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Initial Client Information Questionnaire – NZ

    Please fill in the details below.

    Will you be filling out this form for your spouse as well?

    Will you be filling out this form for your spouse as well?

    YesNo

    1. General Detail

    Taxpayer

    Spouse

    Surname:

    Surname

    Surname (spouse)

    First Name(s):

    First Name

    First Name (spouse)

    Name As Per Social Security Card (if known):

    Name As Per Social Security Card (if known)

    Spouse's Name As Per Social Security Card (if known)

    Social Security Number

    Social Secuity Number

    Social Secuity Number (spouse)

    Date of Birth (DD/MM/YY)

    Date of Birth (DD/MM/YY)

    Spouse's Date of Birth (DD/MM/YY)

    Marital Status

    Marital Status

    Marital Status (Spouse)

    Occupation

    Occupation

    Occupation (spouse)

    Citizenship(s)

    Citizenship

    Citizenship (spouse)

    Have you ever held a Green Card:

    Have you ever held a Green Card?

    YesNo

    Has your spouse ever held a Green Card?

    YesNo

    If yes, when did you hand it back?

    If yes, when did you hand it back?

    If yes, when did your spouse hand it back?

    Residential Address - # and street:

    Your residential address - # and street

    Your spouse's residential address - # and street

    Residential Address - City:

    Residential Address - City

    Residential Address - City (spouse)

    Residential Address - Post Code:

    Residential Address - Post Code

    Residential Address - Post Code (spouse)

    Residential Address - State:

    Residential Address - State

    Residential Address - State (spouse)

    Residential Address - Country:

    Residential Address - Country

    Residential Address - Country (spouse)

    My postal address is different to my residential address

    My postal address is different to my residential address

    YesNo

    Postal Address - # and street:

    Postal Address - # and street

    Postal Address - # and street (spouse)

    Postal Address - City:

    Postal Address - City

    Postal Address - City (spouse)

    Postal Address - Post Code:

    Postal Address - Post Code

    Postal Address - Post Code (spouse)

    Postal Address - State:

    Postal Address - State

    Postal Address - State (spouse)

    Postal Address - Country:

    Postal Address - Country

    Postal Address - Spouse

    Phone number:

    Phone Number

    Phone Number (spouse)

    Mobile number:

    Mobile Phone Number

    Mobile Phone Number (spouse)

    Email:

    Email

    Email (spouse)

    Do you have a mortgage over your property?

    Do you have a mortgage over your property?

    YesNo

    Do you have a mortgage over your property? (spouse)

    YesNo

    Last US State you lived in:

    Last US State you lived in

    Last US State you lived in (spouse)

    When did you leave USA? (DD/MM/YY)

    When did you leave USA? (DD/MM/YY)

    When did you leave USA? (DD/MM/YY) (spouse)

    What year was the last time you filed a US Tax Return?

    What year was the last time you filed a US Tax Return?

    What year was the last time you filed a US Tax Return? (spouse)

    2.Dependents

    I'd like to add a dependent

    Full Name:

    DOB:

    Citizenship:

    SSN or ITIN

    If ITIN Please Tick

    Full Time Student

    Gender

    Dependent 1

    Full Name

    Date of Birth

    Citizenship

    SSN or ITIN

    If ITIN please tick

    Full time student?

    YesNo

    Gender

    I'd like to add another dependent

    Dependent 2

    Full Name

    Date of Birth

    Citizenship

    SSN or ITIN

    If ITIN please tick

    Full time student?

    YesNo

    Gender

    I'd like to add another dependent

    Dependent 3

    Full Name

    Date of Birth

    Citizenship

    SSN or ITIN

    If ITIN please tick

    Full time student?

    YesNo

    Gender

    I'd like to add another dependent

    Dependent 4

    Full Name

    Date of Birth

    Citizenship

    SSN or ITIN

    If ITIN please tick

    Full time student?

