Client Profile Worksheet

First Name

Last Name

Phone

Address

1. In approximatley how many years to do you expect to need this money?

2-3 years

4-6 years

7-10 years

10+ years

2. Do you expect to withdraw more than one third of the money in this account within 7 years?

Yes, in 2-3 years

Yes, in 4-7 years

3. Do you have an emergency fund?

I have an emergency fund, but it's less than 6 months after tax income

Yes, I have an adequate emergency fund

4. If you expect to have other major expenses, do you have a separate savings plan for these expenses?

Yes

I do not expect to have any such expenses

I intend to withdraw a portion of this money for these expenses

I have no separate savings plan for these items at this time

5. Approximately what portion of your total investable assets is designatied for this account?

Less than 25%

Between 25%-50%

Between 51%-75%

More than 75%

6. Which ONE of the following describes your expected future earnings over the next five years?

I expect my earnings increases to far outpace inflation

I expect my earnings increases to stay somewhat ahead of inflation

I expect my earnings increases to keep pace with inflation

I expect my future earnings to decrease

7. Approximately what portion of your monthly take-home income goes toward paying off debt other than home mortgage?

Less than 10%

Between 10% and 25%

Between 25% and 50%

More than 50%

8. How many dependents do you have? (include children you continue to support, elderly parents, etc.)

None

2-3

More than 3

9. Part 1. Have you ever invested in individual bonds or bond investment vehicles (aside from US Savings Bonds)

No, and I would be uncomfortable with the risk if I did

No, but I would be comfortable with the risk if I did

Yes, but I was uncomfortable with the risk

Yes, and I felt comfortable with the risk

Part 2. Have you ever invested in individual stocks or stock investment vehicles?

No, and I would be uncomfortable with the risk if I did

No, but I would be comfortable with the risk if I did

Yes, but I was uncomfortable with the risk

Yes, and I was comfortable with the risk

10. When thinking about your investments, where would you place yourself on the following scale?

1 Less risk/less potential return

4 Moderate risk with greater potential return

8 Maximum potential return regardless of risk

11. Which ONE of the following statements describes your feelings toward choosing an investment?

I would prefer to select investment options that have a low degree of risk associated with them (i.e. I will unlikely lose my original investment)

I prefer to select a mix of investment options with emphasis on those with a low degree of risk, and a small portion in others that have a higher degree of risk, which may yield greater returns

I prefer to select a balanced mix of investment options, some that have a low degree of risk and others that have a higher degree of risk, which may yield higher returns

I prefer to select an aggressive mix of investment options, some that have a low degree of risk, but with emphasis on others that have a higher degree of risk, which may yield greater returns

I would only select investment options that have a higher degree of risk and a greater potential for higher returns

12. If you could increase your chances of improving your returns by taking more risk, would you

be willing to take a lot more risk with all your money?

be willing to take a little more risk with all your money?

be willing to take a little more risk with some of your money?

be unlikely to take much more risk?

13. If a $10,000 investment you made for ten years lost value in the first year, at what point would you sell?

$9,500

$9,000

$8,500

$8,000

Below $8,000

Would not sell

14. What was your marginal tax bracket for last year?

10% or less

15%

25%

33%

35%

Above 35%

15. Diversified portfolios often include international investments. Are there reasons you would not want international funds?

Yes

Select the source of funds you are considering for investments?

Checking account

IRA Rollover

401k, 403b, TSA, 457 Plan, Other employer sponsored plan

Inheritance or life insurance settlement

Lottery, gambling winnings

Other

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CLIENT PROFILE WORKSHEET