Henry AsherbrannerFinancial Advisorhenry.asherbranner@cs-ag.com

Account Open / Transfer Information Request

We use this form to prepare the paperwork that opens your accounts and moves them to us. Answer every question; where an item does not apply, write “N/A.” Please return it through your eMoney Advisor portal (Vault → Shared Documents → Upload Files) — it contains information that should not be emailed.

Your answers save as you go. When you finish, you will save the form as a PDF and upload it to your eMoney Advisor portal.

17sections

15–20minutes, about

Any deviceyour answers save as you go

ANSWER EVERY QUESTION. Accounts cannot be opened or transferred from an incomplete form.

Client Name(s)*

Date*

Section 01

About You

Applicant 1

First Name*

M.I.

Last Name*

Suffix

Date of Birth*

Social Security Number*

Marital Status*

Citizenship*

Government ID Type*

ID Number*

Issuing State / Country*

Expiration Date*

Applicant 2 / Spouse — complete for any joint account

First Name*

M.I.

Last Name*

Suffix

Date of Birth*

Social Security Number*

Relationship*

Citizenship*

Government ID Type*

ID Number*

Issuing State / Country*

Expiration Date*

Number of Dependents

How did you hear about us? / Who referred you?

Section 02

Address & Contact

Street Address*

City*

State*

Zip Code*

Is your mailing address the same as above?*

Mailing Address — if different*

Email*

Mobile Phone*

Home / Work Phone

Spouse Email

Spouse Mobile

Preferred Contact Method

May we send statements and confirmations electronically?*

Section 03

Employment

Employment Status (Employed / Self-Employed / Retired / Homemaker / Student / Not Employed)*

Occupation — or former occupation if retired*

Years With Employer

Employer — or former employer if retired*

Employer Phone

Employer Address

Spouse Employment Status

Spouse Occupation & Employer

Section 04

Required Disclosures

Regulators require us to ask these four questions of every client. A “yes” does not prevent us from opening your account.

Are you, or is an immediate family member, employed by or associated with a FINRA member firm, a broker-dealer, or a securities exchange?*

If yes — name of firm and the person’s relationship to you*

Are you, or is an immediate family member, a director, officer, or 10% shareholder of a publicly traded company?*

If yes — company name and ticker symbol*

Are you, or is an immediate family member or close associate, a current or former senior official of a foreign government, military, or political party?*

If yes, please explain*

Is your advisor named in any of your documents as a beneficiary, trustee, executor, or power of attorney?*

If yes, please explain*

Section 05

Trusted Contact

We ask every client to name someone we may reach out to if we cannot reach you, or if we have a concern about your wellbeing or your account. This person cannot transact on your account.

Trusted Contact — Full Name

Relationship to You

Phone

Address

Section 06

Financial Profile

Annual Household Income ($)*

Annual Household Expenses ($)

Filing Status (Single / Married Joint / Married Separate / Head of Household)*

Net Worth — excluding your home ($)*

Liquid Net Worth — cash and marketable securities ($)*

State of Tax Residence*

Source of the funds being transferred*

Employment income, sale of a business, inheritance, retirement plan rollover, insurance or annuity proceeds, sale of property, gift, other — please specify

Section 07

Investment Objectives & Risk

Primary Investment Objective (Preservation / Income / Growth & Income / Growth / Speculation)*

Risk Tolerance (Conservative / Moderate / Aggressive)*

Time Horizon (Under 5 / 5–9 / 10–19 / 20+ years)*

Investment Experience (None / Limited / Moderate / Extensive)*

Spouse Risk Tolerance

Spouse Time Horizon

Will you need to withdraw from these accounts within the next three years?*

If yes — roughly how much, and when*

Are there investments you want excluded, or values you want reflected in how your money is managed?

Section 08

Accounts to Open or Transfer

List every account you want opened or moved. The account title must match the delivering firm’s records exactly, or the transfer will be rejected.