    YesNo

    Gender

    3. Travel to the USA

    Please fill in the details that are related to the YEARS we are doing your US Tax Returns

    I'd like to add a travel record

    Name:

    Arrival Date:

    Depature Date:

    Reason for Travel

    Travel 1

    Name

    Arrival Date

    Departure Date

    Reason for Travel

    I'd like to add another record

    Travel 2

    Name

    Arrival Date

    Departure Date

    Reason

    I'd like to add another record

    Travel 3

    Name

    Arrival Date

    Departure Date

    Reason

    I'd like to add another record

    Travel 4

    Name

    Arrival Date

    Departure Date

    Reason

    4. FATCA

    Foreign Account Tax Compliant Act.
    At any time during the year, did you have a financial interest in or signature authority over a financial account (such as a bank account, securities account, or brokerage account) located in a foreign country (non-USA)?
    YesNo

    If yes, which countries (list all countries):

    Is the sum of the highest balances of your foreign financial assets greater than USD$10,000?

    Is the sum of the highest balances of your foreign financial assets greater than USD$10,000?

    YesNo

    Do you need US Global Tax Limited to prepare and file your FinCEN 114 (FBAR)?

    Do you need US Global Tax Limited to prepare and file your FinCEN 114 (FBAR)?

    YesNo

    Is the sum of the highest balances of your foreign financial assets greater than USD$200,000?

    Is the sum of the highest balances of your foreign financial assets greater than USD$200,000?

    YesNo

    5. Trusts

    Are you a Settlor, Trustee, or Beneficiary of a foreign trust (non-US)?

    Are you a Settlor, Trustee, or Beneficiary of a foreign trust (non-US)?

    YesNo

    During the year, did you receive a distribution from, or transfered property/cash to a foreign trust (non-USA)?

    During the year, did you receive a distribution from, or transfered property/cash to a foreign trust (non-USA)?

    YesNo

    If you (or your spouse if filing jointly) have a beneficial interest in a trust, (settler, trustee or beneficiary), please list these below

    If you (or your spouse if filing jointly) have a beneficial interest in a trust, (settler, trustee or beneficiary), please list these below

    Name of trust:

    Person with relationship:

    Are you a beneficiary / settlor / trustee:

    Date established:

    Trust 1

    Name of Trust

    Person with Relationship

    Are you a beneficiary / settlor / trustee?

    Date established

    I'd like to add another trust

    Trust 2

    Name of Trust

    Person with Relationship

    Are you a beneficiary/settlor/trustee?

    Date established

    I'd like to add another trust

    Trust 3

    Name of Trust

    Person with Relationship

    Are you a beneficiary/settlor/trustee?

    Date established

    I'd like to add another trust

    Trust 4

    Name of Trust

    Person with Relationship

    Are you a beneficiary/settlor/trustee?

    Date established

    6. Pension/Superannuation

    (applicable to Australian residents)

    Taxpayer

    Spouse

    Do you have a superannuation fund?

    Do you have a superannuation fund?

    You:

    YesNo

    Your spouse:

    YesNo

    Of the total contributions to the account, do your contributions (as opposed to Govt. and Employer contributions) make up the majority of the total contributions value?

    Of the total contributions to the account, do your contributions (as opposed to Govt. and Employer contributions) make up the majority of the total contributions value?

    You:

    YesNo

    Your spouse:

    YesNo

    Estimated value as at 31st December last year:

    Estimated value as at 31st December last year:

    Estimated value as at 31st December last year (spouse)

    If you or your spouse have a self-managed super fund (SMSF), please state the year the fund was formed:

    If you or your spouse have a self-managed super fund (SMSF), please state the year the fund was formed:

    You:

    Your spouse:

    I'd like to add another superannuation fund

    Fund 2

    Of the total contributions to the account, do your contributions (as opposed to Govt. and Employer contributions) make up the majority of the total contributions value?

    Of the total contributions to the account, do your contributions (as opposed to Govt. and Employer contributions) make up the majority of the total contributions value?

