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

3. Financial Information

Annual Household Income

Liquid Net Worth

Total Net Worth (excl. primary residence)

Number of Dependents

Estimated Amount to Invest with Us

Federal Tax Bracket

4. Source of Funds

Where will the funds for investment come from? (Check all that apply)

Employment Income / Savings Business Income / Sale Investment / Stock Sale Proceeds Inheritance / Gift Retirement Account Distribution Real Estate Sale Transfer from Another Advisor Other

If "Other" or additional details, please explain:

5. Investment Timeline & Goals

Current Age

Target Retirement Age

Investment Time Horizon

Primary Investment Objective

Do you need income from this account?

8. Current Financial Situation

Do you currently work with a financial advisor?

Do you anticipate needing to withdraw funds within the next 12 months?

Any investment restrictions or exclusions?

9. 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

10. How Did You Hear About Us?

Referral Source

Referring Person's Name (if applicable)

11. Trusted Contact & Beneficiary Information

FINRA Rule 4512 requires us to request a trusted contact person. This person may be contacted in limited circumstances, such as if we have concerns about your health or welfare.

Trusted Contact (Recommended)

Name

Relationship

Phone

Primary Beneficiary (for reference only - official designation made with custodian)

Name

Relationship

% Allocation

12. 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. Source of Funds

5. Investment Timeline & Goals

6. Risk Tolerance Assessment

7. Investment Experience

8. Current Financial Situation

9. Regulatory Questions

10. How Did You Hear About Us?

11. Trusted Contact & Beneficiary Information

Trusted Contact (Recommended)

Primary Beneficiary (for reference only - official designation made with custodian)

12. Additional Information

Certification

Simpli-FI Alpha LLC

INVESTOR PROFILE QUESTIONNAIRE

1. Personal Information

2. Contact Information

3. Financial Information

4. Source of Funds

5. Investment Timeline & Goals

6. Risk Tolerance Assessment

7. Investment Experience

8. Current Financial Situation

9. Regulatory Questions

10. How Did You Hear About Us?

11. Trusted Contact & Beneficiary Information

Trusted Contact (Recommended)

Primary Beneficiary (for reference only - official designation made with custodian)

12. Additional Information

Certification

Thank You!

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