RIE Worksheet

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Retirement Income Evaluator. Fill out and submit to me So I can provide you with an in depth look at your Retirement Income Scenario.

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RIE Worksheet

  1. 1. WWW. JANNEY.COM • © 2012 JANNEY MONTGOMERY SCOTT LLC MEMBER: NYSE, FINRA, SIPC • REF. 124386 • RETIREMENT INCOME EVALUATION QUESTIONNAIRE • PAGE 1 W E A L T H M A N A G E M E N T Reti rement Income Evaluation client information Personal Information Client Co-Client Title First Name Last Name Social Security # Birth Date Gender Marital Status Citizenship Contact Information Client Co-Client Home Telephone Business Telephone Cellular Telephone Fax E-mail Address Client Co-Client Address Line 1 Street City State Zip Code Country Filing Status  Single  Married/Jointly  Married/Separately Salary Specify the gross income numbers and the average annual increase of your salary, if applicable. Client Co-Client Current Annual Salary $ $ Average Salary Increase $ $ Estimated Retirement Income Client Co-Client Annual Social Security Benefit ($) Annual Pension Benefit ($) Immediate Annuity Fixed/Variable Annuities Income from Real Estate Business/Trust Income Other Income Tax Rates If you choose, you may indicate different tax rates in the table below for Before Retirement and During Retirement. Before Retirement During Retirement Average Federal Tax Rate % % Average State Tax Rate % % This four-page document will help you gather basic information about your taxes, income sources, assets, expenses and risk tolerance needed to complete your Retirement Income Evaluation. Please provide as much information as possible in each section. In some cases, it may be necessary to provide estimates or assumptions. If more room is needed, please feel free to attach a separate sheet of information. In order for your Financial Advisor to provide the most effective and accurate analysis, we recommend that you provide statements for any accounts held outside of Janney. Your Janney Financial Advisor will contact you to clarify the information that you have provided and to collect any missing data.
  2. 2. Liquid Assets Balances Client Co-Client Checking Savings Money Market CDs Investment Accounts (Please list account type, e.g. general/IRA) Investment Account 1 Account Name Owner Account Type Current Balance Annual Contributions Start Age End Age Before Taxes $ After Taxes $ Check Current Allocation (if known)  40% Fixed Income, 60% Equity  100% Cash  30% Fixed Income, 70% Equity  80% Fixed Income, 20% Equity  10% Fixed Income, 90% Equity  60% Fixed Income, 40% Equity  100% Equity Investment Account 2 Account Name Owner Account Type Current Balance Annual Contributions Start Age End Age Before Taxes After Taxes Check Current Allocation (if known)  40% Fixed Income, 60% Equity  100% Cash  30% Fixed Income, 70% Equity  80% Fixed Income, 20% Equity  10% Fixed Income, 90% Equity  60% Fixed Income, 40% Equity  100% Equity Investment Account 3 Account Name Owner Account Type Current Balance Annual Contributions Start Age End Age Before Taxes After Taxes Check Current Allocation (if known)  40% Fixed Income, 60% Equity  100% Cash  30% Fixed Income, 70% Equity  80% Fixed Income, 20% Equity  10% Fixed Income, 90% Equity  60% Fixed Income, 40% Equity  100% Equity Investment Account 4 Account Name Owner Account Type Current Balance Annual Contributions Start Age End Age Before Taxes After Taxes Check Current Allocation (if known)  40% Fixed Income, 60% Equity  100% Cash  30% Fixed Income, 70% Equity  80% Fixed Income, 20% Equity  10% Fixed Income, 90% Equity  60% Fixed Income, 40% Equity  100% Equity Investment Account 5 Account Name Owner Account Type Current Balance Annual Contributions Start Age End Age Before Taxes After Taxes Check Current Allocation (if known)  40% Fixed Income, 60% Equity  100% Cash  30% Fixed Income, 70% Equity  80% Fixed Income, 20% Equity  10% Fixed Income, 90% Equity  60% Fixed Income, 40% Equity  100% Equity Other Assets Real Estate Trust Business Other Owner Value Original Loan Amount Loan Start Year Loan Interest Rate Remaining Loan Bal. Payment Amount Payment Frequency Estimated Sale Price Estimated Sale Year Retirement Goals (Please see Living Expenses Budget Planner) Desired Annual Income NEED $ Desired Annual Income WANT $ Client Co-Client Estimated Retirement Age Estimated Life Expectancy How Much Do You Want to Leave as a Legacy? WWW. JANNEY.COM • © 2013, JANNEY MONTGOMERY SCOTT LLC • MEMBER: NYSE, FINRA, SIPC • REF. 124386, REVISED 1/2013 • RETIREMENT INCOME EVALUATION QUESTIONNAIRE • PAGE 2
