'Confidential Client Profile'
Personal Details

BASIC INFORMATION

SELF

SPOUSE/PARTNER

Please Complete the form in BLOCK CAPITALS. When providing monetary value please specify currency

NAME (Title,Forename and Surname)
   

Principal Address

   
   
   

Telephone Number(including international code)

   

Email Address

Fax Number

Date of Birth

Marital Status

Country of Domicile

Nationality

   

CHILDREN

Name

Date of Birth

Relationship

Health

Have you arranged/Do you intend to fund education for children?

YES  NO

If YES, Please give details in note section, including name of the prospective school/college and location

Do you have any other commitments, for any other dependents, eg. elderly relative

YES  NO
   

HEALTH / PASTIMES

SELF

SPOUSE/PARTNER

Have you smoked yet in the last 12 months
do you have any intention of doing so in future?

 YES   NO YES   NO

Have you consulted doctor in last 5 years?

 YES   NO YES   NO

Are you suffering from any illness, disability
or taking any medication?

 YES   NO YES   NO

Do you take any part in hazardous pursuits?

 YES   NO YES   NO

Have any of your natural parents, brother(s) or sister(s) ever suffered from heart disease, stroke, cancer, diabetes, kidney disease,high blood pressure or any hereditary disorder?

 YES   NO YES   NO

If you have answered yes to any questions, please provide details in the note and additional information section at the end of the booklet, clearly identify the section to which the information refers. If there is insufficient space, please continue on a separate sheet?

WILLS

SELF

SPOUSE/PARTNER

Have you made a will

YES   NO YES   NO

Have your circumstances changed
since it was made?

 YES   NO YES   NO

Do you require further advice concerning your WILL?

 YES   NO YES   NO

Do you have an Accountant / Tax Advisor?

 YES   NO YES   NO

If Yes, please give name and address

  
  
  
  
  
Tick relevant checkbox *Delete as appropriate

RESIDENCE

SELF

SPOUSE/PARTNER

Are you a non resident of UK for tax purposes?

YES NO YES NO

In what country do you reside for tax purposes?

Is it your intention to leave in the UK?

 YES NO YES NO

If Yes, from when?

Have you previously lived in the UK?

 YES NO YES NO

How long have you lived in your present country of residence?

 Yrs Mths Yrs Mths

Do you intend to live there permanently?

YES NO YES NO

If NO, what are your intentions?
  

EXPATRIATES LEAVING THE UK

SELF

SPOUSE/PARTNER

If you are leaving the UK to either work or retire overseas please complete this section

Date of intented departure?

Length of contract/stay overseas

New Address( If known )

  

  

Date When expected to be in UK again
( please indicate duration)

Country where you expect to retire

EMPLOYMENT DETAILS

SELF

SPOUSE/PARTNER

Employment status

Employee Self-employed Employee Self-employed
   Partner     Director Partner     Director
   Retired Other(please specify) Retired Other(please specify)

Occupation

Nature of job/business

Employer

How long have you worked in your current Employment?

Is your employment status likely to change within next 6 months?

 YES NO YES NO

Basic salary ( or net profit if self employed)

Please state in which currencies paid

Benefits-in-kind (please specify)
(eg. company car)
  
  

How long would your employer pay you if you were unable to work due to accident or long-term sickness?

How much would your employer pay you (please give details)
  

Do you have medical insurance?

 YES NO YES NO

If YES, Please give details
  

Previous employment (please give brief details)

Please use the notes and additional information section at the end of the booklet to record any further details, clearly identify the section to which the information refers. If there is insufficient space, please continue in a separate sheet.

Tick relevant box *Delete as appropriate