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Client Name
Advisor Name
Date
MM slash DD slash YYYY
CLIENT INFORMATION
Full Legal Name
Date of Brith
MM slash DD slash YYYY
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
Email
Social Security Number
Employer Name
Title / Occupation
Employer Address
Employer Phone
SPOUSE INFORMATION
Spouse, Full Legal Name
Date of Birth
MM slash DD slash YYYY
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
Email
Social Security Number
Employer Name
Title / Occupation
Employer Address
Employer Phone
FINANCIAL INFORMATION
Approximate Net Worth (excluding primary residence)
Annual Household Income
Name - Primary Beneficiary (IRA accounts only)
Social Security Number
Relationship
Date of Birth
MM slash DD slash YYYY
Percentage (default is 100%)
Name - Contingent Beneficiary (optional)
Social Security Number
Relationship
Date
MM slash DD slash YYYY
Percentage (default is 100%)
CONTRA FIRM ACCOUNTS
1: Account Owner Name
Account Location (Firm Name)
Approximate Value
Type of Account
Account Number
Recent Acct. Statement Received?
2: Account Owner Name
Account Location (Firm Name)
Approximate Value
Type of Account
Account Number
Recent Acct. Statement Received?
3: Account Owner Name
Account Location (Firm Name)
Approximate Value
Type of Account
Account Number
Recent Acct. Statement Received?
CLIENT ACCOUNT ASSIGNMENT
Client Name
Current Account Firm
Account Type
Account Value
Current Account Firm
Account Type
Account Value
Current Account Firm
Account Type
Account Value
BULWARK PORTFOLIO
Annuity
Product
Amount
Separately Managed Accounts
Roth IRA
Individual
Joint Tenants
Helios Model Worksheet
Helios Smart Growth Alpha
Helios Smart Growth Opportunity
Helios Smart Growth Balanced
Document Checklist
Account Application
Account Transfer Form (ACAT)
Move Money Authorization
CCFM Asset Management Agreement (confirm management fee percentage)
Contra Firm Statement(s) Received
HOUSEHOLD FINANCIALS
Annual Living Expenses
Federal Tax Bracket
Income Sources
Amount in Checking/Savings
Liquid Assets
Total Non-Liquid Assets
Total Debt, Excluding Mortgage(s)
Reverse Mortgage?
Home
About
Our Team
Services
Our Services
Investment Management
Financial Planning
Retirement Planning
Annuities
Podcast
Media
Blog
In The Headlines
Media Kit
Events
Contact
Client Login
Schwab Alliance
Orion
eMoney
253.799.6416
invest@bulwarkcapitalmgmt.com