Financial Tax Suitability Assessment

FINANCIAL TAX SUITABILITY ASSESSMENT

Purpose: This Financial Tax Suitability Assessment collects client tax, income and investment information necessary for evaluating the suitability of tax-sensitive financial strategies. Completion and signature certify that the information provided is true, accurate, and complete to the best of the signer’s knowledge and that the client understands the limits of this assessment as set forth in the Declaration and Consent section below.

1. Client Identification

Date of Birth:

Individual    Trust    Sole Proprietor    Partnership    Corporation    S-Corporation    LLC

2. Tax Residency and Filing

Country of Legal Residence:

State of Residence (if applicable):

U.S. citizen    U.S. resident alien    Non-resident alien

Single    Married filing jointly    Married filing separately    Head of household    Other:

Most recent tax return filed (tax year):

Have you filed amended or late returns in the past 5 years?   Yes    No

3. Income and Taxable Events (Estimated)

Primary Sources of Income — indicate amount where applicable

4. Current Investments and Tax-Advantaged Accounts

IRA / Roth IRA — Balance:

401(k) / 403(b) — Balance:

Taxable brokerage — Balance:

Municipal bonds — Par value:

Cryptocurrency holdings — Estimated value:

5. Tax Objectives and Preferences

Primary tax objectives (check all that apply):

Tax deferral    Tax-loss harvesting    Income tax minimization    Estate tax planning    Maximizing tax credits

6. Experience, Time Horizon and Risk Considerations

Self-reported tax and investment experience (select one)

None    Limited    Moderate    Sophisticated

Investment time horizon (select one)

Short-term (0-3 years)    Medium-term (3-7 years)    Long-term (7+ years)

Are you willing to accept temporary increases in taxable income to pursue long-term tax benefits?   Yes    No

7. Known or Anticipated Taxable Events

Sale of real property    Sale of business interest    Realization of large capital gains    Recognition of significant losses    Receipt of inheritance or bequest

8. Declaration, Consent and Acknowledgements

By signing below I, the undersigned client, certify under penalty of perjury that the information contained in this Financial Tax Suitability Assessment is true, correct, and complete. I acknowledge and agree that:

(a) This assessment is provided to assist in evaluating the suitability of tax-sensitive investment strategies and is not a substitute for specific tax advice. I will obtain independent tax counsel or a qualified tax professional for any binding tax determinations or when complex tax consequences may arise.

(b) The firm and its representatives may rely on the information provided herein in formulating recommendations; I agree to promptly notify the firm of any material changes in my tax status, income, residency or holdings that could affect suitability.

(c) I understand that tax rules and applicable law are subject to change and that the firm does not guarantee any particular tax result. I release the firm from liability for tax consequences that result from inaccurate or incomplete information provided by me, or from reliance on tax law that is later changed.

(d) I consent to the firm obtaining and retaining copies of my relevant tax documents as necessary to perform the suitability assessment, subject to the firm’s document handling and confidentiality policies.

9. Advisor / Analyst Use Only

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