Spartan Secure Client Information Form

Legal First Name *

Middle Initial

Last Name *

Nickname (if applicable)

Suffix (if applicable)

What is your date of birth? (mm/dd/yyyy) *

Social Security Number (#########, no dashes) *

Email Address *

Phone Number (##########, no dashes) *

Type of phone number? *

Home Street Address *

Address Line 2

City *

State *

Zip Code *

State/Province/Region (If not U.S.)

Country (If not U.S.)

Employment Status *

What is the source of your income? *

What is your annual income? *

What is your approximate net worth (not including primary residence)? *

What is the name of the company for which you work? *

What is your title at the company where you work? *

Company Address *

Company Address Line 2

Company City *

Company State *

Company Zip Code *

Company State/Province/Region (If not U.S.)

Company Country (If not U.S.)

Who is your main contact at Spartan? *

Check here if you are a: *

U.S. Citizen

Permanent Resident

Not a U.S. Citizen

Country of Citizenship: *

Country of Dual or Secondary Citizenship (if applicable):

Country of Birth: *

Do you hold a current U.S. immigration visa? *

Yes

No

Specify visa type: *

Visa number: *

Expiration: *

Are you or your spouse, any member of your immediate family, including parents, in-laws, siblings, and dependents, a member of the board of directors, 10% shareholder, or policy-making officer of a publicly traded company. *

Yes

No

Please specify the company name, address, city, and state. *

Are you or your spouse, any member of your immediate family, including parents, in-laws, siblings, and dependents licensed, employed by, or associated with, a broker-dealer firm, a financial services regulator, securities exchange, or member of a securities exchange. *

Yes

No

Please specify entity *

Please provide a copy of the required authorization letter

Are you married AND planning to have your spouse's account(s) managed? *

Yes

No

______________________________________

Great, please fill in the following information for your spouse.

Legal First Name (spouse) *

Middle Initial (spouse)

Last Name (spouse) *

Nickname (if applicable) (spouse)

Suffix (if applicable)

Date of Birth (mm/dd/yyyy) (spouse) *

Social Security Number (#########, no dashes) *

Email Address (spouse) *

When is your anniversary? (mm/dd/yyyy) (spouse) *

Phone Number (##########, no dashes) (spouse) *

Type of Phone Number (spouse) *

Is home address same for both spouses? *

Yes

No

Home Street Address (spouse) *

Address Line 2 (spouse)

City (spouse) *

State (spouse) *

Zip Code (spouse) *

State/Province/Region (If not U.S.)

Country (If not U.S.)

Employment Status (spouse) *

What is the source of your income? (spouse) *

What is your annual income? (spouse) *

What is your approximate net worth (not including primary residence)? (spouse) *

What is the name of the company for which you work? (spouse) *

What is your title at the company where you work? (spouse) *

Company Address (spouse) *

Company Address Line 2 (spouse)

Company City (spouse) *

State (Company) (spouse) *

Zip Code (Company) (spouse) *

State/Province/Region & Country (If not U.S.)

Check here if you are a: (spouse) *

U.S. Citizen

Permanent Resident

Not a U.S. Citizen

Country of Citizenship: (spouse) *

Country of Dual or Secondary Citizenship (if applicable):

Country of Birth: (spouse) *

Do you hold a current U.S. immigration visa? (spouse) *

Yes

No

Specify visa type: (spouse) *

Visa number: (spouse) *

Expiration: (spouse) *

Is your spouse your primary beneficiary? *

Yes

No

How many beneficiaries would you like to include? *

How many contingent beneficiaries would you like to include? *

Beneficiary #1 Full Name *

Beneficiary #1 Date of Birth (mm/dd/yyyy) *

Beneficiary #1 Relation to Client *

Beneficiary #1 Type: *

Primary

Contingent

Beneficiary #1 Per Stirpes? 🛈

Yes

No

Beneficiary #1 Social Security Number (###-##-####)

Beneficiary #1 Share % *

______________________________________

Beneficiary #2 Full Name *

Beneficiary #2 Date of Birth (mm/dd/yyyy) *

Beneficiary #2 Relation to Client *

Beneficiary #2 Type: *

Primary

Contingent

Beneficiary #2 Per Stirpes? 🛈

Yes

No

Beneficiary #2 Social Security Number (###-##-####)

