LET’S GET STARTED Investing/Banking Quick Form First Name * Last Name * Email * Phone Number * Date of Birth * What are you interested in? * Investing Banking Mortgage What type of investing are you interested in? * Stocks Bonds RRSPs Mutual Funds TFSAs High Interest Saving How much do you want to invest on a monthly basis? * $ If you are human, leave this field blank. Submit → OR Online Application Your birthdate Next → What are you interested in? Investments Banking ← Back Next → What is your address? Province ---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Country Canada ← Back Next → Are you a canadian citizen? Yes No What is your residency status? ---Permanent ResidentOn VisaOn Work VisaOn Student VisaRefugee StatusApplied for Permanent Status Previous Country of Residence ---United States (USA)ArubaAfghanistanAngolaAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntigua and BarbudaAustraliaAustriaAzerbaijanBurundiBelgiumBeninBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaBelarusBelizeBermudaBolivia, Plurinational State ofBrazilBarbadosBrunei DarussalamBhutanBotswanaCentral African RepublicCanadaSwitzerlandChileChinaCôte d’IvoireCameroonCongo, the Democratic Republic of theCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaSpainEstoniaEthiopiaFinlandFijiFranceGabonUnited KingdomGeorgiaGhanaGuineaGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGuatemalaGuamGuyanaHong KongHondurasCroatiaHaitiHungaryIndonesiaIndiaIrelandIran, Islamic Republic ofIraqIcelandIsraelItalyJamaicaJordanJapanKazakhstanKenyaKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, Republic ofKuwaitLao People’s Democratic RepublicLebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMacedonia, the former Yugoslav Republic ofMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia, Federated States ofMoroccoMonacoMoldova, Republic ofMadagascarMontenegroMongoliaMozambiqueMyanmarNamibiaNigerNigeriaNicaraguaNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People’s Republic ofPortugalParaguayPalestine, State ofQatarRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSerbiaSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSeychellesSyrian Arab RepublicChadTogoThailandTajikistanTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTuvaluTaiwan, Province of ChinaTanzania, United Republic ofUgandaUkraineUruguayUzbekistanSaint Vincent and the GrenadinesVenezuela, Bolivarian Republic ofVirgin Islands, U.S.Viet NamVanuatuSamoaYemenSouth AfricaZambiaZimbabwe Date of entry into Canada ← Back Next → Where were you born? CanadaUnited States (USA)ArubaAfghanistanAngolaAlbaniaAndorraUnited Arab EmiratesArgentinaArmeniaAmerican SamoaAntigua and BarbudaAustraliaAustriaAzerbaijanBurundiBelgiumBeninBurkina FasoBangladeshBulgariaBahrainBahamasBosnia and HerzegovinaBelarusBelizeBermudaBolivia, Plurinational State ofBrazilBarbadosBrunei DarussalamBhutanBotswanaCentral African RepublicCanadaSwitzerlandChileChinaCôte d’IvoireCameroonCongo, the Democratic Republic of theCongoCook IslandsColombiaComorosCape VerdeCosta RicaCubaCayman IslandsCyprusCzech RepublicGermanyDjiboutiDominicaDenmarkDominican RepublicAlgeriaEcuadorEgyptEritreaSpainEstoniaEthiopiaFinlandFijiFranceGabonUnited KingdomGeorgiaGhanaGuineaGambiaGuinea-BissauEquatorial GuineaGreeceGrenadaGuatemalaGuamGuyanaHong KongHondurasCroatiaHaitiHungaryIndonesiaIndiaIrelandIran, Islamic Republic ofIraqIcelandIsraelItalyJamaicaJordanJapanKazakhstanKenyaKyrgyzstanCambodiaKiribatiSaint Kitts and NevisKorea, Republic ofKuwaitLao People’s Democratic RepublicLebanonLiberiaLibyaSaint LuciaLiechtensteinSri LankaLesothoLithuaniaLuxembourgLatviaMacedonia, the former Yugoslav Republic ofMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia, Federated States ofMoroccoMonacoMoldova, Republic ofMadagascarMontenegroMongoliaMozambiqueMyanmarNamibiaNigerNigeriaNicaraguaNetherlandsNorwayNepalNauruNew ZealandOmanPakistanPanamaPeruPhilippinesPalauPapua New GuineaPolandPuerto RicoKorea, Democratic People’s Republic ofPortugalParaguayPalestine, State ofQatarRomaniaRussian FederationRwandaSaudi ArabiaSudanSenegalSingaporeSolomon IslandsSierra LeoneEl SalvadorSan MarinoSomaliaSerbiaSao Tome and PrincipeSurinameSlovakiaSloveniaSwedenSwazilandSeychellesSyrian Arab RepublicChadTogoThailandTajikistanTurkmenistanTimor-LesteTongaTrinidad and TobagoTunisiaTurkeyTuvaluTaiwan, Province of ChinaTanzania, United Republic ofUgandaUkraineUruguayUzbekistanSaint Vincent and the GrenadinesVenezuela, Bolivarian Republic ofVirgin Islands, U.S.Viet NamVanuatuSamoaYemenSouth AfricaZambiaZimbabwe ← Back Next → Are you politically exposed? Yes No ← Back Next → Are you employed? Yes No What is your occupation? What is your employer's name? How long have you been employed here? What is your annual income? Please describe your current employment status ---StudentTemporarily Laid OffSeeking New EmploymentStay Home ParentRetiredOther ← Back Next → Do you have any non-employment income? Yes No ← Back Next → Please confirm your net worth Savings and Investments * Value of your home Mortgage Balance Other Debts * Net Worth ← Back Next → Who would you like to name as your beneficiaries? Your beneficiaries are the people who will collect your life insurance payout. Full name * Relationship---SpousePartnerHusbandWifeChildSonDaugtherGrandaughterGrandsonGrandmotherGrandfatherFriendBrotherSisterAuntUncleParentNieceNephewEx-spouseOther Percent Full name * Relationship---SpousePartnerHusbandWifeChildSonDaugtherGrandaughterGrandsonGrandmotherGrandfatherFriendBrotherSisterAuntUncleParentNieceNephewEx-spouseOther Percent Full name * Relationship---SpousePartnerHusbandWifeChildSonDaugtherGrandaughterGrandsonGrandmotherGrandfatherFriendBrotherSisterAuntUncleParentNieceNephewEx-spouseOther Percent Full name * Relationship---SpousePartnerHusbandWifeChildSonDaugtherGrandaughterGrandsonGrandmotherGrandfatherFriendBrotherSisterAuntUncleParentNieceNephewEx-spouseOther Percent ← Back Next → Do you have a driver's license? Yes No Please provide your license number Issuing province: ---AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ← Back Next → Do you have any other investments? Yes No Please provide more details Amount * Investment type ---StocksBondsRRSPsMutual fundsTFSASHight interest savingCredit ManagementRisk Management With who? ---BankInsurance CompanyOther institution Amount * Investment type ---StocksBondsRRSPsMutual fundsTFSASHight interest savingCredit ManagementRisk Management With who? ---BankInsurance CompanyOther institution Amount * Investment type ---StocksBondsRRSPsMutual fundsTFSASHight interest savingCredit ManagementRisk Management With who? ---BankInsurance CompanyOther institution Amount * Investment type ---StocksBondsRRSPsMutual fundsTFSASHight interest savingCredit ManagementRisk Management With who? ---BankInsurance CompanyOther institution ← Back Next → What is your cell phone number? We need your cell phone number to send you a code that's needed to access important documents By submitting this form, I agree to receive further communications from Wealth Sense Inc. You must agree to the terms before you can submit the questionnaire ← Back
