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Verified Expert (VE™) Application
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* All fields must be completed to ensure the application is processed.

Your First Name: *
Your Middle Name:
Your Last Name: *
Firm Name: *
Division or Branch:

Firm Type: *

Address: *
City: *
State/Province: *
Zip: *
Country: *
Phone: *
E-mail: *
Web Site:
Select specialties and years of experience: *

Yes Years
General Practitioner
IRA Specialist
401(k) Plan Adviser
Foundation/endowment Adviser
Financial Planner
401(k) Participant Advisor
IRA Specialist
Adviser Declarations
Holders of the VE™ certification agree to the following by checking each box and signing this application:
I will disclose all compensation expected or received, directly or indirectly, to my client(s) on a regular basis but no less frequently than annually.
I understand that by receiving compensation for my advice that I will always act in the best interest of my client(s).
I agree to provide DALBAR with the disclosures required for prudent selection and periodic review of my practice as required by ERISA and federal regulations.
General Disclosures
I am
I have * years of experience providing investment advice as an investment professional.
I have been at my current firm for * years, which has been in business since (YYYY).
I work with a team of other advisers and a support staff of .
the last 12 months I have received professional compensation from:
  Individual Clients Institutional
(including employer sponsored plans)
  Number of clients      
  Assets $ $
I have liability insurance in the amount of $ that is currently in force with (name of insurance company): .
Geographic Coverage
Please list the states and cities in which your business is concentrated. (Max. 1000 Characters).
Services Provided
Please indicate the services that you provide to clients:
Investment Management Services

ERISA Related Activities

Please list the business affiliations you have:
Type of Firm Name of Firm % You Own Nature of Affiliation Size of Firm
  RIA       %
  Number of IARs:
  Broker/Dealer       %
  Number of RRs:
Disclosure of Regulatory History
I have had regulatory sanctions or other incidents in the past five years.
Date/Description: (Max. 2000 Characters).

Nothing to report.
Service Provider Disclosures
The product providers I have used most often are:
(Provider Names)
Compensation Disclosures
What is the fee structure and fee that you intend to charge for your services? (Max. 1000 Characters).
What contractual arrangements do you have that result in direct or indirect compensation to you or the firm you represent if clients take actions on the basis of your advice. (Max. 2000 Characters).
Please list your sources of compensation and % from each of up twelve sources, largest first.
1. Source     % 5. Source     % 9.   Source     %
2. Source     % 6. Source     % 10. Source     %
3. Source     % 7. Source     % 11. Source     %
4. Source     % 8. Source     % 12. Source     %
Are there other factors or suggestions from others that could improperly influence the advice you give to clients? Please explain. (Max. 1000 Characters).
Investment Theory Disclosure
Please describe the investment theory you use to advise clients. (Max. 3000 Characters).
Adviser Profile & Signature
Existing Designation(s):
Qualified Training:
License #:
CRD #:
ADV #:
Date of Birth: *
SSN or Tax ID or N/A: *  Your SSN will be encrypted
Payment Method: *
Adviser Signature: *