Client Data Information Sheet
Client Information
Exact legal company name or individual's name:
*
Address:
*
City:
*
State:
*
Zip:
*
Contact person:
*
Title:
*
E-Mail:
*
Phone:
*
Fax:
*
Payroll Provider:
*
In-House
Type of business:
LLC
Sole Proprietor
Partnership
C-Corp.
S-Corp.
If an LLC, how is the LLC taxed?
Corporation
Partnership
Tax ID #:
*
(If a Sole proprietor, Social Security #s are not acceptable. Client must apply for an EIN.)
Business Inception Date:
*
State of Incorporation:
*
Fiscal Year End:
*
Business Code/Type:
Union EE's?
Yes
No
Do you own other businesses, does your spouse or does any other immediate family members:
Yes
No
(if yes complete a seperate Client Data Sheet for each company)
Participating Employer:
Unrelated
Controlled Group
Affiliated Service Group
None
(
Attach seperate Client Data Information Sheet for each entity
)
Other Plans
Do you now or have you in the past had a Qualified plan?
Yes
No
401(k)
Profit Sharing
Money Purchase
Defined Benefit
Where are the assets held:
Exisiting Plan Year End:
If you have a qualified plan we must have copies of the following immediately:
The Adoption Agreement & Plan Document
Most recent Valuation
Most recent 5500 form filed
Do you have a
SEP IRA
or a
Simple IRA
- if so what was the last year funded:
Ownership
* Corporate Officers
Title
% of Stock Owned
Director on Board?
Y
N
Y
N
Advisors
Broker:
Accountant:
Firm:
Firm:
Address:
Address:
City:
City:
State:
Zip:
State:
Zip:
Phone:
Phone:
Email:
Email:
Remarks:
* denotes required fields
Arlene Williams
Phone: 818.593.3535
The Senex Group
Fax: 818.593.3550
Woodland Hills Financial Center
arlene@senexgroup.com
21021 Ventura Boulevard, Suite 310
Woodland Hills, CA 91364