Data Gathering. Questionnaire

Transcription

1 Data Gathering Questionnaire

2 Personal Information CLIENT 1 Name Address City, State Zip Phone: Home Work Cell Birth date Marital Status Single Married Widowed Are you a citizen of the United States? Yes No Occupation Employer Salary CLIENT 2 Name Address City, State Zip Phone: Home Work Cell Birth date Marital Status Single Married Widowed Are you a citizen of the United States? Yes No Occupation Employer Salary Tax Bracket 10% 15% 25% 28% 33% 35% I/We are subject to Alternative Minimum Tax Yes No Do you have capital loss carry forwards? Yes No If yes, how much? Dependents (list name and birth dates) Do you have an attorney? Yes No Do you have a tax advisor? Yes No Do you have a financial consultant? Yes No BFE& CO Exp 6/8/2013 DATA GATHERING QUESTIONNAIRE 2

3 Asset/Liability Ownership Investment Account Information (Please list Benjamin F. Edwards & Co. account numbers, and provide recent statements for any accounts held outside of Benjamin F. Edwards & Co., e.g. brokerage statements, company plan statements, etc.) Outside Investment Account Values Checking & Saving Money Market CDs Taxable Accounts Employer Retirement Plans (401k,403b etc.) IRAs Roth IRAs Annuities* Life Insurance Cash Value** CLIENT 1 CLIENT 2 JOINT Other Asset values Home Business Real Estate Other( ) Liabilities Short Term Debt (Auto Loans, Credit Cards, Margin Debt etc.) Home Mortgage Real Estate Mortgage Business Loans Other ( ) *List Annuity Contracts Death Cash Owned By Type of Contract* Issuer Beneficiary Benefit Value $ $ $ $ $ $ **Life Insurance Policies Death Policy Company Type* Owner Insured Beneficiary Benefit Number $ $ $ * G-Group Term, SL-Survivorship Life, SPWL-Single Premium Whole Life, T-Term, UL-Universal Life, WL-Whole Life BFE& CO Exp 6/8/2013 DATA GATHERING QUESTIONNAIRE 3

4 Financial Planning Goals Financial Objectives Rank the following in order of importance Not Very Important Important Asset Allocation Analysis Educational Savings Plan Retirement Planning Other Goal Investment Attitude Risk 1 How important is capital preservation? 2 How important is growth? 3 How important is low volatility? 4 How important is inflation protection? 5 How important is current cash flow? 6 How much risk are you willing to take to achieve a higher return? None A moderate amount A lot BFE& CO Exp 6/8/2013 DATA GATHERING QUESTIONNAIRE 4

5 Return Financial Planning Goals (continued) Investment Profile/Portfolio Objective What is the primary goal for these assets? (Check one) Conservative Income - Primary goal is to generate income with tolerance for a relatively low degree of risk and volatility associate with fixed income security. Willing to tolerate a minor degree of risk involving equity securities Moderate Income Primary goal is to generate income with tolerance for a moderate degree of risk and volatility associated with fixed income securities. Willing to tolerate moderate risk involving equity securities Aggressive Income Primary goal is to generate income with tolerance for a potentially substantial degree of risk and volatility associated with fixed income securities. Willing to tolerate higher risk involving equity securities to maximize income Conservative Growth & Income - Primary goal is to achieve a blend of both current income and appreciation of account value with tolerance for a relatively low degree of risk and volatility associated with fixed income and equity securities Moderate Growth & Income - Primary goal is to achieve a blend of both current income and appreciation of account value with tolerance for a moderate degree of risk and volatility associated with fixed income and equity securities Aggressive Growth & Income - Primary goal is to achieve a blend of both current income and appreciation of account value with tolerance for a potentially substantial degree of risk and volatility associated with fixed income and equity securities Conservative Growth - Primary goal is to generate capital appreciation with tolerance for a relatively low degree of risk and volatility associated with equity securities Moderate Growth - Primary goal is to generate capital appreciation with tolerance for a moderate degree of risk and volatility associated with equity securities Aggressive Growth - Primary goal is to generate capital appreciation with tolerance for a potentially substantial degree of risk and volatility associated with equity securities. Conservative Income Moderate Income Aggressive Income Conservative Growth and Income Moderate Growth and Income Aggressive Growth and Income Conservative Growth Risk Moderate Growth Aggressive Growth BFE& CO Exp 6/8/2013 DATA GATHERING QUESTIONNAIRE 5

6 Retirement Planning Goal Goal Importance If not important, you may skip to the next section Amount Client 1 Client 2 Retirement Income need $ Anticipated Retirement Age Inflate? Yes No Inflation Rate? Retirement Income Sources Client 1 Client 2 Social Security Pension Other Annual Savings Taxable Savings Employer Retirement Plan Employee contribution Employer contribution IRA/Roth IRA contribution Education Planning Goal Goal Importance If not important, you may skip to the next section List all children or grandchildren whose education you will be funding College to Attend Indicate % (you may list public or Funds Savings Funded Name Age private if unknown) Set Aside Vehicle* By You *Educational Savings Vehicles Custodial Account, 529 Plan, Education Savings Account, Other BFE& CO Exp 6/8/2013 DATA GATHERING QUESTIONNAIRE 6

7 Stock Options/Restricted Stock Positions If you would like a Stock Option Analysis, please complete this page and attach a copy of your option summary statement. If applicable, please also include your restricted stock vesting schedule and we will incorporate these benefits into your plan. Goal Importance If not important, you may skip to the next section Name of Company Stock Symbol Price Target Time Horizon for Price Target Stock Option Goals (check all that apply): Exercise and sell to raise cash Exercise and sell for diversification Exercise at price target Exercise and hold for investment Exercise at or close to expiration Restrictions I am an SEC insider/control person. I am subject to window periods. Please describe open windows Due to my employment, I am required to maintain a certain position in my company s stock. Please list the amount, if applicable: Outside of stock options and restricted stock grants, I hold approximately shares of my company s stock. BFE& CO Exp 6/8/2013 DATA GATHERING QUESTIONNAIRE 7

8 Anything Else We Should Know Do you have a living trust? Yes No Do you have income from real estate? Yes No Do you expect to care for a child or parent? Yes No Do you expect an inheritance? Yes No Do you have long term care protection? Yes No Please use this section to describe anything else you would like us to incorporate into the analysis. Items might include additional goals, sale of property, etc. This questionnaire provided by your Benjamin F. Edwards financial consultant is solely incidental to his or her conduct as a broker. It was developed as a tool to assist you in identifying certain financial goals and objectives and should not be considered an overall financial plan. Any decision to buy or sell securities should be made by you and in the context of your overall financial plan. BFE& CO Exp 6/8/2013 DATA GATHERING QUESTIONNAIRE 8