New Customer Form — Wellbeing Investments

Personal Information

Full Name

Email

Telephone

Address

Post Code

Date of Birth You must be 18 or over.

Form Date

Marital Status

Immigration Status

Employment

Annual Salary

Gross annual income before tax.

National Insurance Number Optional — leave blank if you don’t have it.

Number of Dependents

Living Status

Are you a Company Owner?

Yes No

Any missed payments or defaults?

Yes No

Do you have a deposit?

Yes No

Do you have Life Insurance?

Yes No

Do you have a credit report?

Yes No

Preferred Broker

I agree to Wellbeing Investments contacting me about my enquiry and have read the privacy note.