Beneficiary #2 Share % *

______________________________________

Beneficiary #3 Full Name *

Beneficiary #3 Date of Birth (mm/dd/yyyy) *

Beneficiary #3 Relation to Client *

Beneficiary #3 Type: *

Primary

Contingent

Beneficiary #3 Per Stirpes? 🛈

Yes

No

Beneficiary #3 Social Security Number (###-##-####)

Beneficiary #3 Share % *

______________________________________

Beneficiary #4 Full Name *

Beneficiary #4 Date of Birth (mm/dd/yyyy) *

Beneficiary #4 Relation to Client *

Beneficiary #4 Type: *

Primary

Contingent

Beneficiary #4 Per Stirpes? 🛈

Yes

No

Beneficiary #4 Social Security Number (###-##-####)

Beneficiary #4 Share % *

______________________________________

Beneficiary #5 Full Name *

Beneficiary #5 Date of Birth (mm/dd/yyyy) *

Beneficiary #5 Relation to Client *

Beneficiary #5 Type: *

Primary

Contingent

Beneficiary #5 Per Stirpes? 🛈

Yes

No

Beneficiary #5 Social Security Number (###-##-####)

Beneficiary #5 Share % *

______________________________________

Beneficiary #6 Full Name *

Beneficiary #6 Date of Birth (mm/dd/yyyy) *

Beneficiary #6 Relation to Client *

Beneficiary #6 Type: *

Primary

Contingent

Beneficiary #6 Per Stirpes? 🛈

Yes

No

Beneficiary #6 Social Security Number (###-##-####)

Beneficiary #6 Share % *

Beneficiary #1 Full Name *

Beneficiary #1 Date of Birth (mm/dd/yyyy) *

Beneficiary #1 Relation to Client *

Beneficiary #1 Type: *

Primary

Contingent

Beneficiary #1 Per Stirpes? 🛈

Yes

No

Beneficiary #1 Social Security Number (###-##-####)

Beneficiary #1 Share % *

______________________________________

Beneficiary #2 Full Name *

Beneficiary #2 Date of Birth (mm/dd/yyyy) *

Beneficiary #2 Relation to Client *

Beneficiary #2 Type: *

Primary

Contingent

Beneficiary #2 Per Stirpes? 🛈

Yes

No

Beneficiary #2 Social Security Number (###-##-####)

Beneficiary #2 Share % *

______________________________________

Beneficiary #3 Full Name *

Beneficiary #3 Date of Birth (mm/dd/yyyy) *

Beneficiary #3 Relation to Client *

Beneficiary #3 Type: *

Primary

Contingent

Beneficiary #3 Per Stirpes? 🛈

Yes

No

Beneficiary #3 Social Security Number (###-##-####)

Beneficiary #3 Share % *

______________________________________

Beneficiary #4 Full Name *

Beneficiary #4 Date of Birth (mm/dd/yyyy) *

Beneficiary #4 Relation to Client *

Beneficiary #4 Type: *

Primary

Contingent

Beneficiary #4 Per Stirpes? 🛈

Yes

No

Beneficiary #4 Social Security Number (###-##-####)

Beneficiary #4 Share % *

______________________________________

Beneficiary #5 Full Name *

Beneficiary #5 Date of Birth (mm/dd/yyyy) *

Beneficiary #5 Relation to Client *

Beneficiary #5 Type: *

Primary

Contingent

Beneficiary #5 Per Stirpes? 🛈

Yes

No

Beneficiary #5 Social Security Number (###-##-####)

Beneficiary #5 Share % *

______________________________________

Beneficiary #6 Full Name *

Beneficiary #6 Date of Birth (mm/dd/yyyy) *

Beneficiary #6 Relation to Client *

Beneficiary #6 Type: *

Primary

Contingent

Beneficiary #6 Per Stirpes? 🛈

Yes

No

Beneficiary #6 Social Security Number (###-##-####)

Beneficiary #6 Share % *

Are both spouses each other's primary beneficiary? *

Yes

No

Spouse's primary beneficiary full name *

Spouse's primary beneficiary date of birth (mm/dd/yyyy) *

Spouse's primary beneficiary relation to client *

Spouse's primary beneficiary Per Stirpes? 🛈

Yes

No

Spouse's primary beneficiary Social Security Number (###-##-####)

