Confidential Intake, International Broker Co

Personal Information

Number of Applicants

1 2 3

Full Name

Email Address

Phone Number

Date of Birth

Marital Status

Do you have a partner/spouse involved in this restructure?

Yes No

Partner's Full Name

Number of Dependent Children

Current Residential Address

City

State / Province

Postal / ZIP Code

Country

Current Citizenship(s)

Passport(s) Held List all passports, separate from citizenship, matters for banking & travel

Current Personal Tax Residency Country

Are you currently tax resident anywhere outside your home country?

Yes No

Where?

How many days per year do you spend in your home country?

Assets

📈 Shares / Equities

Approximate Current Value AUD

Original Cost Base / Purchase Price AUD What did you originally pay? Used for CGT calculations

Where Are They Held?

₿ Crypto

Approximate Current Value AUD

Original Cost Base / Purchase Price AUD What did you originally pay? Used for CGT calculations

Where Is It Held?

💰 Cash / Savings

Approximate Value AUD

Where Is It Held?

🏢 Other Business Interests

Approximate Current Value AUD

Original Cost Base / Purchase Price AUD What did you originally invest? Used for CGT calculations

Location / Jurisdiction

Properties Owned

Exit Tax & Prior Advice

Have you received any professional advice on exit tax or international structuring?

Yes No

Brief Summary of Advice Received

Have you already taken any steps? (moved country, opened foreign company, etc.)

Yes No

What Have You Done So Far?

Goals & Timeline

Primary Goal, Select All That Apply

Reduce ongoing tax Plan for business exit Relocate personally International business structure International banking All of the above

Do You Have a Target Country in Mind?

Yes No Still exploring

Which Country?

Intended Timeline

Anything Else You'd Like Us to Know Before the Call?

I consent to International Broker Co securely storing this confidential information in its CRM and GoHighLevel account to prepare for and follow up on my consultation.

Your information is kept strictly confidential and used only to prepare for and follow up on your consultation.

✓ Received

Thanks, we'll review your confidential intake before the call.
You'll hear from us shortly to confirm your consultation time.