Step 1 of 10 10% Confidential Profile Family InformationName(Required) First Last Nickname Date of Birth(Required) Marital Status(Required) Married Single Spouse's Name(Required) First Last Nickname Spouse's Date of Birth(Required) Date of Marriage(Required) Do you have children?(Required) Yes No Children's Names and Ages(Required)Child's nameAge Add RemoveResidence Address(Required) Business Address Cell Phone(Required)Office PhonePersonal Email(Required) Confidential Profile Continued OccupationYour Job Title(Required) Employer (last, if retired)(Required) # of Years(Required) Retirement Date Spouse's Job Title Spouse's Employer (last, if retired) Spouse's # of Years Spouse's Retirement Date Personal AdvisorsCurrent Financial Advisor's Name Firm Name Do you have a preference or a commitment to this advisor? Yes No Attorney's Name Firm Name Do you have a preference or a commitment to this attorney? Yes No Accountant's Name Firm Name Do you have a preference or a commitment to this accountant? Yes No What is important about money to you? What is important about money to you? Objectives & Concerns GeneralAre you anticipating any major lifestyle changes? Yes No Uncertain (i.e., marriage, divorce, retirement, moving, college, etc) If so, what changes are you expecting? Are you comfortable with your current cash flow? Yes No Uncertain Retirement PlanningWhat minimum income will you need or want at retirement (in today’s dollars)?Are you contributing to an IRA/401K? Yes No How much are you contributing per month?Do you have a pension? Yes No How much monthly income at age 65?ProtectionDisability Income Insurance(Required)Monthly Income Benefit ($)Monthly Premium ($)Personal Liability CoverageAmount of Coverage ($)Monthly Premium ($)Life Insurance(Required)Death Benefit ($)Number of Term Years Remaining at Current CostMonthly Premium ($)Any Whole Life or Universal Life Insurance?Do you have long-term care insurance for nursing home expenses? Yes No Uncertain Estate PlanningDo you have current wills? Yes No Uncertain Have you established any trusts? Yes No Uncertain Are you the beneficiary of any trusts? Yes No Uncertain Family Balance Sheet AssetsInvestments (Non-Retirement)Cash(Required)Stocks(Required)Bonds(Required)Mutual Funds(Required)ETF(Required)Business(Required)Real Estate(Required)Other(Required)Investments (Retirement)IRA(Required)401(k) or 403(b)(Required)Roth (IRA)(Required)Profit Sharing(Required)Total AssetsLiabilitiesShort-TermCredit Cards, Auto, Etc.(Required)Long-TermHome Mortgage(Required)Business Debt(Required)Additional Properties(Required)Total Liabilities Family Income Statement Annual Income:Earned Income(Required)Investment Income(Required)Social Security(Required)Real Estate / Other(Required)Total Annual IncomeAnnual Expenses:Fixed(Required)Variable(Required)Total Annual Expenses Risk Profile Please select the appropriate response for each question:1. What is your investment experience with stocks, stock ETF’s or equity mutual funds?(Required) None A Little A Fair Amount A Great Deal 2. What is your investment experience with bonds, bond ETF’s or bond mutual funds?(Required) None A Little A Fair Amount A Great Deal 3. What is your investment goal?(Required) Retirement Saving for a major purchase Gifting More current income Other 4. How many years do you have until retirement?(Required) Already Retired Less than 5 Years 5 to 10 Years More than 10 Years 5. What are your major objectives for your investments?(Required) Current and Future Income Keep Ahead of Inflation Preserving Capital Increasing Returns Keeping Wealth for Heirs 6. When do you expect to use the bulk of the money you are accumulating in your investments?(Required) At any time now in the coming Months. Liquidity is highly important. In 1 to 5 Years In 6 to 10 Years In 11 to 20 Years 7. Over the next several years, do you expect your household annual income to:(Required) Stay About the Same Decrease Moderately Grow Moderately Decrease Substantially Grow Substantially 8. I am expecting an inheritance in:(Required) 0 to 5 Years 5-10 Years 10 to 15 Years More than 15 Years No Inheritance Approximately how much inheritance are you expecting?9. Due to a general market correction, if one of your investments loses 25% of its value a short time after you buy it, what do you do?(Required) Sell the investment Hold it and wait for it to climb back up, then sell. Hold it Buy more at the new lower price 10. Some people need their investment portfolio to generate current income to meet ongoing needs. This typically tilts the investment portfolio toward bonds and dividend paying stocks. How accurately does this describe your objectives?(Required) Very Accurate Moderately Accurate Slightly Accurate Not Accurate at All 11. You have just reached the $100,000 plateau on a TV game show. Now you must choose between quitting with the $100,000 in hand or betting the entire amount on one of the three scenarios below. Which do you choose?(Required) Take the money and run A 50% chance of winning $500,000 A 20% chance of winning $750,000 A 5% chance of winning $1,000,000 12. By what percentage do you expect your portfolio to grow annually over the long term, 10+ years?(Required) 4%-6% 6%-8% 8%-10% 10%-12% 12%-14% 13. How large of a temporary decline in your portfolio are you willing to accept before changing your investment strategy, assuming you start with $100,000?(Required) 10% decline (portfolio value is $90,000) 15% decline (portfolio value is $85,000) 20% decline (portfolio value is $80,000) 25% decline (portfolio value is $75,000) Risk Profile How can we help you? On a scale of 1 to 5 (1 being low and 5 being high) please rate the following: Increase my net worth by 50%(Required) 1 2 3 4 5 Reduce my tax burden(Required) 1 2 3 4 5 Pay education expenses for my children(Required) 1 2 3 4 5 Financial security at retirement(Required) 1 2 3 4 5 Purchase real estate(Required) 1 2 3 4 5 Plan for long-term care(Required) 1 2 3 4 5 Provide for my family in the event of my (or my spouse’s) death(Required) 1 2 3 4 5 Minimize the cost of probate and estate taxes(Required) 1 2 3 4 5 Fund a charitable endeavor(Required) 1 2 3 4 5 If you could change three things about your current financial situation what would you change?If you could change 3 things (#1)If you could change 3 things (#2)If you could change 3 things (#3) Investment Goals Rate each investment goal based on their priority level:Return should exceed inflation rate None Low Medium High Urgent Principal should be safe None Low Medium High Urgent Investments should be liquid None Low Medium High Urgent Diversification is important None Low Medium High Urgent Professional asset management None Low Medium High Urgent Reduce my taxable income None Low Medium High Urgent Build tax-free income None Low Medium High Urgent Long-term growth None Low Medium High Urgent Urgent short-term profits None Low Medium High Urgent Risk Tolerance Rate Your Risk Tolerance Level on a Scale of 1 to 10 1 2 3 4 5 6 7 8 9 10 Digital Signature (Type Your Full Name)Date MM slash DD slash YYYY Referred By: Δ