Spouse's primary beneficiary Share % *

Are contingent beneficiaries the same for both spouses? *

Yes

No

How many contingent beneficiaries would you like to include? (spouse) *

Beneficiary #1 Full Name *

Beneficiary #1 Date of Birth (mm/dd/yyyy)

Beneficiary #1 Relation to Client *

Beneficiary #1 Per Stirpes? 🛈

Yes

No

Beneficiary #1 Social Security Number (###-##-####)

Beneficiary #1 Share % *

______________________________________

Beneficiary #2 Full Name *

Beneficiary #2 Date of Birth (mm/dd/yyyy)

Beneficiary #2 Relation to Client *

Beneficiary #2 Per Stirpes? 🛈

Yes

No

Beneficiary #2 Social Security Number (###-##-####)

Beneficiary #2 Share % *

______________________________________

Beneficiary #3 Full Name *

Beneficiary #3 Date of Birth (mm/dd/yyyy)

Beneficiary #3 Relation to Client *

Beneficiary #3 Per Stirpes? 🛈

Yes

No

Beneficiary #3 Social Security Number (###-##-####)

Beneficiary #3 Share % *

______________________________________

Beneficiary #4 Full Name *

Beneficiary #4 Date of Birth (mm/dd/yyyy)

Beneficiary #4 Relation to Client *

Beneficiary #4 Per Stirpes? 🛈

Yes

No

Beneficiary #4 Social Security Number (###-##-####)

Beneficiary #4 Share % *

______________________________________

Beneficiary #5 Full Name *

Beneficiary #5 Date of Birth (mm/dd/yyyy)

Beneficiary #5 Relation to Client *

Beneficiary #5 Per Stirpes? 🛈

Yes

No

Beneficiary #5 Social Security Number (###-##-####)

Beneficiary #5 Share % *

______________________________________

Beneficiary #6 Full Name *

Beneficiary #6 Date of Birth (mm/dd/yyyy)

Beneficiary #6 Relation to Client *

Beneficiary #6 Per Stirpes? 🛈

Yes

No

Beneficiary #6 Social Security Number (###-##-####)

Beneficiary #6 Share % *

Do you have any investment holdings that we cannot trade for legal or compliance reasons? (i.e. You're on a board or are a senior executive at a publicly-traded company etc.) *

Yes

No

How many different holdings do you have that we can't trade? *

1. Name or symbol of holding *

1. Approximate quantity of shares held

______________________________________

2. Name or symbol of holding *

2. Approximate quantity of shares held

______________________________________

3. Name or symbol of holding *

3. Approximate quantity of shares held

______________________________________

4. Name or symbol of holding *

4. Approximate quantity of shares held

______________________________________

5. Name or symbol of holding *

5. Approximate quantity of shares held

Do you or your spouse have any investment holdings that we cannot trade for legal or compliance reasons? (i.e. You're on a board or are a senior executive at a publicly-traded company etc.) *

Yes

No

How many different holdings do you or your spouse have that we can't trade? *

1. Name or symbol of holding *

1. Approximate quantity of shares held

______________________________________

2. Name or symbol of holding *

2. Approximate quantity of shares held

______________________________________

3. Name or symbol of holding *

3. Approximate quantity of shares held

______________________________________

4. Name or symbol of holding *

4. Approximate quantity of shares held

______________________________________

5. Name or symbol of holding *

5. Approximate quantity of shares held

If applicable, would you and your spouse like to have visibility over each other's accounts at TD Ameritrade? 🛈

We would like to have ONE login to see all of our accounts.

We would like to BOTH have logins that can each see all of our accounts.

We would like to each have logins to only see accounts that are ours. (i.e. each spouse would not see the other spouse's accounts)

N/A

Other

Please describe your preference: *

Please upload an image of a voided check for the account you will use to fund your investment accounts and receive distributions.

(Note: Providing this check will allow us to pre-fill any move money forms before we send them to you to sign. If you are unable to upload a check at this time, please upload one to the secure link provided in the "Welcome to Our Team & Documents to Complete" email sent from your advisor at your earliest convenience.) 🛈

Thank you for completing this form!

Please take a minute to review all of your information before submitting.