This form contains 70 fields organized into 17 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Analysis Process Description
Analysis Process Description Text
Provide a detailed description of the process and/or tools used for analyzing the cost of the current recommendation and its reasonably available alternatives.
Benefits of Selected Product
4. Investment Options Checkbox
Check this box if the selected product offers investment options that the alternative products do not.
4. Tax Benefits Checkbox
Check this box if the selected product offers tax benefits that the alternative products do not.
4. Income Generation Checkbox
Check this box if the selected product offers income generation that the alternative products do not.
4. Death Benefit Checkbox
Check this box if the selected product includes a death benefit that the alternative products do not.
4. Diversification Checkbox
Check this box if the selected product offers diversification that the alternative products do not.
4. Inflation Protection Checkbox
Check this box if the selected product offers inflation protection that the alternative products do not.
4. Access to Cash Checkbox
Check this box if the selected product offers access to cash that the alternative products do not.
4. Lower Cost Checkbox
Check this box if the selected product offers lower cost than the alternative products.
4. Other Checkbox
Check this box if the selected product offers another benefit not listed above that the alternative products do not.
Other Benefit/Need Text
Please specify any other benefit or need that the selected product offers that alternative products do not. Fill only if '4. Other' is 'Yes'.
Depends on: 4. Other
Client Financial Needs
Death Benefit/Enhanced Death Benefit Checkbox
Check this box if the client's financial needs include providing a death benefit or an enhanced death benefit.
Debt Protection Checkbox
Check this box if the client's financial needs include protecting against or paying off debt.
Business Purposes Checkbox
Check this box if the client's financial needs are related to business purposes.
Estate Planning Checkbox
Check this box if the client's financial needs involve estate planning.
Diversification of Investments Checkbox
Check this box if the client's financial needs include diversifying their investment portfolio.
Asset Rebalancing Checkbox
Check this box if the client's financial needs include rebalancing their assets.
Charitable Giving Checkbox
Check this box if the client's financial needs involve charitable giving.
Income Generation Checkbox
Check this box if the client's financial needs focus on generating income from their investments.
Annuitization Options Checkbox
Check this box if the client's financial needs include annuitization options.
Savings, Accumulation Checkbox
Check this box if the client's financial needs involve saving and accumulating wealth.
Retirement Funding Checkbox
Check this box if the client's financial needs are for funding their retirement.
Education/College Funding Checkbox
Check this box if the client's financial needs are for funding education or college expenses.
Other Checkbox
Check this box if the client has financial needs not listed above and provide details.
Other Financial Need Text
Please specify any other financial need that the client is trying to meet through this product or account type. Fill only if 'Other' is 'Yes'.
Depends on: Other
Client Information
Client Name Text
Please provide the full name of the client.
Client SSN/Tax ID Text
Please provide the client's Social Security Number or Tax ID.
Client's Preferred Investment Strategy
Buy/Hold Strategy Checkbox
Check this box if the client's preferred investment strategy is to purchase and hold securities for an extended period, focusing on long-term growth rather than short-term fluctuations.
Dollar Cost Averaging Checkbox
Check this box if the client's preferred investment strategy involves investing a fixed amount of money at regular intervals, regardless of market price, to reduce the average cost per share over time.
Income Generation Checkbox
Check this box if the client's preferred investment strategy is primarily focused on generating regular income from their portfolio, typically through dividends, interest, or rental income.
Margin Checkbox
Check this box if the client's preferred investment strategy includes using borrowed funds from a brokerage firm (margin) to purchase securities.
Asset Allocation Checkbox
Check this box if the client's preferred investment strategy involves distributing investments among various asset classes, such as stocks, bonds, and cash equivalents, to manage risk and return.
Hedging Checkbox
Check this box if the client's preferred investment strategy includes using financial instruments to offset potential losses in an existing investment or portfolio.
Fixed Income Laddering Checkbox
Check this box if the client's preferred investment strategy involves staggering the maturity dates of fixed income securities to manage interest rate risk and provide a consistent stream of income.
Explicit Hold Checkbox
Check this box if the client's preferred investment strategy requires specific instructions to hold certain assets, possibly due to tax implications or long-term strategic goals.
Diversification Checkbox
Check this box if the client's preferred investment strategy emphasizes spreading investments across various assets, industries, and geographic regions to minimize risk.
