Signator Investors, Inc.

Signator Investors, Inc.
Client Profile Form Instructions
Complete each applicable section of the Client Profile Form. Failure to complete all applicable sections will result in
processing delays and the OSJ’s inability to perform an independent evaluation of your client’s suitability for the investment
suggested and/or purchased.
Instructions
■
This form must be submitted with all new VA account applications, all new VL applications, all new fixed annuity
applications, new equity indexed annuity applications, new 529 account applications, new Brinker and SEI accounts
applications, new purchases of direct mutual funds, new group annuity applications, limited partnerships and all other
investment products and changes of Broker Dealer. This form must also be submitted to update SII of changes to client’s
financial profile for above investment accounts and Brokerage Accounts.
■
Fill out all information. If client is opening multiple accounts, a separate Client Profile Form must be completed for each
account.
■
In accordance with Section 326 of the US Patriot Act, Signator Investors, Inc. (SII) Registered Representatives must ask to
see and collect certain information to verify the identity of customer(s) opening the account. Additional identification
documents may be requested, and SII may reject or close the account/contract or policy at current value, at any time,
based on findings as they apply to these requirements.
■
Client signs this form to certify the accuracy of the information documented.
■
Representative signs where indicated, certifying accuracy, and notes SII Rep Number.
■
Principal signs where indicated, indicating approval of suitability and acceptance on behalf of SII, and notes SII Rep
Number. The Date Application Received by OSJ and Date Sent to Carrier sections must also be completed.
■
Forward the original Client Profile, the original application, check and any other required documentation to the Agency
designated OSJ for suitability review and approval. Upon approval, the OSJ will forward the new account paperwork to
the appropriate fund company/carrier for processing. Please note that procedures for Brokerage account paperwork vary
from this procedure.
■
Maintain a copy of the signed Client Profile Form and accompanying documents for suitability validation in the client file.
■
Please note that account or transaction information included on this Client Profile is not considered trade instructions.
Account or policy applications will be forwarded separately for processing by the fund company/carrier upon receipt in
good order.
■
Client must complete Section E4 – Source of Funds Section, where applicable.
■
For Trusts, UGMA/UTMA, Corporations, Partnerships and Estates: The form should be completed so it reflects the
financial information and objectives of the account owner (the minor, the trust, or entity).
■
Registered Representatives will be held responsible for losses incurred from failure to follow the above procedures.
Page 1 of 10
Client Profile Form
Section A
New Account Record – Variable Annuity, Variable Life, Fixed Annuity, Equity Indexed Annuity, 529 Plans, Brinker and
SEI Accounts, Mutual Fund, Group Annuity, Limited Partnerships, change of broker dealer, etc. (For Brokerage accounts,
please complete the Brokerage application)
Update to existing Account Record (Mutual Fund, Variable Annuity, Variable Life, Brokerage, Limited Partnerships, etc.)
Please list Existing Account/Policy Number:
Section B: Account Type
Individual
Joint
Trust
Custodian (UGMA/UTMA)
Partnership
Corporation
Keogh
Other:
Select type of account
IRA
SEP
403(b) TSA
401(k)
Profit Sharing
Money Purchase
Pension Plan
Other:
Section C1: Personal Information for Account Owner #1
(Complete Section D if account owner is an Entity. Trustee information must be provided below. Legal address and
verification of ID is not required for the minor of an UGMA/UTMA account)
–
First, Middle Initial, Last
–
/
SSN/EIN
Legal Address – No P.O. Box
City
Country of Citizenship
USA
Other:
/
Date of Birth
State
Zip
Country
(Must provide Passport, Permanent Resident Alien Card or Visa)
Please check if dual citizenship applies. List other country:
Verification of Identification
Driver’s License
/
State
Number
/
Expiration (month/day/year)
/
State ID
/
State
Number
Expiration (month/day/year)
State
Number
Expiration (month/day/year)
Passport
/
/
VISA
Country
Number
/
Expiration (month/day/year)
Resident or Permanent Resident Alien Card
/
Country
Other:
/
Number
/
Expiration (month/day/year)
Check if expiration date is not included.
