Client Questionnaire - JMG Financial Group

Client 1 Information

Name *

First

Middle

Last

Date of Birth *

Social Security Number *

Citizenship *

Current Employer *

If not employed or you're retired, please enter "n/a" or "retired".

Current Position/Title

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Business Address

Address Line 1

Address Line 2

City

State

Zip Code

Preferred Email Address(es)

Layout

Email Type: *

Email: *

Other Email Address

Layout

Preferred Phone Number

Phone 1

Phone Type: *

Phone Number:

Other Phone Number(s)

Phone 2

Phone 3

Restrictions

Checkboxes

I am considered an insider for SEC purposes.
I am restricted to trading windows and blackout periods.

Please note any restriction on boards or other companies

Government Issued ID

Layout

Front of ID

Click or drag a file to this area to upload.

Back of ID

Click or drag a file to this area to upload.

Is there a second client? *

Yes
No

Client 2 Information

Name *

First

Middle

Last

Date of Birth *

Social Security Number *

Citizenship *

Current Employer *

If not employed or you're retired, please enter "n/a" or "retired".

Current Position/Title

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Only need to fill if differs from Client 1.

Business Address

Address Line 1

Address Line 2

City

State

Zip Code

Preferred Email Address(es)

Email Addresses (copy)

Other Email Address

Layout

Preferred Phone Number

Phone 1

Other Phone Number(s)

Phone 2

Phone 3

Restrictions

Checkboxes

I am considered an insider for SEC purposes.
I am restricted to trading windows and blackout periods.

Please note any restriction on boards or other companies

Government Issued ID

Layout (copy)