Fiduciary Attestation Form

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Fiduciary Attestation Form
As a prospective client I request a written response to the following:
Please check the appropriate box, and sign and date below.
As your financial advisor/advisory firm I acknowledge my responsibility
.
as your fiduciary and agree to put your best interests first at all times
My
duty of loyalty is to you.
As your financial advisor/advisory firm I cannot accept responsibility as
your fiduciary and you must recognize that your best interests may be in
conflict with mine or my firm’s best interests. My duty of loyalty is to my
firm.
Advisor Signature
Supervisor Signature
Advisor Printed Name
Supervisor Printed Name
Supervisor Title
Advisor Title
Date
Firm Name

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