Preliminary Discovery Form

Welcome to Northern Pacific Asset Management. Please complete this form prior to your preliminary discovery meeting. Your responses help us understand your financial life and tailor our conversation—so we can help you Live^Exponentially.

Progress

Step 1 of 3

Leave blankLeave blankLeave blank

Section 1 of 3

Personal Client Information

Status *

Preliminary DiscoveryNew Client

First Name *

Last Name *

First Name *

Last Name *

Physical Address *

Mailing address is the same as physical address

Mailing Address

Date of Birth *

Co-Client Date of Birth *

Job Title

Co-Client Job Title

Employer

Co-Client Employer

US Citizen? *

YesResidentNon-ResidentNo

Co-Client US Citizen? *

YesResidentNon-ResidentNo

Country of Dual Citizenship, if applicable

Co-Client Country of Dual Citizenship, if applicable

Primary Phone *

Co-Client Primary Phone *

Email Address *

Co-Client Email Address *

Client Preferred Contact Method *

Co-Client Preferred Contact Method *

How did you hear about us?

Referral from Existing ClientLegal or Tax Advisor ReferralOnline Search (Google, Bing, Yahoo, etc.)Social Media (LinkedIn, Facebook, X/Twitter, etc.)Financial News Websites or BlogsOther

Referral Source

Section 3 of 3

Consent & Submission

Review the disclosures below, provide your electronic signature, and submit.

Data Protection & Privacy

At Northern Pacific Asset Management, LLC., we deeply value the trust you place in us by sharing your personal and confidential information. This statement is a concise overview of our comprehensive Privacy Policy, tailored to the context of your interaction with this form.

Key Aspects of Our Privacy Approach:

1. Personal Information Handling

In line with our Privacy Policy, we collect personal information such as contact details, financial and commercial information, internet or electronic activity data, and other identifiers. This information is essential for offering and providing our services, operating our business, and ensuring compliance with legal obligations.

2. Purposeful Data Utilization

The information you provide is used to understand and meet your financial needs, facilitate transactions, improve our services, and maintain the security of our networks and systems. We do not sell your personal information for third-party promotional purposes.

3. Data Security Measures

Secured with AES-256-bit encryption. Your data is transmitted directly to Northern Pacific Asset Management.

4. Disclosure and Sharing of Information

Consistent with our Privacy Policy, we may disclose personal information to service providers, business partners, and governmental authorities as necessary for business operations, legal compliance, and service provision.

5. Your Privacy Rights

You have rights regarding your personal information, including the right to access, update, and request deletion. Our practices align with federal and state laws, including the California Consumer Privacy Act (CCPA), ensuring your right to non-discrimination in services.

6. Ongoing Updates and Transparency

Our Privacy Policy may be updated periodically. We commit to keeping you informed of any significant changes and encourage you to review the policy regularly.

For a full understanding of how we manage and protect your personal information, we encourage you to review Osaic Wealth, Inc. detailed Privacy Policy.

If you have any questions or concerns regarding the handling of your data, please do not hesitate to contact our customer service team. Trust and transparency are the pillars of our relationship with you.

Thank you for your trust in Northern Pacific Asset Management, LLC.

Legal Disclosure

This form is provided for informational purposes only and does not constitute investment, legal, or tax advice. The information you provide will be used to facilitate your advisory discussion and does not create or modify any advisory agreement. All investments involve the risk of potential investment losses and no strategy can assure a profit. Please consult with a qualified professional for specific legal, tax, or accounting advice. Northern Pacific Asset Management and Osaic Wealth do not provide tax or legal advice.

I consent to the collection and use of my personal and financial information as described in the Data Protection & Privacy disclosure above and the Osaic Privacy Policy.I confirm that the information provided in this form is accurate to the best of my knowledge and understand it will be used to prepare for my advisory meeting.

Electronic Signature (Type Full Name) *

Date *

Thank You!

Your preliminary discovery form has been submitted successfully. Your advisory team at Northern Pacific Asset Management will review your responses and prepare for a productive first conversation.

A confirmation will be sent to the email you provided. If you need to make changes, please contact your advisor directly at (832) 559-3771.