    You:

    YesNo

    Your spouse:

    YesNo

    Estimated value as at 31st December last year:

    Estimated value as at 31st December last year:

    Estimated value as at 31st December last year (spouse)

    I'd like to add another superannuation fund

    Fund 3

    Of the total contributions to the account, do your contributions (as opposed to Govt. and Employer contributions) make up the majority of the total contributions value?

    Of the total contributions to the account, do your contributions (as opposed to Govt. and Employer contributions) make up the majority of the total contributions value?

    You:

    YesNo

    Your spouse:

    YesNo

    Estimated value as at 31st December last year:

    Estimated value as at 31st December last year:

    Estimated value as at 31st December last year (spouse)

    7. Pension/Superannuation

    (applicable to New Zealand residents)

    Taxpayer

    Spouse

    Do you have a KiwiSaver or Superannuation Account?

    Do you have a KiwiSaver or Superannuation Account?

    You

    YesNo

    Your spouse

    YesNo

    If so, of the total contributions to the account, do your contributions (as opposed to Govt. and Employer contributions) make up the majority of the total contributions value?

    If so, of the total contributions to the account, do your contributions (as opposed to Govt. and Employer contributions) make up the majority of the total contributions value?

    You:

    YesNo

    Your spouse

    YesNo

    Estimated value as at 31st December last year:

    Estimated value as at 31st December last year:

    You

    Your spouse

    I'd like to add another superannuation fund

    Fund 2

    Of the total contributions to the account, do your contributions (as opposed to Govt. and Employer contributions) make up the majority of the total contributions value?

    Of the total contributions to the account, do your contributions (as opposed to Govt. and Employer contributions) make up the majority of the total contributions value?

    You:

    YesNo

    Your spouse

    YesNo

    Estimated value as at 31st December last year:

    Estimated value as at 31st December last year:

    You

    Your spouse

    I'd like to add another superannuation fund

    Fund 3

    Of the total contributions to the account, do your contributions (as opposed to Govt. and Employer contributions) make up the majority of the total contributions value?

    Of the total contributions to the account, do your contributions (as opposed to Govt. and Employer contributions) make up the majority of the total contributions value?

    You:

    YesNo

    Your spouse

    YesNo

    Estimated value as at 31st December last year:

    Estimated value as at 31st December last year:

    You

    Your spouse

    8. Capital Gains

    Please list any capital gains or losses you (or your spouse if filing jointly) have from any sale or disposal of assets during the year.

    I'd like to add an asset

    Asset:

    Purchase date:

    Purchase cost:

    Disposal date:

    Disposal value:

    Asset 1

    Asset Name

    Purchase Date:

    Purchase Value:

    Disposal Date:

    Disposal Value:

    I'd like to add another asset

    Asset 2

    Asset Name

    Purchase Date:

    Purchase Value:

    Disposal Date:

    Disposal Value:

    I'd like to add another asset

    Asset 3

    Asset Name:

    Purchase Date:

    Purchase Value:

    Disposal Date:

    Disposal Value:

    I'd like to add another asset

    Asset 4

    Asset Name:

    Purchase Date:

    Purchase Value:

    Disposal Date:

    Disposal Value:

    I'd like to add another asset

    Asset 5

    Asset Name:

    Purchase Date:

    Purchase Value:

    Disposal Date:

    Disposal Value:

    I'd like to add another asset

    Asset 6

    Asset Name:

    Purchase Value:

    Purchase Value:

    Disposal Date:

    Disposal Value:

    9. Income

    Comment:

    Did you (or your spouse if filing jointly) have any income from wages / salaries / commissions/bonuses?

    Did you (or your spouse if filing jointly) have any income from wages / salaries /commissions / bonuses?

    YesNo

    Comment:

    Please select which of the following COVID-19 stimulus payments (2020 and 2021) you received.

    Please select which of the following COVID-19 stimulus payments (2020 and 2021) you received.

    None1st payment2nd payment3rd payment

    Did you (or your spouse if filing jointly) have any interest income during the year, from;

    Did you (or your spouse if filing jointly) have any interest income during the year, from;

    - US Accounts

    - US Accounts

    YesNo

    Comment:

    - Other Accounts

    - Other Accounts

    YesNo

    Comment:

    Did you (or your spouse if filing jointly) have any dividend income during the year?

