Secure Client Personal Information Form

Please complete all applicable sections. Your information is kept strictly confidential.

Step 1 of 11 Tax Years

Tax Year Information

What is the last tax year you filed?

Never Prior to 2022 2023 2024 2025

Which tax years do you need to file? (select all that apply)

2023 2024 2025

Personal Information

Please enter your name exactly as it appears on your Social Security card.

First Name

Last Name

Social Security Number

Optional – you may attach a copy of your card below instead

📎Attach Social Security Card (optional)

Israeli ID Number (Teudat Zehut)

Date of Birth

Occupation

When did you move to Israel?

Born in Israel Moved to Israel

Year you moved to Israel

Home Address

Apartment / Suite / Unit No.

City

Postal Code

Phone

Marital Status

Are you married?

Yes No

Is your spouse a US citizen or Green Card holder?

Yes No

Spouse Information

Enter spouse's name exactly as it appears on their Social Security card.

Spouse First Name

Spouse Last Name

Spouse Phone

Spouse Email

Spouse Social Security Number

📎Attach Spouse's Social Security Card (optional)

Spouse Date of Birth

Spouse Israeli ID Number

Filing History

Have you ever filed US taxes before?

Yes No – this is my first time

Please attach your most recently filed US Form 1040 and FBAR (FinCEN 114) if applicable. Multiple files are allowed.

📎Attach Prior Returns (Form 1040, FBAR) – multiple files allowed

Dependent Children

Do you have children under the age of 17?

Yes No

How many children under 17?

Children's names must appear exactly as on their Social Security card. Children without a Social Security number are not eligible for the child tax credit.

Education / Student Status

Are you a university student?

Yes No

You may be eligible for up to $1,000 per year in student credit.

University

Please specify your university or college

Only one of the listed universities, or colleges affiliated with one of them, is eligible for the student credit.

Do you have Form 1098-T?

Yes No

1098-T Documents

Please attach Form 1098-T for each year you are claiming student credit.

Ishur Limudim or Tuition Statement Where to get: University tuition office.

Please attach an Ishur Limudim or Tuition Statement for each year you are claiming student credit.

Do you have any children who are university students?

Yes No

Child students (for credit)

Add each child who is a university student and for whom you are claiming the student credit.

Employment Information

What is your employment status?

Select all that apply (e.g. employed part of the year and unemployed part of the year).

Employed Self-Employed / Freelance Unemployed Retired

Were you unemployed for any portion of the year?

Yes No

Unemployment documents

Attach 1099-G (US unemployment) and/or Bituach Leumi statement (Israel unemployment), as applicable.

📎1099-G (US unemployment)

📎Bituach Leumi statement (Israel unemployment)

Employers

Add each employer if you have more than one.

Employment Documents Where to get 106: Your employer or the Mas Hachnasa website.

Attach 106 or December Tlush Mascoret for each employer, W-2 from US employer, or other foreign employer documents — for each year you are filing.

How many clients do you have?

One Two More than 2

Client 1

Name of client

Address

Client 2

Name of client

Address

Self-Employment Documents Where to get Doch Revach V'Hefsed: Israeli accountant.

Attach one or more per year: Doch Revach V'Hefsed, Form 1301, Shumat Mas (from Israeli accountant), 1099 from US payer, or a list of expenses.

Business Revenues

Enter total business revenue (optional).

Total revenue

Business Expenses

Enter amounts for each applicable expense category (optional).

Advertising

Car and Truck Expenses

Commissions and Fees

Contract Labor

Insurance

Interest – Mortgage

Interest – Other

Legal and Prof. Services

Office Expenses

Pension & Profit-Sharing

Rental of Equipment

Other Business Property

Repairs & Maintenance

Supplies

Taxes & Licenses

Travel

Travel Meals/Entertainment

Utilities

Telephone

Internet

Dues and Subscriptions

Misc

Spouse Employment Information

Spouse's employment status

Employed Self-Employed Both Unemployed Retired

Spouse Employer Name

Spouse Employment Documents Where to get 106: Your employer or the Mas Hachnasa website.

Spouse Self-Employment Documents Where to get Doch Revach V'Hefsed: Israeli accountant.

Business Ownership

Do you own an Israeli company (LTD or Hevrat B'Aam)?

Yes No

Please attach your company's Doch Ksafim (Doch Caspim Shel HaHevra) or Maazan Bochan. Where to get: Israeli accountant.

📎Attach Company Financial Documents – multiple files allowed

Other Income

Are you retired?

Yes No

Do you receive US Social Security benefits?

Yes No

📎Attach SSA-1099 (e.g. one per person – multiple files allowed)

Do you receive a pension from the United States?

Yes No

📎Attach Form 1099-R (multiple allowed)

Do you receive a pension from Israel?

Yes No

📎Attach 106 from Israeli Pension Company (multiple allowed) Where to get (106 / Doch Shnati Mekutzar): Pension company website.

Do you have any investment income?

Yes No

📎1099s from US Investment Companies (multiple allowed)

📎K-1 Forms (USA) (multiple allowed)

📎Form 867 from Israeli Banks (multiple allowed) Where to get Form 867: Bank website.

Do you have Israeli reserve army income (Millium)?

Yes No

📎Attach Israeli Reserve Army (Millium) income documents (multiple allowed)

Did you sell a property in one of the years for which you have to file taxes?

Yes No

Were you living in the house for at least two out of the last 5 years before you sold the property?

Yes No

Purchase Price

Purchase Date

Sale Price

Sale Date

Repairs & Other Expenses

Closing Expenses

📎HUD-1 from the purchase

📎HUD-1 from the sale

Do you have any rental property?

Yes No

How many rental properties?

Currency for rental amounts

Foreign Bank Accounts (FBAR)

Do you have over $10,000 combined in bank accounts, pension funds, and hishtalmut funds outside the United States?

Yes No Don't worry, I will file my own FBAR

Does your FBAR have more than $200,000?

Yes No

📎Attach a copy of your FBAR

How many Israeli / foreign bank accounts do you have?

How many pension / hishtalmut accounts do you have?

Do you have other foreign accounts outside Israel?

Yes No

US Bank Account

Important: Due to new IRS regulations, paper checks are issued only in very limited circumstances. We strongly recommend all clients receive tax refunds to a US bank account.

Do you have a US bank account for refunds or tax payments?

Yes No

Please enter US banking information only.

Bank Name

Routing Number (ACH)

Account Number

📎Attach Voided Check or Bank Account Information (optional)

Would you like us to open a US bank account for you? (Cost: 150 NIS)

Yes, please set one up No thank you

Please attach the following documents:

📎US Passport

📎Teudat Zehut (Israeli National ID Card)

📎Ishur Nihul Cheshbon (Bank Confirmation of Ownership)

📎Recent Utility Bill in Your Name (water or electricity, may be in Hebrew)

Send confirmation email to client with form summary. Uncheck if staff is filling out on behalf of the client.

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