Simpli-FI Alpha LLC

New Client Intake Form

Please complete all required fields. Your information is kept strictly confidential.

INVESTOR PROFILE QUESTIONNAIRE

Confidential Client Information

1. Personal Information

Legal First Name

Legal Last Name

Middle Name

Suffix

Date of Birth

SSN (Last 4 digits)

Marital Status

Citizenship

Employer / Company

Occupation / Title

2. Contact Information

Email Address

Mobile Phone

Home Phone

Work Phone

Street Address

City

State

ZIP

Preferred Contact Method

Best Time to Contact

6. Regulatory Questions

These questions are required for compliance purposes.

Are you or an immediate family member a senior political figure, senior executive of a government-owned enterprise, or an immediate family member of such person? (Politically Exposed Person - PEP)

No Yes

Are you or an immediate family member a director, 10% shareholder, or policy-making officer of a publicly traded company?

No Yes

Are you employed by or affiliated with a broker-dealer or investment adviser?

No Yes

7. How Did You Hear About Us?

Referral Source

Referring Person's Name (if applicable)

8. Additional Information

Is there anything else you'd like us to know about your financial situation, goals, or concerns?

What questions do you have for us?

Certification

By submitting this form, I certify that:

• The information provided is true, complete, and accurate to the best of my knowledge
• I understand this information will be used to assess my suitability for investment advisory services
• I agree to notify Simpli-FI Alpha LLC promptly of any material changes to this information
• I consent to being contacted by Simpli-FI Alpha LLC regarding investment advisory services

Full Legal Name (as signature)

Date

Simpli-FI Alpha LLC

INVESTOR PROFILE QUESTIONNAIRE

1. Personal Information

2. Contact Information

3. Financial Information

4. Investment Timeline & Goals

5. Risk Tolerance

6. Regulatory Questions

7. How Did You Hear About Us?

8. Additional Information

Certification

Simpli-FI Alpha LLC

INVESTOR PROFILE QUESTIONNAIRE

1. Personal Information

2. Contact Information

3. Financial Information

4. Investment Timeline & Goals

5. Risk Tolerance

6. Regulatory Questions

7. How Did You Hear About Us?

8. Additional Information

Certification

Thank You!

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