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Click here to download the COMPLETE Questionnaire.doc Click here to download the COMPLETE Questionnaire.doc Document Transcript

  • INVESTMENT OBJECTIVE. GUIDELINE AND RESTRICTION QUESTIONNAIRE FOR ESTABLISHING A WRITTEN INVESTMENT POLICY Individual Investments Including Personal Accounts IRAs and Rollovers and Personal Trusts The setting of investment objectives for individual pools of assets is extremely important. However, it has traditionally been greatly complicated by misunderstandings due to differences of definition and interpretation. The answers to the following questions will assist in establishing mutually agreeable goals and, at the same time, establish a framework for communications and mutual understanding in a client/investment manager relationship. PERSONAL Financial Goals Please rank the following as to priority: _____ Accumulate Wealth to fund my retirement at age _____(self ) _____(spouse) _____ Accumulate wealth for a child's education for ___ years of public/private school. _____ Accumulate wealth for another financial goal in ___ years. (for example, buy a house, start a business, etc.) _____ Provide High Current Income for my Current Lifestyle _____ Preservation of Capital ______Maximum capital appreciation ______Inflation hedge ______Consistent returns, low volatility Comments ___________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ An important consideration when making investment decisions is where you are in your life cycle and how long you have before you will need the money you are investing. In about how many years do you expect to need the money you are investing? ___ A. Within 2 to 3 years ___ B. Within 4 to 5 years ___ C. Within 6 to 10 years ___ D. More than 10 years Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • How far in the future would you anticipate the need to withdraw more than 20 percent of your portfolio to meet a short-term financial need? ___ A. Less than 3 years ___ B. Within 3 to 7 years ___ C. More than 7 years Which statement best describes your portfolio income needs? ___ A. I can forego at least 10 percent of my total current portfolio income. ___ B. My present income is adequate for my needs. ___ C. I need at least 10 percent more portfolio income. Given interruptions of periodic income or other unforeseen circumstances, some individuals are forced to tap their investment resources to meet living expenses. In such an instance, how many months of living expenses could be covered by your current liquid investments? ___ A, More than 12 months, or not a concern ___ B. Between 4 and 12 months ___ C. Less than 4 months, or already withdrawing In light of other resources of income you may have, how do you anticipate using the earnings of your investment portfolio? ___ A. Reinvest I 00 percent of my investment earnings. ___ B. Reinvest 80 to 100 percent of my investment earnings. ___ C. Reinvest 20 to 79% of my investment earnings. ___ D. Reinvest 0% (receive all investment earnings for cash flow). Although tax status does not affect your risk profile, it may be a consideration when allocating specific investments within your portfolio. Given you current marginal income tax bracket, are there any special tax constraints which would lead you to invest primarily in non taxable investments, such as municipal bonds? _____Yes _____ No Total earnings, which includes earned and investment income, is a requirement when assessing your risk tolerance and determining allocation of assets. What is your total annual household income (including interest and tax deferred income) ___A. More than $200,000 ___B. $150,000to $199,999 ___ C. $100,000to $149,999 ___ D. $50,000 to $99,999 ___ E. Less than $49,999 The percentage of your total income that you currently save is approximately: ___ A. 0 percent ___ B. 0 to 9 percent ___ C. 10 to 20 percent ___ D. More than 20 percent Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • INVESTMENT PHILOSOPHY Overall, how would you generally categorize your investment objectives? (choose one) ______Growth -- Maximum growth of capital with little or no income considerations. ______Growth plus Income -- Primary emphasis on capital growth with some focus on income. ______Balanced -- A balanced portfolio with equal emphasis on capital growth and income. ______Income Oriented -- Income as a primary emphasis. ______Tax Deferral -- Tax Deferral as the Primary Investment Objective ______Liquidity -- Liquidity as the Primary Investment Objective ______Other -- Please describe._________________________________________ _____________________________________________________________ _____________________________________________________________ Which of the following statements best describes your overall approach to investing? _____ A. Pursue current income, forego capital gains and minimize risk to principal. _____ B. Increase investment value while minimizing potential for loss of principal. _____ C. Pursue investment growth, accepting moderate levels of risk and principal fluctuation _____ D. Seek maximum long-term returns, accepting maximum risk with principal fluctuation. For each group, indicate the attitude most closely resembling your own expectations regarding the policies of the investment advisor. ______Invest in established companies OR ______Invest in new companies which are considered to have good growth Potential OR ______Both of the above ______Generally sell individual stocks when the stock price is higher in value than the financial value of comparable companies in the market OR ______Generally sell stocks when technical market analysis indicates by exercising a high degree of stock market timing judgment regardless of the financial value of the individual stocks Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • INCOME AND RETURN EXPECTATIONS Total return on the entire portfolio is made up of income return (i.e., dividends and interest received) and capital appreciation. As a general rule, the higher the income expectations, the lower the capital return expectations. Do you have any absolute requirements for immediate income cash flow withdrawals? ______NO ______Yes. Please indicate the appropriate income yield range you expect the total portfolio to generate. ______8-12% ______4-8% ______2-4% ______Other. Please specify annual dollar amount__________ Do you see a need for growth in income within the next five years? ______YES ______NO One guide to the type of stock that might be applicable for the portfolio is the dividend yield. the higher the anticipated growth or capital appreciation, the smaller the dividend yield. Do you require stocks in the portfolio to have a specified dividend yield? ______No. I feel capital appreciation is more desirable ______I would like all stocks to yield an average of 0-4%. ______I would like all stocks to yield an average of 4-6%. ______I would like all stocks to yield an average of 6-8%. ______1 would like all stocks to yield an average of over 8% What average annual target rate of return (as opposed to a "relative" return to a market index) do you consider to be the investment objective for the fund on a long-term basis? In general, the higher the goal, the greater the risk the manager must take. The average total return for the past 65 years have been 10.1% for stocks and 5.1 % for corporate bonds. Total ______over 12% per year. ______10- 1 2% per year ______8-10% per year ______below 8% per year ______exceeds inflation (CPI) by______% ASSET ALLOCATION/DIVERSIFICATION Do you think common stocks are a good inflation hedge? ______YES ______NO Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • How do you feel about investing in common stocks in general? ______I feel stocks are very attractive and should occupy a dominant role in a portfolio. ______Common stocks should have a place in an investment portfolio. ______I have no opinion. ______I feel stocks are relatively risky and their use should be limited. ______I feel stocks should be used very sparingly, if at all. Do you believe it is necessary that the portfolio always contain bonds if it is to be adequately diversified? ______YES ______NO Do you think that the stock market is currently offering enough potential over the next year to compensate for the increased price fluctuation versus the bond market? ______YES ______NO What is your attitude about owning stocks and bonds at various points in a market cycle? ______I believe the percentage of stocks in the portfolio should be based on the intrinsic values available in each stock, regardless of the economic or overall market environment. OR ______I believe the economic and market outlook should be evaluated first and the percentage in stocks should reflect that outlook. ______I believe bonds are always a good investment regardless of the outlook for bond prices. OR ______I think the economic and market outlook should be considered in making bond investments and the percentage in bonds should vary with this outlook. Bond interest rates generally vary inversely with the quality and maturity length of the bond. What bond quality and maturity length do you feel is most appropriate for the portfolio? QUALITY ______All AAA rated highest possible ______None lower than AA ______None lower than A ______None lower than BAA ______Speculative bonds for high return and capital gains Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • MATURITY ______Under 5 years (short-term) ______1-10 years (intermediate) ______10+ years (long-term) In regard to your ongoing objectives, you may have a predisposition how your portfolio should be balanced among stocks, bonds, other fixed income investments and cash. Please indicate your preferred maximum/minimum mixes for the following asset classes. Maximum Minimum Target Domestic Equities (stocks) ________ ________ ________ Intemational Equities (stocks)________ ________ ________ Fixed Income (bonds) ________ ________ ________ Cash (money market) ________ ________ ________ What diversification pattern should your equity portfolio take? ______Each equity position in the portfolio should represent no more than 5% of the total portfolio value OR ______Any one equity position can represent as much as _______% of the portfolio value. ______No combined equity positions should represent more than 15% of any one industry group and 30% of any industry sector. OR ______Combined equity positions can represent as must as ________% of an industry group and ________% of any industry sector. RISK Understanding your tolerance for investment risk relative to your investment return expectation is an important step in designing your portfolio. The following questions will aid in developing a more accurate financial image of you and your possible investment future. The answers you provide will tell us your comfort level with investment risk and your ability