Client Profile

  • The Client Profile must be completed prior to a strategy or product recommendation. Multiple recommendations may re-use sections 1 - 4 if within 90 days of original client signature date or completion date when a client signature is not required. A photo copy of original sections 1 - 4 must be attached to the newly completed sections 5 - 8 for each product recommendation/sale.
  • Complete all fields in each section. If not applicable, use “N/A”. Bolded fields with an asterisk are critical for good order review and if not completed, will delay processing.
  • The completion of a separate Risk Tolerance Questionnaire for each investment goal is also required to complete this form. Please review all documents for completeness and consistency prior to submission.

1. Background Information

Primary

Client/Owner

First Name
Last Name
SSN/TIN
Year of Birth
DOB
Street Address
City
State
Zip
Please complete previous address if changed within last 12 months
Street Address
City
State
Zip
Citizenship:
If non-US, specify
Day/Work Phone:
Evening/Home Phone:
Mobile Phone:
Email:
Status:
Occupation: [?]
Employer Name:
Employer Address:
Employer Address:
No. of Years:
Education: [?]

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Joint or Spouse

Is Joint Owner/Client also the Spouse?

Joint Client/Owner. Check the Box if N/A and add Spousal Information if applicable

First Name
Last Name
SSN/TIN
Year of Birth
DOB
Street Address
City
State
Zip
Please complete previous address if changed within last 12 months
Street Address
City
State
Zip
Citizenship:
If non-US, specify:
Day/Work Phone:
Evening/Home Phone:
Mobile Phone:
Email:
Status:
Occupation:
Employer Name:
Employer Address:
No. of Years:
Education:

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Family
Marital Status:
# of Dependents Age(s)
Name(s)
Name(s)

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2. USA Patriot Act Information

Owner Form of Identification (Please check one.)
Identification Number
State/Country
Issue Date
Exp. Date
Owner Form of Identification (Please check one.)
Identification Number State/Country Issue Date Exp. Date

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Joint Owner Form of Identification (Please check one.)
Identification Number
State/Country
Issue Date
Exp. Date
Joint Owner Form of Identification (Please check one.)
Identification Number State/Country Issue Date Exp. Date

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3. Financial Household (HH) Information

Income
Client/Owner Income Gross HH Income (all sources) [?]
$
Joint Client/Owner Income Gross HH Income (all sources) [?]
$
= *Est. Gross Annual HH Income(s) [?] $
*Est. Monthly Fixed HH Expenses [?] $
Fed. Marginal Tax Bracket: [?]

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Investment Experience (in Years) [?]


INVESTMENT EXPERIENCE (IN YEARS)

None<11-45+
a) CDs [?]
b) Stocks
c) Bonds
d) Annuities
e) Mutual Funds

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Current Holdings [?]

CURRENT HOLDINGS
Complete all that apply (a-i).

a) Cash and Cash Equivalents: $
b) Stocks: $
c) Bonds: $
d) Annuities: $
e) Mutual Funds: $
f) Other Property(ies) Net Equity (excludes primary residence): [?]
$
g) Retirement Accounts (401(k), 403(b), IRA): $
h) Other (529 plans, life policy cash values, alternative investments, etc.): [?] $
 
= i) *Total Assets (above): [?] $
*Net Worth (modified: all assets minus debts; excludes primary residence and associated debt): [?] $
*Liquid Net Worth: [?] $



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4. Insurance Coverage [?]

Indicate issuer and policy coverage:

Indicate issuer and policy coverage:

Client/Owner
Life Insurance
Disability Insurance
Long-Term Care Insurance

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Joint Client/Owner or Spouse
Life Insurance
Disability Insurance
Long-Term Care Insurance
Client/OwnerJoint Client/Owner or Spouse
Life Insurance
Disability Insurance
LT Care Insurance

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Comments
Comments:





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5. Investment Goal [?]

What is the purpose of this investment/insurance?
(Select Only One)
(Select only One):*
What best describes your investment objective
(Select Only One)
objective (Select Only One)*:
After completing a Risk Tolerance Questionnaire specific to this goal, what is your Risk Tolerance?
(Select Only One)
(Select Only One)*

