New Clients

Client Intake Form

Please complete all sections as accurately as possible.

Your information is secure. This form is transmitted securely. Your information will be sent directly to the RJMwealth team and will not be stored on this website.

1. Personal Information

Last Name *

First Name *

Middle Name

SIN #

Date of Birth

Street Address

City

Province

Postal Code

Home Phone

Cell Phone

Email *

Driver's License #

Marital Status

3. Beneficiary Information

Up to 4 beneficiaries

Beneficiary 1 Name

Date of Birth

Relationship

Beneficiary 2 Name

Date of Birth

Relationship

Beneficiary 3 Name

Date of Birth

Relationship

Beneficiary 4 Name

Date of Birth

Relationship

4. Employment Information

Client

Occupation

Employed Since (year)

Employer

Work Phone

Annual Income

Pension Details (if any)

5. Financial Information

Assets

Residence Value

Vehicle(s)

RRSPs

Investments

Other Assets

Bank Balance

Liabilities

Mortgage Details (fixed/variable, rate, term)

Mortgage Balance

Mortgage Payments

Vehicle Financing

Credit Cards

Personal Loans

Other Liabilities

Summary

Total Assets

Total Liabilities

Net Worth

Insurance Payments