HELPLINE: DTB Wealth Management
LET’S GET TO KNOW YOU BETTER
Personal Details
YOU AND YOUR FAMILY
YOU AND YOUR FAMILY
INCOME, ASSETS AND LIABILITIES
LIABILITIES & EXPENDITURES
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.
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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
UK National Insurance number (NIN)
French TAX identification number (see top left of tax d'habitatioon or impots sur le revenue
Primary address (specify the country please)
N° of months spent at that addresse per year
Secondary address (if any)
Telephone
Mobile
Nationality
Dual nationality (Please specify)
Other (Please specify)
Country of residence (Please select)
The date you left the UK
Your last UK address
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
UK National Insurance number (NIN)
French TAX identification number (see top left of tax d'habitatioon or impots sur le revenue
Primary address (specify the country please)
N° of months spent at that addresse per year
Secondary address (if any)
Telephone
Mobile
Nationality
Dual nationality (Please specify)
Other (Please specify)
Country of residence (Please select)
The date you left the UK
Your last UK address
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 ?
If yes, please specify
Have you other dependent relatives living with you ?
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 ?
If yes, please specify
Have you other dependent relatives living with you ?
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 ?
If yes, please give details
Are any family arrangements, like donations or legacy planned in a close future ?
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
YOUR OBJECTIVES
Please check the objectives that apply to you or your partner
YOU - Are you a politically exposed person (PPE)
PARTNER - Are you a politically exposed person (PPE)
YOU - Is anyone around you a PPE?
PARTNER - Is anyone around you a PPE?
YOU - What type of investor are you (what is your aversion to risk)
PARTNER - What type of investor are you (what is your aversion to risk)
YOU - On a scale from 1 to 7 what would be your level of risk you are prepared to take (1is very low, 7 is very high)
PARTNER - On a scale from 1 to 7 what would be your level of risk you are prepared to take (1is very low, 7 is very high)
YOU - What type of client are you
PARTNER - What type of client are you
Please explain in a few words your objectives, projects, or what you need and expect from us
Upload Proof of Address
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Upload Proof of ID
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Upload any other relevant documents
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Upload your Private Pension 1
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Upload your Private Pension 2 (or your partners)
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Upload your Private Pension 3 (or your partners)
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Upload your partner's passport
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Upload the introductory document signed *
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SUSTAINABILITY – ESG
SUSTAINABILITY CRITERIA The ESG criteria include three different criteria: • Environnemental, • Social, • Governance. These criteria make it possible to measure the extent to which companies take sustainable development and long-term issues into account. These criteria are associated with several good and bad practices to be avoided: • Environmental criteria: carbon footprint, greenhouse gas emission reduction strategy, energy consumption, waste management and recovery, prevention of impacts on biodiversity (e.g., pollutant discharges), etc. • Social criteria: parity, inclusiveness of minorities and disabilities, compliance with labor law, quality of dialogue with stakeholders, employee training, safety at work, etc. • Governance criteria: consideration of stakeholders' opinions in the management of the company, third-party auditing, diversity on the board of directors, transparency of salaries, fight against corruption, etc.
Are you likely to be interested in sustainable investment, ESG criteria?
Do you wish to invest a minimum percentage of the investment in sustainable investment ?
Would you like your advisor to consider Environnemental criteria?
Would you like your advisor to consider Social criteria ?
Would you like your advisor to consider Governance criteria?
Are you prepared to accept lower performance in case of ESG investments ?
Within your investment, what is your environmental/sustainability/social objective in your investments (in %)?
For each of the criteria below, please indicate your preference:
Acceptance
I would like my advisor to take this criterion into account in part in his recommendations and proposed investments, but if I must choose between respecting this criterion and a negative impact on the risk/return ratio of the investment or a hardening of my investor profile, I prefer to reduce or abandon this criterion.
Please indicate your choice for each criterion based on the above: