7152 Knapp St NE Ada, MI 49301 www.hbwtaxservices.com p) 616.682.4604 f) 616.682.5367 pathway@hbwsecurities.com Hello and welcome to HBW Partners Tax Services (HBWPTS)! A little about us: HBWPTS is one of four HBW entities: HBW Partners, HBW Advisory Services, HBW Securities and HBW Partners Tax Services. Our entities provide a variety of products for agents and representatives to offer to their clients. For more information about HBW and the roles of each entity, please visit the following websites: www.hbwpartners.com www.hbwadvisory.com www.hbwsecurities.com Why taxes? Sometimes the complexity and magnitude of taxes can make it easy to wonder why in the world would I want to do taxes? As intricate as it may be, tax preparation provides a fantastic opportunity to grow your business in multiple ways. For example, most of your clients probably need to file tax returns. Instead of taking their personal information to another agency, they could bring it to someone they already know and trust. Additionally, more than 136 Million tax returns were filed in 2014. This provides a great opportunity for referrals since SO many people need this service! Also, with referrals comes the chance to discuss investments, insurance needs, and so on. When you open the door for taxes, you also open the door for many other business expansion prospects. Why HBWPTS? Great question The federal tax code has over 3,700,000 words in it (for comparison purposes, the bible has approximately 700,000 words). Yikes! We are here to help you learn the ins and outs of taxes and provide some guidance and stability as you study those 3,700,000 words. We provide your preparation software, liability insurance, and will be walking with you as you go through the certification course and as you venture into the tax season to begin preparing returns. How it works: The first step is to fill out the pre-registration form. Once completed, you may send it to the contact information found in the header. Upon acceptance, we will contact you and request payment for the first year affiliation fee (this covers the course materials, insurance and your tax software for the season). You will then receive the course material and be given access to short training sessions for each federal chapter of the class. The federal material consists of 20 chapters broken down into 4 modules (California has additional modules specific to the state). There are tests after each chapter and module, however, all tests are open-book and are taken online. The goal for completion is 3 months from the start of the class (no later than November 30 th ). We can t wait to get started on this journey with you so please take some time to fill out the following paperwork and submit it to the contact information above. We look forward to working with you! -The HBW Partners Tax Services Staff 7152 Knapp St NE Ada, MI 49301 pathway@hbwsecurities.com p) 616.682.4604 f) 616.682.5367 www.hbwtaxservices.com
Tax Professional Application Personal Information Name: Gender: SSN: DOB: Home Address: City: State: Zip: Work Address: City: State: Zip: Office Number: Cell Number: Email Address: Licenses Held: Past 5 Years of Employment History Please send completed applications to Joel D. Broersma e: joel.broersma@hbwsecurities.com p: 616.682.4604 f:616.682.5367 7152 Knapp Street NE, Ada, MI 49301
Acknowledgements and Requirements :: HBW Partners Tax Services (HBWPTS) requires a new tax preparer to complete the certification class provided by HBWPTS and The Income Tax School. :: This class is a required course. Exceptions may be granted to those who are either a CPA or EA. Contact Joel Broersma for this exception. :: There is an annual affiliation fee to be a tax preparer with HBWPTS. The funds will be applied to tax software, E&O insurance, and training, all of which is provided by HBWPTS. :: First year affiliation fee: $500 ($700 for State of California), includes the cost of the course. (nonrefundable - all pricing subject to change) :: Additional state requirements may apply. States include: California http://www.ctec.org New York http://www.tax.ny.gov/tp Maryland http://dllr.maryland.gov/license/taxprep/taxpreplic.shtml Oregon not available through HBWPTS Please visit your state's website for more details. (states and requirements subject to change) Consent for Pre-Registration I,. hereby give name SSN my consent to HBW Partners Tax Services LLC to review my background and registration through FINRA and to check my credit history and background through any service deemed acceptable to the firm. I acknowledge that I have read and understand the requirements stated above and agree to comply. Signature: Date: Please send completed applications to Joel D. Broersma e: joel.broersma@hbwsecurities.com p: 616.682.4604 f:616.682.5367 7152 Knapp Street NE, Ada, MI 49301
Legal Questions for Contracting and Appointment Requests Please answer the following questions. If you answer YES to any question, be sure to provide a full, detailed explanation including specific dates. Name: 1. Have you ever been charged or convicted of, plead guilty or no contest to any Felony, Misdemeanor, federal/state insurance and/or securities or investment regulations or statutes? 1a. Have you ever been on probation? 1b. Have you ever been convicted of, plead guilty or no contest to, or been charged with any Felony? 1c. Have you ever been convicted of, plead guilty or no contest to, or been charged with any Misdemeanor? 1d. Have you ever been convicted of, plead guilty or no contest to, or have been charged with a violation of federal or state securities, investment related regulations, insurance related regulations or taxing authorities? 1e. Has any foreign government, court, regulatory agency or exchange ever entered an order against you related to tax fraud? 2. Have you ever been or are you currently being investigated, have any pending indictment, lawsuits or have you ever been in a lawsuit with an insurance agency? 2a. Are you currently under investigation by any legal, regulatory or taxing authority? 2b. Have you ever been or are you currently involved in any pending indictments, lawsuits, civil judgments or other proceedings (civil or criminal) (you may omit family court). 3. Have you ever been alleged to have engaged in any fraud? 4. Have you ever been found to have engaged in any fraud? 5. Has any insurance or financial services company or broker-dealer terminated your contract or appointment or permitted you to resign for a reason other than lack of sales? 5a. Were you fired because you were accused of violating insurance or investment related statutes, regulations, rules or industry standards of conduct? 5b. Were you fired because you were accused of fraud or the wrongful taking of property? 5c. Were you fired for failure to supervise in connection with insurance, investment or tax related statutes, regulations, rules or industry standards of conduct? YES NO
6. Have you ever had an appointment with any insurance company denied or terminated for cause? 7. Does any insurer, insured or other person claim any commission chargeback or other indebtedness from you as a result of any insurance transactions or business? 8. Has any lawsuit or claim ever been made against your surety company, or errors and omissions insurer, arising out of your sales or practices, or, have you been refused surety bonding or E&O coverage? 8a. Has a bonding or surety company ever denied, paid on or revoked a bond for you? Or, have you ever had a claim filed against your surety company? 8b. Has any Error & Omissions (E&O) carrier ever denied, paid claims on or cancelled your coverage? Or, have you ever had a claim filed against your E&O carrier? 9. Have you ever had an insurance or securities licensed denied, suspended, cancelled or revoked? 10. Has any state or federal regulatory body found you to have been a cause of an investment or insurance-related business having its authorization to do business denied, suspended, revoked or restricted? 11. Has any state or federal regulatory agency revoked or suspended your license as an attorney, accountant or federal contractor? 12. Has any state or federal regulatory agency found you to have made a false statement or omission or been dishonest, unfair or unethical? 13. Have you had any interruptions in licensing? 14. Has any state, federal or self-regulatory agency filed a complaint against you, fined, sanctioned, censured, penalized or otherwise disciplined you for a violation of their regulations or state or federal statutes? 14a. Has any regulatory body ever sanctioned, censured, penalized or otherwise disciplined you? 14b. Has any state, federal or self-regulatory agency filed a complaint against you, fined or sanctioned you? 14c. Have you ever been the subject of a consumer initiated complaint? 15. Have you personally filed a bankruptcy petition or declared bankruptcy? 16. are there any unsatisfied judgments, garnishments or liens against you? 17. Are you connected in any way with a bank, savings & loan association or other lending or financial institution? 18. Have you ever used any other names or aliases? 19. Do you have any unresolved matters pending with the IRS or other taxing authority? YES NO If you answered YES, proved an explanation that includes dates, actions and descriptions. Attach additional paper if necessary I attest that the information I have provided is true to the best of my knowledge. I acknowledge that if any information changes, I will notify HBW Tax Partners within 5 days of such change. Signature: Date: