Client Name(s)*


Telephone

Email Address*




Section 1: Investment Objectives


What is the intent of your portfolio? Please select the most appropriate answer.
 To generate income for today. To generate income at a later date. To provide for my dependents. (I do not anticipate using these funds.) To fund a large purchase in the future.
What is the major goal for your portfolio? Please select the most appropriate answer.
 To ensure my portfolio remains secure. To see my portfolio grow and to avoid fluctuating returns. To balance growth and security, and to keep pace with inflation. To provide growth potential, and to accept some fluctuation in returns. To provide the sole objective of potential long-term growth.

Section 2: Personal Information


Which of these describes your age range?
 Under 30 30-39 40-49 50-59 60-69 70-79 80 and Over
Which of the following ranges best represents your current annual family incomes (including pensions) before taxes?
 Under $30,000 $30,001 – $60,000 $30,001 – $60,000 $90,001 – $120,000 Over $120,000
After deducting any loan or mortgage balances, which one of the following ranges best represents your immediate family’s overall net worth?
 Under $30,000 $30,001 – $50,000 $50,001 – $100,000 $100,001 – $200,000 $200,001 - $300,000 Over $300,000

Section 3: Investment Horizons


Investors often have distinct phases in the investment plans. The initial phase is savings and growth. During this time an investory builds up a portfolio toward a future goal. The second phase is typically use of funds, either for a specific purpose or for income.

When do you anticipate using these funds?
 Immediately 1-3 Years 4-5 Years 6-10 Years 11-15 Years 16-20 More Than 20 Years
At the time you need this money, when will you withdraw it?
 All at once in one lump sum Over a period of less than 2 years Over a period of 2-5 years Over a period of 6-9 years Over a period of 10-15 years Over a period of more than 15 years
What are your intentions regarding withdrawals and/or contributions to your investments today and over the next five years?
 I will certainly withdraw money at regular intervals and do not plan on making contributions. I plan to withdraw money at regular intervals and do not plan on making contributions. I will likely be making both contributions and withdrawals. I will likely make additional contributions and will not be withdrawing any funds. I will certainly make additional contributions and will not be withdrawing any funds.

Section 4: Attitudes Towards Risk


Which statement best describes your knowledge of investments?
 I have very little knowledge and I rely exclusively on the recommendations of financial advisors. I have limited knowledge of stocks and bonds, but I do not follow financial markets. I have good working knowledge and I regularly follow financial markets. I understand completely how different investment products work, including stocks and bonds, and I follow financial markets closely.
Realising that there will be downturns in the market, in the event of a significant loss, how long are you prepared to hold your existing investments in anticipation of a recovery in value?
 Less than three months Three to six months Six months to 1 year 1 to 2 years 2 to 3 years 3 or more years
Assuming that you are investing $100,000 for the long term, what is the maximum drop in your portfolio’s value that you could comfortably tolerate in any given year?
 I’d be uncomfortable with any loss A $5,000 drop is all I could live with A $10,000 decline is something I could tolerate A $15,000 drop would be about all I could stand A $20,000 decline is pretty much my limit. I could live wih a decline of more than $20,000
Which of the following statements would you feel most correctly describes your investment philosophy?
 I can not accept any fluctuation in principal I can only accept minimal fluctuations, and prefer to invest in safer, lower return investments I am willing to tolerate some ups and downs in the value of my investments to achieve overall higher returns in the long run My main interest is high, long-term returns and I am not concerned about short-term decreases in the value of my investments

Section 5: Portfolio Viability


Investment portfolios aimed at providing higher returns tend to have greater swings in value (providing both gains and losses). The more aggressive your portfolios, the more pronounced these swings become, and the more often short-term losses can occur.

A portfolio is a basket of different investments. The returns earned by a specific portfolio depend on the mix of investments that make up the portfolio. The following graph shows the probable range of returns (form best to worst) of four hypothetical portfolios over a nine-year period. In which of these portfolios would you prefer to invest?
 Portfolio A Portfolio B Portfolio C Portfolio D
Some investors are more willing than others to accept periodic declines in the value of the portfolio as a trade-off for potentially higher long-term returns.

Which response best represents your feelings toward the following statement?
“I am willing to experience potentially large and frequent declines in the value of any investment if it will increase the likelihood of achieving higher long term returns.”
 Strongly Agree Agree Disagree Strongly Disagree

Section 6: How important are the following features to your investment plans?


0 - Not at all
2 - Very likely

Professional management

Diversification

Simplicity

Liquidity

Flexibility - partial withdrawals, specific income creation

Deferring taxes as long as possible

Tax minimization strategies

Flexibility to move assets with concerns regarding tax consequences

Reduced estate probate costs

Protecting your investments' value at death or maturity

Privacy - avoid asset transfer becoming public records (probate)

Expediency - assets transferred quickly to beneficiaries

Potential creditor protection - minimizing exposure to personal and/or professional liability