Account	Institution	Account Title — exactly as registered	Registration Type	Account Number	Approx. Value $
Account 1
Account 2
Account 3
Account 4
Account 5

Registration types: Individual · Joint (JTWROS or Tenants in Common) · Traditional IRA · Roth IRA · Inherited IRA · SEP or SIMPLE IRA · 401(k) or TSP · Trust · UTMA/UGMA · Business

For each account above	Full or Partial Transfer?	Transfer In-Kind or Liquidate?	Recent Statement Attached?	RMD Already Taken This Year?
Account 1
Account 2
Account 3
Account 4
Account 5

If any transfer is partial — which account, and which holdings or how much to move

Do any of these accounts carry surrender charges, a market value adjustment, or a back-end load?*

If yes — which accounts, and the approximate amount*

Do you currently work with another advisor on any of these accounts?*

If yes — the firm, and whether an advisory agreement is in place*

Section 09

Beneficiaries

Percentages must total 100% within each tier. Note which account each designation applies to.

Primary Beneficiaries

Full Name	Relationship	Date of Birth	SSN / TIN	% Share	Applies to Account(s)

Contingent Beneficiaries

Full Name	Relationship	Date of Birth	SSN / TIN	% Share	Applies to Account(s)

Should any designation pass per stirpes — that is, to a beneficiary’s children if that beneficiary dies before you?

If yes — which beneficiaries

Section 10

Banking — for deposits and withdrawals

Attach a voided check.

Name on the Account

Bank Name

Account Type (Checking / Savings)

Routing Number

Account Number

Section 11

Household Inventory — Savings

This gives us the whole picture, including accounts you are not moving. Where a line does not apply, write “N/A.”

Item	Where Held	Interest Rate %	Joint $	You $	Spouse $
Checking
Savings
Money Market
Certificate of Deposit
Credit Union
Savings Bonds
Health Savings Account (HSA)
529 / Education Savings
UTMA / UGMA
Other

Section 11b

Retirement Accounts

Item	Where Held	You $	Spouse $
Traditional IRA
Roth IRA
Inherited IRA
SEP / SIMPLE IRA
401(k) / 403(b) / TSP
Roth 401(k)
457(b)
Solo 401(k)
Pension — vested value
Deferred Compensation
Other

Do you have a retirement plan still held at a former employer?

If yes — the employer, the plan type, and the approximate value

Section 11c

Investment-Type Assets

Item	Where Held	Rate of Return %	Joint $	You $	Spouse $
Brokerage / Managed Account
Stocks
Mutual Funds / ETFs
Bonds / Bond Funds
Annuity — note the type
Cash Value Life Insurance
Employer Stock / RSUs / Options
Business Interest
Partnerships
Other

Section 12

Real Estate

Property	Own or Rent	Market Value $	Purchase Price $	Year Acquired	Titled As
Residence
Second Home
Rental Property
Land
Other

Section 13

Loans & Debt

Debt	Monthly Payment $	Interest Rate %	Months Left	Unpaid Balance $	Pay Off at Death? (Y/N)
Home / Mortgage
Second Mortgage / HELOC
Automobile
Automobile 2
Student / Education
Credit Cards
Credit Cards 2
401(k) Loan
Taxes Owed / IRS Plan
Other

Section 14

Income by Source

Yearly amounts, before tax. An estimate is fine.

Item	You $	Spouse $
Salary
Bonus
Commissions
Self-Employment
Rental Income
Social Security
Pension
IRA / 401(k) Withdrawals
Interest & Dividends
Other Income

Section 15

Remarks

Finished

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The financial professionals of Cornerstone Advisor Group are Investment Adviser Representatives and investment advisory services are offered solely by ESI Financial Advisors, 10472 Armstrong Street, Fairfax VA 22030, (866) 868-1492. Cornerstone Advisor Group is independent of ESI Financial Advisors.

10472 Armstrong Street, Fairfax Virginia 22030www.cornerstoneadvice.com866-868-1492CAG-ASSET-IR v2026.08