Name

Email Address

Current place of residence?

How long have you lived there?

What is/are your Citizenship(s)?

What is your filing status?
SingleMarried Filing JointlyMarried Filing Separately

What are your sources of income?
SalaryShare based remunerationSecurities tradingInvestment IncomePensionsSocial SecurityCapital Gains TaxOther

Are your US Federal/State tax filings up to date?
YesNo

Do you have a requirement to file a Foreign Bank Account Report? If so, for what year did you last file such a report ?
YesNo

Any other relevant information?