to withstand it. They will help to analyze your daily financial needs, your investment style, and your personal investment goals. Risk Tolerance: (check one) ______Aggressive ______Moderate ______Conservative Do investment objectives allow speculation? ______YES ______NO Primary Source of Income: (check one) ___Investments ___Compensation ___Retirement Assets (Amount)__________ Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • How many years until your youngest child is 18? __________ What are your estimated monthly living expenses with children? __________ What are your expected monthly living expenses without children? __________ What is your monthly earned income? __________ What is your anticipated monthly pension incomes? __________ What is your anticipated monthly survivor benefit? __________ What is the amount of your existing life insurance coverage? __________ What is the amount of your group life insurance coverage? __________ If your retirement plan provides a death benefit, what is the amount? __________ What is the anticipated amount of your final expenses? __________ How much of total savings could be considered emergency reserves? __________ What is the amount of your total current family debts? __________ Risk Factor Before you make a decision on any investment, you need to consider how you feel about the prospect of potential loss of principal. This is a basic principal of investing: the higher return you seek, the more risk you face. Which factor is most important to you in allocating a portfolio or choosing a particular investment? _____ A. How quickly I may be able to increase my wealth. _____ B. The amount of monthly income the portfolio can generate. _____ C. The safety of my investment principal. The value of most investments fluctuate from year to year as well as over the short-term. How would you feel if an investment that you had committed for ten years lost 10% of its value during the first year? _____ A. I would be extremely concerned and would consider selling and moving the investment. _____ B. I would be moderately concerned, and may consider selling and moving the investment. _____ C. I would be somewhat concerned, but I probably would not consider selling the investment. _____ D. I would not be overly concerned, given my investment philosophy. After observing the yearly volatility in each of the following hypothetical portfolios, with which would you feel most comfortable? Average Year I Year 2 Year 3 Year 4 Year 5 Annual Return __A 5% 5% 5% 5% 5% 5% __B. 4% 7% 8% 2% 9% 6% __C. -5% 21% 8% 2% 9% 7% __D. 9% -11% 26% 3% 18% 9% __E. 14% -21% 40% -4% 31% 12% Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • The investment process requires various trade-offs in the quest of superior results. Quantifying what trade-offs an investor is willing to accept in order to achieve a superior total return constitutes an ongoing challenge. In evaluating your attitudes, please check one item for each where you feel most uncomfortable. ______Holding large cash reserves during a strong market environment OR ______Being fully invested during a weak market environment ______Selling an investment and seeing it immediately rise. OR ______Buying an investment and watching it immediately decline, Which is the most attractive alternative? ______Being invested in both up and down phases of a full market cycle. OR ______Trying to time the market's direction of movement ______No down years OR ______Outperform the market over a full market cycle An increase in capital return usually associated with an increase in the acceptable level of fluctuation of the portfolio value market cycle to market cycle. Which is most attractive to you: ______Accepting a wider possible range of fluctuation in an attempt to achieve a higher return OR ______Consistent returns with lower fluctuation. How much downside market volatility can you tolerate in an attempt at potentially higher returns? ______Can tolerate more than one year or negative absolute returns through difficult phases in a market cycle OR ______Can tolerate 2-3 quarters of negative absolute returns through difficult phases in a market cycle OR ______Can tolerate only infrequent, very moderate losses through a market cycle Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • What is your disposition as it relates to investing in the international securities markets (excluding money market) for this portfolio? ______This portfolio is to be invested solely in international securities. ______This portfolio is to be invested in the international and domestic securities (global) ______The majority of the portfolio is to be invested in domestic securities and may own international securities as determined by the manger. ______This portfolio is to have no international securities. Are there any securities that you would prefer not to be invested in? ______If NO please Explain______________________________________________ ______If YES Please List ______________________________________________ ______________________________________________ ECONOMY How do you feel about the short-term outlook for the U.S. economy (12-24 months)? ______I feel the outlook is good. ______I'm neutral; there are opportunities and problems. ______I'm quite concerned; the outlook is poor. How would you describe your outlook on the U.S. economy over the next ten years? ______Optimistic ______Pessimistic ______Undecided How would you describe your outlook on the World economy over the next ten years? ______Optimistic ______Pessimistic ______Undecided How do you feel about the inflation outlook over the long-term (5-10 years) ______It will be a problem for a long time and may get worse ______The rate of inflation will probably remain at about current levels ______Inflation is only a tempo;-ary problem; the rate will back down. In the next five years, you expect that your earned income will probably: ___ A. Decrease ___ B. Stay about the same ___ C. Increase modestly ___ D. Increase significantly MEASUREMENT The primary emphasis in examining the investment performance for this account should be based upon: Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • ______"Absolute" comparison. That is, comparing the actual account returns to an absolute (target) rate of return ______"Relative" comparison. That is, comparing the actual account returns to various market indices. ______"Comparing to a "real" return (i.e., exceeds the inflation factor by x%). ______Using "target" and "relative" rate of return measurements ______I have no real preference The time period used in evaluating an investment medium has a significant impact on the probability of realizing a stated return objective. What investment time horizon seems most appropriate for the account? ______Ten years or more ______Five to ten years ______A complete market cycle (3 - 5 years) Relative to popular stock market indices (S&P 500), which of the following is your preference for equity performances I through 4: ______Generally beat the market index in each UP market year ______Generally beat the market index in each DOWN market year ______Surpass the market index, on average, over an extended period of time (without regard to each individual year) ______Do as well as the market over an extended period of time ______I consider performance relative to a market index to be irrelevant. I prefer to specify our objective in other ways (please specify) _______________________________________________________________ _______________________________________________________________ COMMUNICATION What regularity of direct contact with your investment advisor is preferred? Meeting Telephone E-Mail Letter Annually _______ _______ _______ _______ Semi-Annually _______ _______ _______ _______ Quarterly _______ _______ _______ _______ Monthly _______ _______ _______ _______ Other:__________ _______ _______ _______ _______ Only When Deemed Necessary _______ _______ _______ _______ Is geographic location of your portfolio manager important to you? NO: _______ If Yes Please Explain Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • Retirement Planning Client Spouse In how many years do you plan to retire? _________ _________ How much do you spend annually on mortgage payments? $_________ _________ How many years from now will mortgage be paid off? $_________ _________ What is your annual living expense, net of taxes, $_________ _________ excluding mortgage? In how many years, do you plan to collect Social Security? _________ _________ What is/will be your annual estimated benefit? $_________ _________ (if unsure check www.ssa.gov) In how many years will your pension begin? _________ _________ What is/will be your annual pension income during retirement? (excluding 401k, IRA, etc.) $_________ _________ In how many years will your pension end? _________ _________ What is the amount of annual pension survivor's benefit? $_________ _________ Is your pension adjusted per year for inflation?. Yes/No Yes / No What annual earned income do you anticipate receiving during retirement? $_________ _________ In how many years will your earned income end? _________ _________ Is your earned income adjusted per year for inflation? Yes/No Yes / No Do you have any other annual income? Yes/No Yes / No Other annual income begins in how many years? _________ _________ Other annual income stops in how many years? _________ _________ Is your other annual income adjusted for inflation? Yes/No Yes / No What is the amount of your life insurance coverage? $_________ _________ How much are currently saving for retirement each year? $_________ _________ How much would you like to have set aside as a contingency fund or pass to your heirs at your death? $_________ _________ Current value of all taxable investments $_________ _________ Hypothetical annual return on taxable portfolio $_________ _________ Annual contributions (excluding reinvested earnings) $_________ _________ Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • Current value of all tax free investments $_________ _________ Hypothetical annual return on tax free portfolio _____% _____% Annual contributions (excluding reinvested earnings) $_________ _________ Current value of all non-qualified deferred investments (such as commercial annuities, etc.) $_________ _________ Hypothetical annual return on non qualified portfolio _____% _____% Annual contributions (excluding reinvested earnings) $_________ _________ Current value of all qualified deferred investments (such as IRAs, 401k, profit sharing plan, etc.) $_________ _________ Hypothetical annual return on qualified portfolio _____% _____% Annual contributions (excluding reinvested earnings) $_________ _________ What is your filing status? _____Joint _____Single _____Head of Household What is the number of Personal exemptions? _____ Number of additional deductions for Blind, over 65, etc.? _____ Estate Planning What type of will do you have? (Simple or Credit Shelter) Client? _______________ Spouse? _________________ A Credit Shelter Will incorporates the appropriate drafting to utilize the applicable unified credit exemption equivalent amount upon the first spouse's death. What type of trust do you have? (Revocable or Irrevocable) Client? _______________ Spouse? _________________ A Revocable Trust is a trust which can be changed and is commonly referred to as a living trust while an irrevocable trust is non-changeable and will have its own tax LD. number. Assuming you predecease your spouse, upon your death, what amount of your estate do you plan to bequest to someone other than your spouse? Client? _______________ Spouse? _________________ Do you plan to leave assets to your spouse outright or in trust at your death? Client? _______________ Spouse? _________________ Leaving assets in trust transfers assets to your spouse in a trust and would not expose these assets to probate fees at your spouse's death. Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • How much do you plan to leave to charity? Client? _______________ Spouse? _________________ If you have reported taxable gifts in the past which exceed $ 10,000 enter the amount Client? _______________ Spouse? _________________ TAX Planning Taxable and Non-Taxable Income What is the amount of your current wages and salary? _________ What is the total amount you have contributed to employer-provided retirement plans? _________ What is the amount of your current self-employment income? _________ What is the total amount of your IRA distributions? _________ What is the total of any other miscellaneous income? _________ What is your net long-term capital gain or loss, if any? _________ What is your net short-term capital gain or loss, if any? _________ What is your total taxable interest & dividend income? _________ What is your total tax exempt interest income? _________ What is the amount of your total non-reportable income? _________ Adjustments To Income Alternative Minimum Tax Adjustments & Preference items _________ What is your annual deductible traditional IRA contribution? _________ Itemized Deductions Medical Expenses _________ Investment Interest _________ State/Local Property taxes _________ Charit. Contributions _________ State/Local Income Taxes _________ Misc. 2% Deductions _________ Mortgage Interest Paid _________ Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • Educational Funding Child 1 Name: _______________________ Child 2 Name: _______________________ For Private elementary and secondary school Starts school in how many years_____ Starts school in how many years_____ Number of years to finish _____ Number of years to finish _____ Cost per year ________ Cost per Year ________ Total Cost ________Total Cost ________ Current Educational Savings _____ Current Educational Savings _____ Continue to save per year _____ Continue to save per year _____ For Post-Secondary (College and Post Graduate) Starts school in how many years_____ Starts school in how many years_____ Number of years to finish _____ Number of years to finish _____ Cost per year ________ Cost per Year ________ Total Cost ________Total Cost ________ Current Educational Savings _____ Current Educational Savings _____ Educational IRA savings _____ Educational IRA savings _____ Section 529 educational savings _____ Section 529 educational savings _____ Trust or other funds _____ Trust or other funds _____ Continue to save per year _____ Continue to save per year _____ Child 3 Name: _______________________ Child 4Name: _______________________ For Private elementary and secondary school Starts school in how many years_____ Starts school in how many years_____ Number of years to finish _____ Number of years to finish _____ Cost per year ________ Cost per Year ________ Total Cost ________Total Cost ________ Current Educational Savings _____ Current Educational Savings _____ Continue to save per year _____ Continue to save per year _____ For Post-Secondary (College and Post Graduate) Starts school in how many years_____ Starts school in how many years_____ Number of years to finish _____ Number of years to finish _____ Cost per year ________ Cost per Year ________ Total Cost ________Total Cost ________ Current Educational Savings _____ Current Educational Savings _____ Educational IRA savings _____ Educational IRA savings _____ Section 529 educational savings _____ Section 529 educational savings _____ Trust or other funds _____ Trust or other funds _____ Continue to save per year _____ Continue to save per year _____ Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • Asset Inventory Personal Assets Date Cost Value Spouse / Description Acquired Jointly owned Residence ___/_____ $________ $________ C/S/J 2nd Residence ___/_____ $________ $________ C/S/J Other Real Estate ___/_____ $________ $________ C/S/J Collectibles ___/_____ $________ $________ C/S/J Vehicles ___/_____ $________ $________ C/S/J Personal Property ___/_____ $________ $________ C/S/J Jewelry ___/_____ $________ $________ C/S/J Other ________________ ___/_____ $________ $________ C/S/J Taxable Assets (from below) ___/_____ $________ $________ C/S/J Tax Free Assets ( " ) ___/_____ $________ $________ C/S/J Non-Qualified Assets ( " ) ___/_____ $________ $________ C/S/J Tax-Deferred Assets ( " ) ___/_____ $________ $________ C/S/J Total Personal Assets: _____________ Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • Personal Liabilities Original Balance Home Mortgage ___/_____ $________ $________ C/S/J 2nd Residence Mortgage ___/_____ $________ $________ C/S/J Other Real Estate Mortgage ___/_____ $________ $________ C/S/J Loans - Investments ___/_____ $________ $________ C/S/J Short Term Notes ___/_____ $________ $________ C/S/J Credit Card Balances ___/_____ $________ $________ C/S/J Other ________________ ___/_____ $________ $________ C/S/J Total Personal Liabilities: _____________ Personal Income Client Spouse Salary Commissions, Bonus $_________ $_________ Self Employment Earnings $_________ $_________ Pension Income $_________ $_________ IRA, 401K, etc Income $_________ $_________ Mutual Fund, other Investment Income $_________ $_________ Social Security $_________ $_________ Other Income $_________ $_________ Total Annual Income: _____________ Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • Personal Expenses Housing and Utilities $_________ $_________ Taxes (State and Federal) $_________ $_________ Transportation $_________ $_________ Food, Clothing, Living Expenses $_________ $_________ Savings $_________ $_________ Other _______________________ $_________ $_________ Total Annual Expenses: _____________ Client / Taxable Assets Date Cost Value Spouse / Description Acquired Jointly owned __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J (examples: Stocks, Bonds, CD, Mutual Fund, Money Market, REIT, UIT, etc.) Total Taxable Assets: _____________ Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • Taxfree Assets Date Cost Value Spouse / Description Acquired Jointly owned __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J (examples: Municipal Bonds, Tax Free Mutual Funds, Roth IRA, etc.) Total Taxfree Assets: _____________ Non-Qualified Assets Date Cost Value Spouse / Description Acquired Jointly owned __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J (examples: Commercial Annuity, Non-Qualified Deferred Compensation, etc.) Total Non-Qualified Assets: _____________ Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • Taxable Assets Date Cost Value Spouse / Description Acquired Jointly owned __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J __________________ ___/_____ $________ $________ C/S/J (examples: IRA, SEP IRA, Simple IRA, Keogh IRA, 401(k), Profit Sharing, Employee Stock Ownership Program, Tax-Sheltered Annuity, etc.) Total Tax Deferred Assets: _____________ Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • CLIENT INFORMATION Name _______________________________ Social Security Number ____-__-_____ Address______________________________________ Date of Birth ____/____/____ (P. O. Box)___________________________________ Projected Retirement Year ____ Home Phone ( )______-________ Work Phone ( )_____-________x_____ Are you or your immediate family employed by a financial Institution?YES/NO__ Employer's Name___________________________________Phone:_________ Est. Annual Compensation__________________ Employed Since ___________ Employer's Address ________________________________________________ Nature of Business ____________________ Occupation______________ Marital Status:______Single ______Married _____Divorced ______Widowed SPOUSE'S INFORMATION Name ________________________________ Social Security Number ___-___-___ Other Address:______________________________ Date of Birth ____/____/____ Employer's Name______________________________ Phone:-______________ Est. Annual Compensation__________________ Employed Since ____________ Employer's Address _________________________ Projected Retirement Year ____ Nature of Business ____________________ Occupation______________ Children Names Social Security# Date of Birth Graduate HS (year) ____________ ____-__-____ ____/___/___ 20___ ____________ ____-__-____ ____/___/___ 20___ ____________ ____-__-____ ____/___/___ 20___ ____________ ____-__-____ ____/___/___ 20___ Investment Objectives Questionnaire By Lynn R. Siewert © 2002
  • INVESTMENT EXPERIENCE Have you ever had accounts with other brokerage firm(s)? If yes, please specify firm(s) ____________________________________ Est. Total Annual Income (from all sources) ___________________ Current Federal Income Tax Bracket ________________ Est. Liquid Net Worth _____________ Est. Total Net Worth _________________ Stocks Bonds Options Mutual Funds Annuities None _____ _____ _____ _____ _____ Moderate _____ _____ _____ _____ _____ Extensive _____ _____ _____ _____ _____ Since what year _____ _____ _____ _____ _____ Bank Name and Address _____________________________________________ Attorney Name _________________________________ Phone ______________ Accountant Name ______________________________ Phone ______________ Tax Professional Name ___________________________ Phone ______________ Insurance Professional Name _______________________ Phone ______________ Legal State of Residence (if different from above) _________________________ Attached / Requested Documentation: ________ Last Year's Tax Return ________ Financial Statements ________ Listing of Assets ________ Insurance Policies ________ Brokerage Account Statements ________ Retirement Plans/IRA/401k ________ Real Estate Documentation ________ Wills and Trusts ________ Other __________________________________________________________ Signed: _______________ By: ____________ Date: __ __, 2002 Investment Objectives Questionnaire By Lynn R. Siewert © 2002