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DTB Wealth Management

Personal Details
YOU AND YOUR FAMILY
INCOME, ASSETS AND LIABILITIES
LIABILITIES & EXPENDITURES
YOUR OBJECTIVES

Legals

WARNING

You have expressed the wish to obtain an answer from a controlled professional engaged in a regulated activity.

In accordance with the principles of the law of 6 January 1978 relating to data processing, data files and individual liberties, we remind you that this collection of information and its use are made in your interest and are intended to enable the professional to provide advice tailored to your problems.

The quality of its work will depend heavily on the truthfulness, accuracy and completeness of your answers to this questionnaire.

If you do not provide the required information, your adviser will not be able to continue his mission and will have to refrain from recommending transactions, instruments and services relating to his CIF activity. He or she may only provide you with information or research, an assignment falling within the scope of another regulated profession or the non-financial sphere.

Your advisor is committed to respecting the rules of good conduct, including professional secrecy and the protection of your personal data.

The information collected on this form is recorded in a computerised file by DTB WEALTH MANAGEMENT. They are kept for 10 YEARS and are destined.

The information collected on this form is recorded in a computerised file by DTB WEALTH MANAGEMENT for

PLEASE ENTER YOUR NAME

In accordance with the law "informatique et libertés", you can exercise your right of access to data and have them rectified by contacting: DANIEL BUTCHER - DTB WEALTH MANAGEMENT. You may also submit a complaint about the processing of your data to the CNIL.

You acknowledge that you are aware of your consultant's fees, his working methods and that you have in your possession of its legal information sheet ANACOFI-CIF.

DOWNLOAD OUR INTRODUCTORY DOCUMENT

In accordance with the AMF's position no. 2013-02 and ACPR recommendation no. 2013-R-01 of 8 January 2013, we are required to identify and manage any responses that are clearly inconsistent and/or incomplete with each other provided by our clients during the initial gathering of information and when updating it.

Thus, once this document has been completed, we must verify the completeness and consistency of the information provided and, if necessary, alert you to this situation and invite you to make the necessary corrections (for example, information on your financial situation, your investment objectives and your knowledge and experience in financial matters, inconsistencies between objectives and risk profile, etc.).

You

Full Name

Maiden Name (if applicable)

Date of Birth

Place and country of Birth

Primary address (specify the country please)

N° of months spent at that addresse per year

Secondary address (if any)

Telephone

Mobile

Email

Nationality

Dual nationality (Please specify)

Other (Please specify)

Country of residence (Please select)

Other Countries of residence (Please select)

Profession or previous field of activity (if retired)

Your Partner

Full Name

Maiden Name (if applicable)

Date of Birth

Place and country of Birth

Primary address (specify the country please)

N° of months spent at that addresse per year

Secondary address (if any)

Telephone

Mobile

Email

Nationality

Dual nationality (Please specify)

Other (Please specify)

Country of residence (Please select)

Other countries of residence (Please select)

Profession or previous field of activity (if retired)

You

What is your family situation ?

If you are married, date of marriage

The Country you got married in

Do you know your French marital status?

Have you changed your French marital status ? If YES, please provide the new status

Have you granted any libéralities or marital advantages between spouses ?

Do you hold an S1 form or are you entitled to one?

Your Partner

What is your family situation ?

If you are married, date of marriage

The Country you got married in

Do you know your French marital status?

Have you changed your French marital status ? If YES, please provide the new status

Have you granted any libéralities or marital advantages between spouses ?

Do you hold an S1 form or are you entitled to one?

About your children

Please state their full names, date of birth, profession, marital status as well as their country of residence.

Have donations been consented to any of them ?

Yes No

If yes, please specify

Have you other dependent relatives living with you ?

Yes No

If yes, please specify

About your partner's children

Please state their full names, date of birth, profession, marital status as well as their country of residence.

Have donations been consented to any of them ?

Yes No

If yes, please specify

Have you other dependent relatives living with you ?

Yes No

If yes, please specify

Residency situation

If not yet in France, when are you planning to move ?

How long do you intend to live in France ? (in years)

What is the main reason you are moving to, or back to, France ?

Have you applied for state healthcare in France ?

Are you familiar with the healthcare system, do you need advice ?

Professional Situation

What is your current status ?

Which country do you work in ?

What is your partner's current status ?

Which country do they work in ?

INCOME

Your basic annual earned income & origin

Rental income & origin

Pensions & origin

Other income & origin

Your partner's basic annual earned income & origin

Your partner's rental income & origin

Your partner's pensions & origin

Your partner's other income & origin

ASSETS

Real Estate Assets

Main Home: Full Address, Purchase Date, Purchase Value, Content Value, Current Value & Ownership

Second Homes: Full Address, Purchase Date, Purchase Value, Content Value, Current Value & Ownership

Rental Properties: Full Address, Purchase Date, Purchase Value, Content Value, Current Value & Ownership

Other Property Investments: Full Address, Purchase Date, Purchase Value, Content Value, Current Value & Ownership

Are you planning to sale any of the real estate assets listed above ?

Yes No

If yes, please give details

Are any family arrangements, like donations or legacy planned in a close future ?

Yes No

If yes, please give details

Short term assets (bank accounts & liquid assets)

List all assets, opening date, custodian, location, value, currency, interest rate % & ownership

Medium term assets (financial assets)

List all assets, opening date, custodian, location, value, currency, interest rate % & ownership

Assurance vie (not to be confused with Life Insurance)

Ownership, Type of Assurance vie policy, Opening date, Insurer & policy domicile, Allocation of assets - Fond Euros, Mutual Fonds, value (to date), currency, interest rate %, beneficiaries in case of death

Private or Ocupational pension plan's, PERP's, QROPS's

List all assets, opening date, custodian, location, value, currency, interest rate % & ownership

Loans & Mortgages

Type of loan or mortgage, Obtainment date, Lender. Duration (months), Amount outstanding, interest rate % & Ownership

Taxes and other expenses

Type of expenditure or tax, Annual amount, Ownership

DTB Wealth Management