    Did you (or your spouse if filing jointly) have any dividend income during the year?

    YesNo

    Comment:

    Did you receive distributions from a company as a director or a shareholder during the year?

    Did you receive distributions from a company as a director or a shareholder during the year?

    YesNo

    Comment:

    Did you (or your spouse if filing jointly) have any self-employment income during the year?

    Did you (or your spouse if filing jointly) have any self-employment income during the year?

    YesNo

    Comment:

    Did you (or your spouse if filing jointly) make any charitable donations to US-based organisations?

    Did you (or your spouse if filing jointly) have any self-employment income during the year?

    YesNo

    Comment:

    Do you (or your spouse if filing jointly) hold any form of virtual currency?

    Do you (or your spouse if filing jointly) hold any form of virtual currency?

    YesNo

    Comment:

    Did you receive royalty income?

    Did you receive royalty income?

    YesNo

    Comment:

    Do you (or your spouse if filing jointly) hold any form of non-US investment portfolio? If yes; please provide details

    Do you (or your spouse if filing jointly) hold any form of non-US investment portfolio? If yes; please provide details

    YesNo

    Comment:

    Have you made, or do you intend to make a contribution this year
    to a Roth IRA/401K?

    Have you made, or do you intend to make a contribution this year
    to a Roth IRA/401K?

    YesNo

    Were you granted stock or options from your current or previous employer?

    Were you granted stock or options from your current or previous employer?

    YesNo

    If yes, did you dispose of any of your holdings within the tax year?

    If yes, did you dispose of any of your holdings within the tax year?

    YesNo

    10. US State Income

    Please list any income earned in the USA.

    I'd like to add a US income source

    State:

    Income Type:

    Date Received:

    Value (estimate):

    Income 1

    State:

    Income Type:

    Date Received:

    Value (Estimate):

    I'd like to add another income source

    Income 2

    State:

    Income Type:

    Date Received:

    Value (Estimate):

    I'd like to add another income source

    Income 3

    State:

    Income Type:

    Date Received:

    Value (Estimate):

    I'd like to add another income source

    Income 4

    State:

    Income Type:

    Date Received:

    Value (Estimate):

    11. Rental Income

    Did you (or your spouse if filing jointly) have any rental property income during the year?

    Did you (or your spouse if filing jointly) have any rental property income during the year?

    NoYes

    Do you employ the services of a rental property management agency?

    Do you employ the services of a rental property management agency?

    NoYes

    Address/Location

    Purchase Date:

    Disposal Date:

    Residential / Commercial Ownership Details:

    Property 1

    Address/Location

    Purchase Date:

    Disposal Date:

    Residential / Commercial Ownership Details:

    I'd like to add another rental income source

    Property 2

    Address/Location

    Purchase Date:

    Disposal Date:

    Residential/Commercial Ownership Details:

    I'd like to add another rental income source

    Property 3

    Address/Location

    Purchase Date:

    Disposal Date:

    Residential/Commercial Ownership Details:

    I'd like to add another rental income source

    Property 4

    Address/Location

    Purchase Date:

    Disposal Date:

    Residential/Commercial Ownership Details:

    12. Foreign Companies and Partnerships

    If you (or your spouse if filing jointly) hold a shareholding or interest in a non-US company or partnership that was greater than 5% of the share capital of the company (including trustee companies), please provide the details below:

    I'd like to add a foreign company/partnership

    Company Name:

    Shareholder:

    %:

    Is this entity dormant?

    Company/Partnership 1:

    Company Name:

    Shareholder:

    %:

    Is this entity dormant?

    I'd like to add another foreign company/partnership

    Company/Partnership 2:

    Company Name:

    Shareholder:

    %:

    Is this entity dormant?

    I'd like to add another foreign company/partnership

    Company/Partnership 3:

    Company Name:

    Shareholder:

    %:

    Is this entity dormant?

    13. Additional Notes

    "