  3. 3. Annual Living Expenses Budget Planner Expense Amount Type Start Age End Age (Please attach a separate sheet if more space is required.) $0,000 NEED WANT Optional Mortgage   Utilities   Groceries   Travel   Hobbies   Help pay for college for grandchildren                                               Additional Notes You can use this section to provide any additional information you feel may be relevant to your Financial Advisor. WWW. JANNEY.COM • © 2013, JANNEY MONTGOMERY SCOTT LLC • MEMBER: NYSE, FINRA, SIPC • REF. 124386, REVISED 1/2013 • RETIREMENT INCOME EVALUATION QUESTIONNAIRE • PAGE 3 X X X X X X
  4. 4. Risk Profile (Please choose the answer that best describes you.) 1. What is your primary investment objective? Preservation of Capital (You are willing to accept lower returns to avoid losses) (3) Income (You are primarily looking for income from your investment portfolio, through interest and dividends) (4) Growth & Income (You would like to generate income in your portfolio but are willing accept some risk to increase your overall portfolio) (5) Growth of Capital (You are seeking market returns and can tolerate a moderate level of risk) (6) High Potential Returns (You are seeking above-average market returns and are willing to accept an above-average level of risk) (7) 2. How would you categorize your prior investment experience? Little Experience (You have little or some knowledge, not in-depth) (1) Moderate/Somewhat Experienced (Familiar with basic investments) (2) Experienced (You possess knowledge of major asset classes, sources of risk and are well versed in investment and portfolio process) (3) 3.Understanding that investment returns may vary between accounts,taken as a whole,what is your expected return for your overall investment portfolio? Low (Your portfolio returns are less important than preservation of capital) (1) Conservative (Your portfolio returns should match inflation rates) (2) Moderate (Your portfolio returns should be aligned with primary benchmark returns) (3) High (Your portfolio returns should be in excess of primary benchmark returns) (4) Very High (Your portfolio returns should be matched with speculative returns) (5) 4.Which statement below best describes your attitude about the trade-off between short-term risk and the possibility of achieving your long-term goals? Risk is More Important than Return (Avoiding short-term losses is more important to you than achieving your long-term investment goals) (1) Risk and Return Are Equally Important (You are equally concerned with avoiding short-term losses and meeting your long-term goals) (3) Return is More Important than Risk (You can accept short-term losses to maximize the potential that you will achieve your long-term goals) (5) Client Signature Date Client Signature Date 5. How would you categorize yourself as an investor? Very Conservative (0) Conservative (1) Moderate (3) Aggressive (4) Speculative (5) 6. What percent of your overall net worth is represented by your investment portfolio? 75% or Greater (1) 25% – 75% (2) 25% or Less (3) 7.When do you anticipate withdrawing substantial and recurring portions of your assets (greater than 5%)? Within 2 Years (1) 2 Years – 5 Years (2) 5 Years – 10 Years (3) 10 Years or Longer (4) Total Signature(s) Circle One WWW. JANNEY.COM • © 2013, JANNEY MONTGOMERY SCOTT LLC • MEMBER: NYSE, FINRA, SIPC • REF. 124386, REVISED 1/2013 • RETIREMENT INCOME EVALUATION QUESTIONNAIRE • PAGE 4 This scale can be used to determine an appropriate model portfolio. The investment portfolio recommended by your Financial Advisor may differ. Your Financial Advisor will determine your actual investment portfolio based on a combination of your risk profile, stated goals and other factors that make up your total financial picture. Use the scale below to find your appropriate Model Portfolio. Model Portfolio Min. Max. Wealth Preservation & Income 8 11 Wealth Appreciation 12 20 Wealth Accumulation 21 32

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