Financial Representative Questionnaire

We pay up to 110 bps/year.

The restricted areas of this web site include information on our Third Party Investment Advisor (TPIA) program, performance, and fee-sharing information.

Please complete this questionnaire to receive a password to access restricted areas of this web site. We will contact you when we receive this completed questionnaire. The information you provide will be maintained according to our Privacy Policy. All questions are required to be answered.

*Required Field

*Name

*Work address

*City *State

*Zip Code/ Mail Code

*Work phone number

*Work email

*Work Fax

*I: am a Financial Advisor am a Variable Annuity Insurance broker sell retirement plans do something else.

*I hold the following securities licenses:

*I personally sell clients investments, asset management, retirement plans, and/or variable annuities: Yes No

*I am client-centered and gather assets: Yes No Not Applicable

I am investment-centered and manage clients portfolios: Yes No Not Applicable

*I believe in the portfolio management style of: Buy-hold Active risk management Other

*Total assets under my direct management: over $50 Million $25-$50 Million $10-$25 Million $1-$10 Million

*Number of clients I have: over 200 100- 200 40-100 10-40

*Dollar amount of business I place with third party money mangers through my bd/ria

*Total number of financial representatives employed by my bd/ria

*Name of my Bd or RIA

*Complete address of BD or RIA home office

Name of corporate officer who handles new business selling agreements

*I will advocate to my corporate officer to bring HCM on board with my bd/ria. yes no

Phone number of my corporate officer

Complete work address of my corporate officer

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