G-325-A Questionnaire & Checklist

Name

First Last

Gender

Date of Birth

City of Birth

State of Birth

Country Of Birth

Nationality

A Number

Social Security Number

Father's First Name

Father's Last Name

Father's Date of Birth

Father's City of Birth

Father's State of Birth

Father's Country of Birth

Is your father still living?

Father's City of Residence

Father's State of Residence

Father's County of Residence

Mother's First Name

Mother's Last Name

Mother's Date of Birth

Mother's City of Birth

Mother's State of Birth

Mother's Country of Birth

Is your mother still living?

Mother's City of Residence

Mother's State of Residence

Mother's County of Residence

Your Spouse's First Name

Your Spouse's Last Name

Your Spouse's Date of Birth

Your Spouse's City of Birth

Your Spouse's State of Birth

Your Spouse's Country of Birth

Date of Marriage

City of Marriage

State of Marriage

Country of Marriage

Former Spouses (if any). Please list their full name (including maiden), their date of birth, City, State and Country of Birth, the date of termination of marriage and place of termination of marriage

Complete Residence for the last 5 years. Please make sure you include the Street & Number, City, State and Country as well as the time that you lived there.

Your last address outside of the United States for more than one year.

Your employment for the last five years. Please include the full name and address of your employer, your occupation, and the dates of employment.

The Wealth Advisor

The Wealth Counselor

G-325-A Questionnaire & Checklist