(Must be pre-approved in writing by Signator Compliance)
Page 2 of 10
Marital Status
Single
Married
Number of Dependants
Contact Information
Home Phone (
)
Work Phone (
)
E-mail Address
Employment Information
Employed
(Please include details below)
Retired
Unemployed
US Military
Employer Name
Occupation
Business Street Address
City
State
Zip
Country
Affiliations
Client is affiliated with, or works for a stock exchange or a member firm of an exchange or FINRA:
Yes
No
If yes, Member Firm name
Member Firm Address
City
State
Zip
Country
If this is a brokerage account profile update, you must answer the following: Are you a control person or affiliated with a
publicly traded company as defined in SEC Rule 144? This includes, but is not limited to, 10% shareholders, policymaking
executives and members of the Board of Directors.
Yes
No
If yes, company name:
Section C2: Personal Information for Account Owner #2
(For UGMA/UTMA accounts, include trustee information here)
–
First, Middle Initial, Last
–
SSN/EIN
City
Legal Address – No P.O. Box
Country of Citizenship
USA
Other:
/
/
Date of Birth
State
Country
Zip
(Must provide Passport, Permanent Resident Alien Card or Visa)
Please check if dual citizenship applies. List other country:
Verification of Identification
Driver’s License
/
State
State ID
Number
/
Expiration (month/day/year)
/
/
State
Number
Expiration (month/day/year)
State
Number
Expiration (month/day/year)
Passport
/
/
Page 3 of 10
VISA
/
Country
Number
/
Expiration (month/day/year)
Resident or Permanent Resident Alien Card
/
Country
Number
/
Expiration (month/day/year)
Other:
Check if expiration date is not included.
(Must be pre-approved in writing by Signator Compliance)
Marital Status
Single
Married
Number of Dependants
Contact Information
Home Phone (
)
Work Phone (
)
E-mail Address
Employment Information
Employed
(Please include details below)
Retired
Unemployed
Employer Name
Occupation
Business Street Address
City
US Military
State
Zip
Country
Affiliations
Client is affiliated with, or works for a stock exchange or a member firm of an exchange or FINRA:
Yes
No
If yes, Member Firm name
Member Firm Address
City
State
Zip
Country
If this is a brokerage account profile update, you must answer the following: Are you a control person or affiliated with a
publicly traded company as defined in SEC Rule 144? This includes, but is not limited to, 10% shareholders, policymaking
executives and members of the Board of Directors.
Yes
No
If yes, company name:
Section D: Entity Owner Information
Entity Name
Tax ID
Contact Name
Legal Address – No P.O. Box
City
Street
Home Phone (
)
Work Phone (
State
Zip
Country
)
E-mail Address
Page 4 of 10
Verification of Identification
Trust Agreement
Certified Articles of Incorporation
Partnership Agreement
Other:
Government Issued Business License
(Must be approved by Signator Compliance)
Section E1: Account Mailing Information – complete only if mailing address is different from
legal address
Street or P.O. Box
City
State
Zip
Country
Section E2: Please provide the financial information below as it applies to all owner(s) of this
account, contract or policy
Annual Income
(From all sources)
Estimated Net Worth
(Excluding residence)
Liquid Net Worth
$
$
$
Specify Amount
Specify Amount
Tax Bracket
%
Specify Amount
Specify Percentage
Section E3: Please indicate investment experience along with your goals and objectives as they
apply to this account or subaccounts, contract or policy investment experience specific goals
for this account
General Investment
Experience
Specific Investment
Experience
Risk Tolerance
(Select only one)
(Indicate for all that apply:
Conservative
Extensive
E – Extensive, G – Good,
Moderate
Preservation of Capital
Good
L – Limited, N – None)
Aggressive
Income
Limited
Mutual Funds
Capital Appreciation
None
Variable
Annuities
Aggressive Growth
Speculation
Variable Life
(Brokerage updates only)
Limited
Partnerships
Trading Profits
(Select only one)
Investment
Objectives
Time Horizon
(Select only one)
(Select only one)
Short-term
(0 - 5 years)
Intermediate-term
(6 - 10 years)
Long-term
(10+ years)
(Brokerage updates only)