Note to Financial Professional: Please make sure the Client's Investment Objective is in line with his/her stated Risk Tolerance.
Safety of Principal/
Capital Preservation
IncomeIncome & GrowthGrowthAggressive GrowthTrading/Speculation
ConservativeConservativeConservative PlusModerateModerate PlusAggressive
Conservative PlusModerateModerate PlusAggressiveAggressive Plus
Moderate PlusAggressive
What is your expected investment time horizon for this goal?*
Are lifetime income or principal guarantees important to you?
(Select Only One)
(Select only One):*
In making investment decisions, what concerns you most that your Financial Professional can help you with?
(Select Only One)
(Select only One):*
What primary risk do you want addressed most with this investment?
(Select Only One)
(Select only One):*
How do you prefer interacting with your Financial Professional?
(Select Only One)
(Select only One):*
I acknowledge that my Financial Professional will be compensated for the advice, recommendation and service provided.
Note: Not all products allow for fee or commission based compensation. The Financial Professional will inform the client of their options and what products are available with the respective commission/fee structure.
(Select Only One)
(Select only One):*
Accounts and Products GridThe following is based on Primary Investment Goals and Objectives
EducationLarge PurchaseLiquidity(near term)Tax Deferral/ ReliefRetirement/Income/ Wealth Preservation Managing Risk AccumulationOther
Life Index/Universal/WholeDepends on StrategyaNot RecommendedDepends on Strategyaa
Life VariableDepends on StrategyaNot RecommendedDepends on Strategyaa
Corporate Owned Life InsuranceDepends on StrategyaaDepends on Strategyaa
Group Retirement AccountNot RecommendedNot RecommendedNot Recommendedaaa
Brokerageaaaaaa
Brokerage IRANot RecommendedDepends On Time HorizonDepends On Time Horizonaaa
Mutual Fund/Mutual Fund Only Accountaaaaaa
529 PlanaNot RecommendedNot RecommendedNot RecommendedNot RecommendedNot Recommended
Equities/Exchange-Traded Funds/Fixed IncomeDepends on Strategyaaaaa
Advisory AccountsNot RecommendedaaaaDepends On ResponseaDepends On Response
Third Party Asset ManagementNot RecommendedaaaaDepends On ResponseaDepends On Response
Fixed/Immediate AnnuitiesNot RecommendedDepends on Strategy Time HorizonNot Recommendedaaa
Variable / Indexed AnnuitiesNot RecommendedDepends on Strategy Time HorizonNot Recommendedaaa
Alternative InvestmentsNot RecommendedDepends on Strategy Time HorizonNot Recommendedaaa
Client Acknowledgment
(Select Only One)
(Select only One):*

The Accounts and Products Grid may not apply to all entities and depending upon unique client circumstances valid exceptions may apply.

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6. Product Purchase [?]

Unsolicited Transaction(s):
If applicable, recommended hold(s):
Product:
Tax Type (Qual/NQ):
Amount: $
Product
Tax Type (Qual/NQ) Amount: $
(e.g. Retirement Cornerstone)

AXA Network AXA Equitable Fixed and Variable Immediate Annuity and Association Individual Purchases Only

This section is completed for the client's purchase of:
AXA Network non-proprietary fixed annuity product:
AXA Network non-proprietary group annuity / 401k product:
AXA Equitable fixed deferred annuity product:
The proprietary AXA Equitable fixed immediate annuity:
Other:

I am familiar with this product and approve the suitability of this transaction.

Branch Manager (BM) Signature: [?]Print Name:Date:

Branch Manager signature is NOT required for Association 300+ Series, AXA Network variable life and annuity, AXA Network Indexed Life and Annuity and AXA Equitable fixed annuity sales.

Branch Manager signature is always required for:

  • AXA Equitable Variable Fixed Annuities
  • AXA Network Fixed Annuities
  • AXA Network Group Annuities/401k products
Source of funds for this purchase: (Check box and circle sub-item(s)). If more than one box is checked, provide % breakdown. (Must add up to 100%)
Cash:Death Claim, Gift, Inheritance, Checking, Savings, Money Market, Payroll Deduction, CDs: %
Borrowing:Mortgage (Including Reverse Mortgage), Personal Loan, Credit: %
NQ Annuity or Life Insurance: (Replacement, Surrender/Exchange, Policy Loan, Dividend, Withdrawal): %
Qualified Annuity: (Replacement, Surrender/Exchange, Policy Loan, Dividend, Withdrawal): %
401K, Pension Plans, Other Group Retirement Plan: %
NQ: Brokerage, Investment Advisory Assets, Mutual Fund Shares, UIT Shares, Stocks or Bonds: %
Qualified: Brokerage, ERISA Plan, Investment Advisory Assets, Mutual Fund Shares, UIT Shares, Stocks or Bonds: %
Employer Contribution: %
Other: Sale of Car, Home, Business, or Other Asset (specify: ),
Legal Settlement, Lottery/Gaming Proceeds, Other: : %

(For additional Recommendations, attach additional copy of this page)

[California Only]*
Do you intend to apply for means-tested government benefits, including, but not limited to, Medi-Cal or the veterans' aid and attendance benefit?

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7. Additional Client Notes and Important Considerations (Inheritance/windfall, planned retirement date, special care needs, wills, trusts, etc.) [?]

