Client Data Form

We realize this is a lot of data. However, we need to know key information so that we can make the best recommendation for your specific financial situation.

Before you start, please have some basic financial information and property information available.

If you get stuck along the way, no worries. We will follow-up with you to complete the form. Just complete what you can.

1031 Client Data Form

Name of Adviser You Are Working With at Insight

Name of the investment adviser you are working with at Insight

Your Name

First Name

Last Name

Mailing/Contact Address

Please enter the address you would like to receive correspondence regarding 1031/DST

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Preferred Contact Phone #

(###)

###

####

Preferred Method of Contact

Opt In for Text Messages from Insight

If you choose yes, Insight will send you a text message for confirmation.

Annual Household Income

Ballpark your average annual income

Current Tax Bracket

SPOUSE/PARTNER INFORMATION

Name

First Name

Last Name

Mailing/Contact Address

Enter if different for spouse

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Preferred Contact Phone #

Enter if different from spouse

(###)

###

####

Preferred Method of Contact

Social Security #

Date of Birth

NET WORTH

Provide Your Net Worth

Net worth is the value of all the non-financial and financial assets minus the value of all outstanding liabilities. Please give a ballpark estimate of your net worth exclusive of your Primary Residence.

Provide Your Liquid Net Worth

The part of your net worth that can be readily turned into cash. Liquid net worth includes investments such as stocks/mutual funds/401k/etc, but does not include assets that are difficult to readily convert, such as real estate or cars

What are Your Total Liabilities?

Ballpark estimate of your primary liabilities - mortgage, car loans, student loans, etc.

PROPERTY QUESTIONS

In What Name is Your Property Titled

Please list exactly as titled. If an entity, please enter the entity name.

If property in Entity, who can sign on behalf of that Entity?

List each person that can sign on behalf of the entity and if the entity requires all signatures or just one.

Entity Date of Establishment (if applicable)

YYYY

Entity Address (if applicable)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

What State is Your Property Located In?

Are You Selling More Than One Property?

Yes

Estimate Your Property's Value or Sale Price

Ballpark figure (unless you have already sold)

Expected Property Closing Date

Estimate if necessary

Closing Costs

Estimated the closing costs on your sale

Is There Debt on the Property?

If Yes, please estimate how much. If none, enter $0.

What is/was the Net Cash Flow on the Property?

Simply ballpark the average annual net cash flow from your property

What Did Your Pay for the Property?

Again....ballpark figures work

Capital Expenditures

Estimate the capital expenditures you have taken on your property

How Much Depreciation Have You Taken Against the Property?

This is not required, but helpful for us in making a recommendation. Make your best guess if you don't know for sure. This is very important for taxes.

Are You Working with a Qualified Intermediary Regarding your 1031 Exchange?

If yes, enter the name and contact of the qualified intermediary. If no, leave blank.

PLANNING QUESTIONS

Do You Need Income from Your Replacement Property?

If yes, estimate how much. If no, enter $0

Do You Need Cash Out from the Sale of Your Property?

If yes, please estimate how much. If no, enter $0

Have You Consulted Your Accountant Regarding Your Exchange?

If yes, please provide contact information. If no, leave blank

Have You Consulted an Attorney Regarding Your Exchange?

If yes, list name and contact information. If no, enter no

ESTATE PLANNING QUESTIONS

Do You Have a Current Estate Plan?

if yes, enter what type: trust, will, other. If no, leave blank

Do You Have Sufficient Liquid Cash Reserves?

Do You Have Powers of Attorney on File?

Yes

If Something Were to Happen to You, Whom Would You Leave this property to?

List person or entity and contact information