Investment Policy Statement Questionnaire

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1 Investment Policy Statement Questionnaire Client Date Investment Advisor

2 Investor Profile Questionnaire Intended Use of Portfolio: Tax Sensitive: YOUR TIME HORIZON 1. When do you expect to begin withdrawing money from your investments? a) Less than 3 years b) 3 to 5 years c) 5 to 7 years d) 7 to 10 years e) 10 or More Years 2. For how many years will you be making the withdrawals? a) I plan to take a lump sum distribution b) 1 to 5 years c) 6 to 10 years d) 11 to 19 years e) 20 or More Years YOUR RISK OR TOLERANCE FOR LOSS Investing comes with risks. These risks mean you can lose money or that your money may not go as far as you wish. If you reduce one type of risk, you ll usually increase another type of risk. For example, a conservative portfolio can have the risk of growing too slowly to meet your long term goals. Our work together can be more effective when we fully understand your own unique feelings and philosophies about risk. Thank you for investing the time to answer these questions. 1. What portfolio mix makes you the most comfortable? a) A moderate chance of short-term losses in a portfolio intended to grow better than inflation. b) The lowest chance of short-term losses in a portfolio not expected to keep up with inflation. c) A high chance of short-term losses in a portfolio intended to beat inflation by a big margin.

3 2. I am willing to lose larger sums of money in the short term if I can enjoy potentially higher returns in the long term. a) Strongly agree b) Agree c) Disagree d) Strongly disagree e) I cannot handle losing any sum of money 3. Which best describes how you felt about steep losses you experienced in the past? a. I felt anxious for the investment to get back to its high amount, but I accepted that some risk is the price of potential gain. b. I felt angry and could think of nothing else. I do not want to take that amount of risk again. c. I am a long term investor and agree that reasonable risk and possible losses is part of investing. 4. Assume you invest $500,000 for five years. Which of these lower/higher outcomes makes you most comfortable? Lower Higher a) Portfolio 1 $350,000 or -30% $1,000,000 or +100% b) Portfolio 2 $400,000 or -20% $750,000 or +50% c) Portfolio 3 $450,000 or -10% $700,000 or +40% d) Portfolio 4 $475,000 or -5% $650,000 or +30% e) Portfolio 5 $500,000 or -0% $600,000 or +20% 5. What is your primary focus, increasing returns or reducing risk? a) Reducing risk b) Primarily increasing returns while also reducing risk c) Increasing returns d) Primarily reducing risk while also increasing returns e) Losing no principle 6. Which investments are you most comfortable with? a) Highest long-term return with larger and more frequent losses. b) Lowest long-term return with smaller and less frequent losses. c) Moderate long-term return with modest and occasional losses.

4 7. Assume you have a long-term portfolio that has grown to $120,000. If your portfolio dropped to $85,000 in a month s time, how would you react? a) I d be somewhat concerned and I d want to review the account often until it was back to $120,000. b) I d be concerned and would change to a slightly more conservative portfolio. c) I d be so concerned that I would change to a much more conservative portfolio in an attempt to protect my principal. d) I wouldn t be too concerned and would keep the investment because of the potential for higher long-term returns. 8. Which investment has the characteristics you favor most? a) Best chance of meeting long-term goals. Might have losses in one out of every two years. b) Good chance of meeting long-term goals. Might have losses in one out of every three years. c) Least chance of meeting long-term goals. Might have losses in one out of every five years. 9. Assume you are taking income for living expenses from your portfolio. If your portfolio goes down substantially, what lifestyle changes would/could you make? a. I could spend less and reduce my withdrawals in half to help the portfolio recover. b. My expenses are fixed and my lifestyle would be impacted so much that I would have to get out of those investments totally to protect my principal. c. I could spend less and reduce my withdrawals to $0 for a year or more to give my portfolio the biggest chance to recover. d. I would be concerned, but would change neither my spending nor my portfolio. e. I could spend a little less for a year or so, but I would be extremely worried and would want my portfolio to be much more conservative. 10. Which of the following best describes your expectations for performance? a. I am willing to take above-average risk in an attempt to beat the stock market. b. I want to keep up with inflation, but I can only accept a low chance of short-term losses. c. I want my portfolio to keep pace with the overall stock market. d. It is important that I take very little risk with my portfolio, and I am willing to accept growth that may not keep up with inflation.

5 ADDITIONAL CONSIDERATIONS After a three year period, if we were to meet and review your portfolio, what results would lead you to feel satisfied about your progress? Given a choice, would you err on the side of being more conservative or more aggressive? Even if more conservative means less money in the long term? Are there any asset classes or investment vehicles you do not want in your portfolio? Please explain why. Please describe the best and worst investment you have ever experienced and why: Best Investment Experience: Worst Investment Experience:

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