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I. PERSONAL INFORMATION

Name
Email
Phone
Social Security (optional)
Occupation
Employer Name
Employer Address
Annual Income
Net Worth Excluding Personal Residence

II. RISK TOLERANCE

1. You have just received a windfall of $50,000. How would you invest it?
  • I would invest in something that offered moderate current income and was very conservative
  • I would invest in something that offered high current income with a moderate amount of risk
  • I would invest in something that offered high total return (current income plus capital appreciation) with a moderately high amount of risk
  • I would invest in something that offered substantial capital appreciation even though it has a high amount of risk
2. Which of the following statements would best describe your reaction if the value of your portfolio were to suddenly decline by 15%?
  • I would be very concerned because I cannot accept fluctuations in the value of my portfolio
  • If the amount of income I receive was unaffected, it would not bother me
  • Although I invest for long-term growth, I would be concerned about even a temporary decline
  • Because I invest for long-term growth, I accept temporary fluctuations due to market influences
3. Which of the following investments would you be most comfortable owning?
  • Certificates of Deposit
  • U.S. Government Securities
  • Blue-chip stocks
  • Stocks of new, growth companies
4. Which of the following investments would you least like to own?
  • Stocks of new, growth companies
  • Blue-chip stocks
  • U.S. Government Securities
  • Certificates of Deposit
5. Which of the following investments do you feel are the most ideal for your portfolio?
  • Certificates of Deposit
  • U.S. Government Securities
  • Blue-chip stocks
  • Stocks of new, growth companies
6. How optimistic are you about the long-term prospects for the economy?
  • Very pessimistic
  • Unsure
  • Somewhat optimistic
  • Very optimistic
7. Which of the following best describes your attitude about investments outside the U.S.?
  • Unsure
  • I believe that the U.S. economy and foreign markets are interdependent
  • I believe that overseas markets provide attractive investment opportunities

III. INVESTMENT OBJECTIVES

1. Which of the following best describes your investment objectives?
  • Preserving principal and earning a moderate amount of current income
  • Generating a high amount of current income
  • Generating some current income and growing my assets over an extended time frame
  • Growing my assets substantially over an extended time frame
2. How do you expect your standard of living five years from now to compare to your standard of living today?
  • Less than it is today
  • The same as it is today
  • Somwhat higher than it is today
  • Substantially higher than it is today
3. Five years from now, you expect your portfolio value to be:
  • Portfolio value is not my primary concern; I am more concerned with current income
  • The same as or slightly more than it is today
  • Greater than it is today
  • Substantially greater than it is today
4. Generating current income from your portfolio is:
  • A primary concern - (only if you are just about to retire)
  • Not important
5. With the income generated from your portfolio, you plan to:
  • Use it for living expenses
  • Use some and reinvest some
  • Reinvest all income

IV. TIME HORIZON

1. What is your age?
  • 56 and over
  • 46-55
  • 36-45
  • 20-35
2. What is your primary financial goal?
  • Wealth preservation
  • Retirement planning
  • Wealth accumulation
3. What is the time frame for you to achieve your financial goals?
  • 0-5 years
  • 5-10 years
  • 10 years or longer