Liquidation/Withdrawal Checkbox
Check this box if the client's preferred investment strategy includes specific plans for the systematic liquidation or withdrawal of funds from their investments.
Tax Strategy Checkbox
Check this box if the client's preferred investment strategy is significantly influenced by tax considerations and aims to optimize tax efficiency for their investments.
Active Trading Checkbox
Check this box if the client's preferred investment strategy involves frequent buying and selling of securities in an attempt to profit from short-term price movements.
Other Checkbox
Check this box if the client's preferred investment strategy is not adequately described by the other listed options and write in the specific strategy.
Other Investment Strategy Text
Please provide details for any other preferred investment strategy not listed. Fill only if 'Other' is 'Yes'.
Depends on: Other
Conflicts of Interest Disclosure
Oral Conflicts of Interest Disclosure Text
Provide details of any conflicts of interest that were disclosed orally to the client.
Fifth Financial Professional Signature
Fifth Financial Professional Signature Text
Please provide the fifth financial professional's signature.
Fifth Financial Professional Signature Date Date
Please provide the date of the fifth financial professional's signature. Fill only if 'Fifth Financial Professional Signature' is signed.
Depends on: Fifth Financial Professional Signature
Financial Professional Information
Financial Professional Name Text
Enter the full name of the financial professional.
Rep Code Text
Provide the representative code for the financial professional.
First Client Signature
Client Signature Text
Please enter the client's signature.
Signature Date Date
Please enter the date the client signed. Fill only if 'Client Signature' is signed.
Depends on: Client Signature
First Financial Professional Signature
First Financial Professional Signature Text
Provide the signature of the first financial professional.
First Financial Professional Signature Date Date
Provide the date when the first financial professional signed. Fill only if 'First Financial Professional Signature' is signed.
Depends on: First Financial Professional Signature
Form CRS Delivery Date
Form CRS Delivery Date Date
Provide the date the Client Relationship Summary (Form CRS) was delivered.
Fourth Financial Professional Signature
Fourth Financial Professional Signature Text
Enter the full name of the fourth financial professional signing the document.
Date of Fourth Financial Professional Signature Date
Provide the date when the fourth financial professional signed the document. Fill only if 'Fourth Financial Professional Signature' is signed.
Depends on: Fourth Financial Professional Signature
Other Factors in Investment Decision
Other Factors Text
Provide details on any other factors not discussed above that played into the investment decision with the client.
Reasonably Available Alternatives
Annuities Checkbox
Check this box if annuities were considered as a reasonably available alternative with the client.
Investment Advisory Accounts Checkbox
Check this box if investment advisory accounts were considered as a reasonably available alternative with the client.
Taxable Brokerage Account Checkbox
Check this box if a taxable brokerage account was considered as a reasonably available alternative with the client.
Non-taxable Brokerage Account Checkbox
Check this box if a non-taxable brokerage account was considered as a reasonably available alternative with the client.
Life Insurance Checkbox
Check this box if life insurance was considered as a reasonably available alternative with the client.
529 Accounts Checkbox
Check this box if 529 accounts were considered as a reasonably available alternative with the client.
Coverdell Account Checkbox
Check this box if a Coverdell account was considered as a reasonably available alternative with the client.
Direct Mutual Fund Account Checkbox
Check this box if a direct mutual fund account was considered as a reasonably available alternative with the client.
Other Checkbox
Check this box if any other alternatives not listed were considered with the client.
Other Reasonably Available Alternative Text
Please specify any other reasonably available alternative considered with the client. Fill only if 'Other' is 'Yes'.
Depends on: Other
Second Client Signature
Second Client Signature Text
Please enter the second client's full signature.
Second Client Signature Date Date
Please enter the date the second client signed. Fill only if 'Second Client Signature' is signed.
Depends on: Second Client Signature
Second Financial Professional Signature
Second Financial Professional Signature Text
Enter the second financial professional's signature.
Second Financial Professional Signature Date Date
Enter the date the second financial professional signed. Fill only if 'Second Financial Professional Signature' is signed.
Depends on: Second Financial Professional Signature
Third Financial Professional Signature
Third Financial Professional Signature Text
Please enter the signature for the third financial professional.
Date of Third Financial Professional Signature Date
Please provide the date of the third financial professional's signature. Fill only if 'Third Financial Professional Signature' is signed.
Depends on: Third Financial Professional Signature