Wrap Accounts
Section E4: Source of Funds – please check the source of funds and answer questions below
Salary/Current Income
Mutual Fund Redemption
Insurance Surrender/Withdrawal
Savings
Surrender Charge: $
Surrender Charge: $
Stock Redemption
Annuity Surrender/Withdrawal
Other:
Transfer of Assets
Surrender Charge: $
Surrender Charge: $
Page 5 of 10
If source of funds is from a mutual fund or variable annuity redemption
The reason for the exchange is:
Performance did not meet my expectations
My investment objective has changed
Other:
Section E5: Investment Choices – Please check the box that corresponds to the product(s) you
are purchasing
Annuity – Individual
Mutual Fund
(Complete Section F)
(Complete Section G)
Annuity – Group
529 College Savings Plan
(Complete Section F)
(Complete Section G)
Unit Investment Trust
Life Insurance – Individual
Equity Indexed Annuities (Pre-approved
Specify Amount $
(Complete Section F)
by SII) (Complete Section F)
Life Insurance – Group
Wrap Account
Limited Partnership
Specify Amount $
Specify Amount $
(Complete Section F)
Real Estate Investment Trust
Specify Amount $
Section F: Annuities and Life Insurance purchases – Please provide information for the product
you are purchasing
Section F1: Annuity Information (Complete Section F1, F3 & F4)
Company
Fixed Annuity
Product Name
Variable Annuity
Please Indicate Purpose of this Annuity
Investment Amount: $
(check all that apply)
Death Benefit
Retirement Income
Annuitized Payments
College Savings
Tax Deferred Growth
Other:
Please provide the details on how you and the client determined that the contract is suitable for the client.
Page 6 of 10
Section F2: Life Insurance Information (Complete Section F2, F3 & F4)
Company
Product Name
Planned Annual Premium: $
Face Amount: $
Please Indicate Purpose of this Insurance
(check all that apply)
Death Benefit
Charitable Gift Insurance Plan
Mortgage or Debt Liquidation
Replace Family Income
Supplement Retirement Funds
Supplement College Savings
Estate Settlement Costs and Taxes
Other:
Do you currently have any additional insurance coverage?
Yes
No
Amount $
Please provide the details on how you and the client determined that the policy is suitable for the client.
Section F3: Please list sub-account selections and percentage below
Sub-account Name
%
Sub-account Name
%
= 100%
Section F4: If proposed purchase is replacing an insurance policy or annuity contract, please
complete the following section
A: Existing Contract/Policy:
Contract/Policy # (s):
Company:
Product Name
(Annuity contracts only)
Contract/Policy Value:
Surrender Charges Incurred:
Net Surrender Value:
(Insurance policies only) Is the policy a MEC?
Qualified
Non Qualified
Yes
No
Page 7 of 10
B:
Existing Contract/Policy
Fixed Annuity
Traditional Life
Cost/Benefit $/%
Variable Annuity
Variable Life
EIA
Proposed Contract/Policy
Fixed Annuity
Traditional Life
Contract/Policy Type
Variable Annuity
Variable Life
EIA
Age at Issue
Current
Total Death Benefit
At Issue
Remaining Surrender Charge Schedule
Surrender Charge Schedule
Proposed Surrender Charge Schedule
Annual Premium
(Insurance Policies Only)
Administrative Fee (Annuity)/
Administrative Expense
Charge (Insurance)
Mortality & Expense Risk Charge (Annuity)/
Maximum Sales Charge (Insurance)
Total Annual Fund Expenses (Annuity)/
Total Asset Based Charges(Insurance)
Other Riders (list Cost & Fees)
Other Fees (list Cost & Fees)
C: Replacement Justification
1. Please provide the specific benefits of the proposed contract/policy to the customer that cannot be found on the existing
contract/policy (check all that apply):
Increased Death Benefit
Bonus
Guarantees
Lower Fees
Lower Premiums
Other
Increased Investment Options
(please specify)
Riders
(please specify)
(please specify)
(please specify)
2. Please provide the specific disadvantages of replacing the existing contract/policy (check all that apply):
Surrender Charge
New Surrender Schedule
Decreased Death Benefit
Increased Fees
Decreased Investment Options
Interest Rate Decrease
Tax Liability
Loss of Riders
Loss in Guarantees
(please specify)
Other
(please specify)
(please specify)
