purposes (to reset online access if needed)
Do your Spouse have any other Citizenships?
Please list.
Your Spouse's Drivers License Number
Your Spouse's Drivers License State
Your Spouse's Drivers License Expiration Date

MonthDayYear
Date
Your Spouse's Drivers License Issue Date

MonthDayYear
Date
Attach a picture or scan of your spouse's drivers license.

Cancelof
Attach a picture or scan of your spouse's passport.

Cancelof

Beneficiaries

Let's list your beneficiaries...
Beneficiary 1 (Primary)

First NameMiddle NameLast NameSuffix
Beneficiary 1 Relationship to You?
Beneficiary 1 Address (if different from yours)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Beneficiary 1 Email
example@example.com
Beneficiary 1 Phone Number
Beneficiary 1 Social Security
Beneficiary 1 Birthdate

MonthDayYear
Date
Would you like to add another beneficiary?
Beneficiary 2

First NameMiddle NameLast NameSuffix
Beneficiary 2 Relationship to You?
*A contingent beneficiary is a beneficiary of proceeds or a payout if the primary beneficiary is deceased or unable to be located.
Is this a Primary or Contingent Beneficiary?

PrimaryContingent
What percentage would you like to go to this Beneficiary?
Beneficiary 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Beneficiary 2 Email
example@example.com
Beneficiary 2 Phone Number
Beneficiary 2 Social Security
Beneficiary 2 Birthdate

MonthDayYear
Date
Would you like to add another beneficiary?
Beneficiary 3 info (if you have a third beneficiary or contingent beneficiary)
Would you like to add another beneficiary?
Beneficiary 4 info (or contingent beneficiary info)

Beneficiaries

Let's list your beneficiaries...
We assume that you would like to list your spouse as your Primary Beneficiary. If this is NOT the case, please check the box below.

I DO NOT want to list my spouse as my primary beneficiary.
Would you like to add a contingent beneficiary?
*A contingent beneficiary is a beneficiary of proceeds or a payout if the primary beneficiary is deceased or unable to be located.
Your Beneficiary 2

First NameMiddle NameLast NameSuffix
Beneficiary 2 Relationship to you?
What percentage would your spouse like to go to this Beneficiary?
Beneficiary 2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Beneficiary 2 Email
example@example.com
Beneficiary 2 Phone Number
Beneficiary 2 Social Security
Beneficiary 2 Birthdate

MonthDayYear
Date
Would your spouse like to add another beneficiary?
Beneficiary 3 info (if you have a third beneficiary or contingent beneficiary)
Would you like to add another beneficiary?
Beneficiary 4 info (or contingent beneficiary info)

Anything else?

This is the home stretch!
Questions or Comments?
Please attach a picture of a voided check for the account you would like to link. This is a free service.

Cancelof
Attach your most recent statement(s), including bank, 401(k), life insurances, mortgage & other investments. (If we are transferring an account or working on a financial plan).

Cancelof
Want to Chat? Schedule a call now...

Appointment Times
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Client Intake Form