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Investor Profile Questionnaire
General Information
Full Name
(required)
Spouse's Name
Home Address
(required)
Address 2
City
(required)
State
-- Please select a state --
ALABAMA (AL)
ALASKA (AK)
AMERICAN SAMOA (AS)
ARIZONA (AZ)
ARKANSAS (AR)
CALIFORNIA (CA)
COLORADO (CO)
CONNECTICUT (CT)
DELAWARE (DE)
DISTRICT OF COLUMBIA (DC)
FEDERATED STATES OF MICRONESIA (FM)
FLORIDA (FL)
GEORGIA (GA)
GUAM (GU)
HAWAII (HI)
IDAHO (ID)
ILLINOIS (IL)
INDIANA (IN)
IOWA (IA)
KANSAS (KS)
KENTUCKY (KY)
LOUISIANA (LA)
MAINE (ME)
MARSHALL ISLANDS (MH)
MARYLAND (MD)
MASSACHUSETTS (MA)
MICHIGAN (MI)
MINNESOTA (MN)
MISSISSIPPI (MS)
MISSOURI (MO)
MONTANA (MT)
NEBRASKA (NE)
NEVADA (NV)
NEW HAMPSHIRE (NH)
NEW JERSEY (NJ)
NEW MEXICO (NM)
NEW YORK (NY)
NORTH CAROLINA (NC)
NORTH DAKOTA (ND)
NORTHERN MARIANA ISLANDS (MP)
OHIO (OH)
OKLAHOMA (OK)
OREGON (OR)
PALAU (PW)
PENNSYLVANIA (PA)
PUERTO RICO (PR)
RHODE ISLAND (RI)
SOUTH CAROLINA (SC)
SOUTH DAKOTA (SD)
TENNESSEE (TN)
TEXAS (TX)
UTAH (UT)
VERMONT (VT)
VIRGIN ISLANDS (VI)
VIRGINIA (VA)
WASHINGTON (WA)
WEST VIRGINIA (WV)
WISCONSIN (WI)
WYOMING (WY)
-----------------------------------
Armed Forces Africa (AE)
Armed Forces Americas (AA) (except Canada)
Armed Forces Canada (AE)
Armed Forces Europe (AE)
Armed Forces Middle East (AE)
Armed Forces Pacific (AP)
(required)
Home Phone
Mobile Phone
(required)
Work Phone
Fax Number
Date of Birth
Spouse's Date of Birth
Email Address
(valid email required)
Alternate Email Address
What is the approximate initial contribution to your account?
Dollar Amount
(required)
Source of Funds
(required)
What are the intended uses of your investment? Please include the usage of the money, the dollar amount, and the estimated year it will be needed.
Use #1
Use #2
Use #3
Do you anticipate making additional contributions to your portfolio beyond the initial investment at any time in the future?
Yes
No
If yes, please check the type of contribution and describe below.
Regular Periodic Contributions
Details
Lump Sum
Details
What else should we know about your future plans or expectations that would be helpful to us in determining your future financial needs?
Comments
Financial Profile
What are your current financial assets (dollar amounts)
Non-qualified cash
(required)
Non-qualified stocks
(required)
Non-qualified bonds
(required)
Qualified cash
(required)
Qualified stocks
(required)
Qualified bonds
(required)
List any additional assets and amounts
Asset #1
Asset #2
Asset #3
What is your current annual income?
Income
(required)
What is your desired annual retirement income?
Retirement income
(required)
List any additional sources of annual retirement income (dollar amounts):
Annuity
(required)
Life insurance
(required)
Pension
(required)
Social Security
(required)
At what age do you intend to retire?
Retirement age
(required)
Investment Objectives
What is your primary financial goal?
Wealth preservation or emergency savings
Education Funding
Retirement Planning
Long-term wealth accumulation
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
Growing my assets substantially
Five years from now, what do you expect your standard of living to be?
The same as it is now
Somewhat better than it is now
Substantially better than it is now
Ten years from now, what do you expect your portfolio value to be?
The same as or a little more than it is today
Moderately greater than it is today
Substantially greater than it is today
What is your current income requirement (interest plus dividends) from this portfolio?
More than 4%
2% to 4%
0%-2%
What do you want to do with the income generated by your portfolio?
Receive all income
Receive some and reinvest some
Reinvest all income
How do you consider yourself as an investor?
Conservative
Moderate
Moderately Aggressive
Aggressive
Risk Tolerance
You just received a substantial sum of money. How would you invest it?
I would invest in something that offered moderate current income and was very safe.
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 had a high amount of risk.
Which of the following statements best describes your reaction if the value of your portfolio suddenly declined 15%?
I would be very concerned because I cannot accept fluctuations in the value of my portfolio.
If the amount of income I received was unaffected, it would not bother me.
I invest for long-term growth but would be concerned about even a temporary decline.
I invest for long-term growth and accept temporary fluctuation due to market influence.
Which of the following investments would you feel most comfortable owning?
Certificates of Deposit
US Government securities
Stocks of older, established companies
Stocks of newer, growing companies
How optimistic are you about the long-term prospects for the economy?
Pessimistic
Unsure
Somewhat optimistic
Very optimistic
Which of the following best describes your attitude about investments outside the US?
Pessimistic
Unsure
May provide attractive investment opportunities
Provide very attractive investment opportunities
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