Inheritance/windfall, planned retirement date, special care needs, wills, trusts etc.
  1. a)
  2. b)
  3. c)
  4. d)

Please type the words in the image


8. Additional Information/Acknowledgments [?]

*
Is the Client/Owner/Authorized Person affiliated with or employed by a member of FINRA?
If yes, name of member:
Are you a Politically Exposed Person?
If Yes, please provide position and country:
The plan sponsor acknowledges receipt of the ERISA Section 408(b)(2) fee disclosure and description of services reasonably in advance of opening this account.
I acknowledge receipt and review of applicable prospectuses and/or ADV's prior to the purchase of and insurance/investment in the recommended strategies, tools, and products. Further, I agree that if the strategy selected is for retirement income purposes that I understand that withdrawals of income that exceed dividend and or similar amounts, or in the case of life insurance cost basis, or in the case of certain types of annuities, the annual roll-up or withdrawal benefit that such withdrawals constitute and aggressive method of obtaining income and could cause greater likelihood and risk of depleting the investment asset.
Is the Client/Owner/Authorized Person with an interest in the account either (1) a senior military, governmental or political official in a Non-U.S. country or (2) closely associated with or an immediate family member of such official?
If yes, identify the official, office held and country.
*
Has a financial plan been prepared by AXA Advisors for this recommendation in the last 12 months? (Only check for NaviPlan Level 2 non-fee and fee-based plans.)
If yes, plan # or tool name:

Client/Owner/Authorized Person. By signing below, I acknowledge that the above information is true and correct. For deferred variable and fixed annuity purchases only: I understand that the annuity for which I am applying may have surrender charges and/or market value adjustment (MVA) charges and that taxes may apply if I withdraw money. For deferred or immediate variable or fixed annuity purchases: I did receive a copy of the NAIC Buyer's Guide, if state required. For deferred variable annuities: I did receive a copy of the AXA Advisors annuities disclosure brochure and reviewed it with my Financial Professional. I understand that if this purchase is for a qualified retirement plan account, any tax deferral features do not provide additional benefit and that my purchase is for the product's features and/or benefits other than tax deferral. I also understand that if I am purchasing an AXA Equitable variable annuity any checks accompanying my application should be made payable to "AXA Equitable". AXA Equitable will hold the funds for my benefit in a non-interest bearing "Special Bank Account for the Exclusive Benefit of Customers" until my application is approved, not approved or returned by AXA Advisors. I may request the full return of my payment at any time prior to the issuance of the contract by contacting my Financial Professional. For IRA Owners/Plan Sponsors: I acknowledge receipt of the Disclosure Notice in accordance with relevant guidance from the Department of Labor.

Client/Owner/Authorized Person Signature: Date:
Is the Joint Client/Owner/Authorized Person with an interest in the account either (1) a senior military, governmental or political official in a Non-US country or (2) closely associated with or an immediate family member of such official?
If yes, identify the official, office held, and country.
Joint Client/Owner/Authorized Person Signature: Date:

Financial Professional: I have reviewed all sections of the Client Profile with the Client/Owner, if applicable the Joint Client/Owner and acknowledge the information is accurate and current. This includes information collected at the initial point of sale and any subsequent sales. I am familiar with the product(s) being sold and have determined proper suitability. The client received an NAIC Buyer's Guide, if state required. For deferred variable annuity purchases only: I have reasonable grounds for believing that the recommendations for this customer to purchase/exchange an annuity is suitable on the basis of the facts disclosed by the customer as to his/her investments, insurance products and financial situation and needs.

For individuals, I have verified the identity of the client/owner(s) by reviewing the driver's license/passport or if taken via the mail, a copy of the driver's license is in the file. I have also confirmed how the client/owner(s) acquired or accumulated the funds used to make this purchase. For entities, I have verified the identity of the client/owner by reviewing certified articles of incorporation, business license, partnership agreement or trust agreement and also determined the source of funds. I understand that I have primary responsibility for customer identity verification for non-natural owners, and retained a copy of the documentary proof of the entity's existence and authorized persons in the client's file as required by the AXA Advisors Compliance Manual.

Financial Professional Signature: Date:

Client/Owner Profile for Entities Only - do not complete if the client is an individual

What type of Entity?

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Entity Information
A.
Name:
TIN #:
 
B.

Authorized Person(s) to transact business:

Name:
Title/Trustee:
Name:
Title/Trustee:
Authorized Person Form of Identification (Please check one.)

Identification Number:
State/Country:
Issue Date:
Exp. Date:
 
C.
Street Address:
City, State, Zip:
 
D.
Assets. Cash/Bank Accts:
CD/T-Notes:
Stocks:
Bonds:
Annuities:
Mutual Funds:
Other:
Combined Total Assets:
 
E.
Trust or Incorporation Date:
State or Country of Incorporation or Trust Agreement:
 
F.
Type of Business:
 
G.
Employer Name:
No. of Employees:
 
H.
Type of Plan:
Amount: $
The Plan is:
:
Type of Funding:
 
I.
Important Considerations (includes existing insurance coverage, etc.):