Page 8 of 10
3. Has the client exchanged any other contract/policy within the past 36 months?
Yes (please specify)
Life
Annuity
Date
Surrender Charge $
Life
Annuity
Date
Surrender Charge $
Life
Annuity
Date
Surrender Charge $
4. Are you the writing agent on the existing contract/policy that will be replaced?
Yes
No
No
Section G1: For Mutual Fund or 529 Plan purchases, please list fund selection and amount below
Company
Fund Name
Share Class
%
= 100%
If purchasing a 529 Plan, I understand that a plan offered by my state of residence may provide tax benefits that are not
afforded to a plan sponsored by another state.
Section G2: Please indicate whether you or any eligible household member hold shares of any
funds, or have a LOI on file at any company, that would qualify you for a breakpoint
Yes
(please specify)
Company
No
Breakpoint
(Representative – Please notify SII Trade Desk or the Fund Company for direct accounts that the shareholder is eligible for a
breakpoint).
If you are not taking advantage of a breakpoint opportunity, please explain why
Page 9 of 10
Client Acknowledgements
Please review the following acknowledgements for all account, contract and policy types and sign below.
For all accounts, contract or policy types:
1. I (we) acknowledge that I (we) have received a prospectus for the product that I am (we are) purchasing. I (we) have
discussed the material information in the prospectus, including charges and expenses, with my representative, and I (we)
agree with the recommendation to purchase this product.
2. The investor information contained on this form accurately describes my (our) investment objective, financial situation
and employment as it pertains to this account, policy or contract.
3. If the source of funds for the investment to be purchased is from the sale of another investment/insurance policy, I (we)
understand the potential tax consequences resulting from the sale and the fact that I (we) may have paid a sales
charge/commission on the product surrendered or redeemed.
4. I (we) received the Signator Investors, Inc. and John Hancock Financial Network Welcome Brochure, which highlights
important information about Signator Investors, Inc and investment products that you may be considering for purchase.
5. If I am a client of my representative’s previous firm, I understand that I can continue to hold my existing investment(s) at
that firm.
For Limited Partnerships:
1. I (we) have received and read a current offering document for the Limited Partnership selected and understand the
investment objectives and suitability requirements of the partnership.
2. I (we) understand that this is an illiquid investment, and should I (we) need to sell this asset at any time, I (we) risk selling
at a loss, not finding any buyer or losing my (our) entire investment.
3. I (we) understand that a portion of the distributions received from this investment may represent a return of principal.
For Class B-Share Mutual Funds:
1. I (we) acknowledge that my (our) representative has reviewed with me (us) the FINRA Mutual Fund Analyzer which
compares expenses and charges of this Class B share purchase with those of a Class A share purchase (required for
purchases between $50,000 and $99,999).
2. I (we) acknowledge that Class B share purchases over $100,000 will not be accepted.
3. I (we) understand that Signator Investors, Inc. may cancel this trade if deemed inappropriate to my (our) financial goals
and objectives.
Client/Owner Signatures
Primary Account Holder Signature
Date
/
/
Secondary Account Holder Signature
Date
/
/
Registered Representative Signature
I certify that I have seen the customer’s identification indicated in Section C (or have received approval from SII Compliance
for a CIP exception).
Registered Representative Name (Print)
Registered Representative Signature
Representative Number
Date
Agency Number
/
/
Telephone Number
Registered Principal Signatures
Registered Principal Name
(Print)
Representative Number
Date Application Received at OSJ
SII380 02/08
/
Date
Registered Principal Signature
Agency Number
/
/
/
Telephone Number
Date Sent to Carrier
/
/
Page 10 of 10