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CLIENT REGISTRATION
 PERSONAL DETAILS
 
Title:   
First Name:   *
Last Name:   *
  Residential / Correspondence Address
House Number/Name:   *
Street Name:   *
 City/Town:  
 County:  
 Country:   
Country of Domicile is indicated by the passport you hold i.e. if you hold a UK passport, your country of domicile is the UK even if you live in spain 52 weeks of the year
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Post Code:  
  Please use international dialing code Format [+44 1260 299 700]
Contact Number:   *
Mobile Number:  
Skype Name:  
Do you have NIE number?   
 CASE DETAILS
If you do not have an introducer/promotion code please leave blank
Introducer / Promotion / Agent Code:    
Property Location:   
Town/Region in the Country:  
Property Address:  
   Estimate Value should not include € sign.  Format (000,000)
Estimated Value of Property (Euros €):   *
No of Owners:   
Beneficiary Section Example: "I leave everything to my spouse (Primary beneficiary) but should they die before me, I leave everything to my child (Contingent beneficiary)"
Primary Beneficiaries:   
Contingent Beneficiaries:   
Estimated Value of your Estate in the UK (£):   
Do you have a mortgage?     [Click for Yes]
 If you have mortgage, please specify the balance in Euros(€)
Outstanding Mortgage (€)?       Format(000,000)
Would you like information on our staged payment option?     [Click for Yes]
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©Wincham Consultants Limited 2009, Wincham House - Greenfield Farm Trading Estate
Congleton - Cheshire, England - CW12 4TR