Couples Dual Questionnaire

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1 Investor Profile Questionnaire Your responses will help us recommend a custom investment program tailored to your needs. Clients names How did you hear about us? Are you: Married Single Please complete Sections 1 and 2 separately for each individual. Complete Section 3 together. 1 Section 1 Contact information Preferred title (Mr., Mrs., Ms., Dr., etc.) First name Last name Date of birth: / / U.S. Citizen: Yes No Street address City State Zip code Home phone Work phone Cell phone address Emergency contact name Relationship Phone

2 Occupation Working Retired Retirement date: / / Job title (Last, if retired) Employer (Last, if retired) Education Highest level attended Major Name of School Family Other dependents Personal interests Hobbies Pets Favorite charities Volunteer opportunities Social or environmental issues of concern Couples Dual Questionnaire 2

3 Estate plans Do you have the following documents? Yes No Will Living trust (Name of trust) Power of attorney (Please provide copy) Name of estate planning attorney Financial concerns Not concerned Very concerned Please rank according to your level of concern Outliving my money Increasing cost of living Beating the market Maximizing investment return Reducing risk in my portfolio Generating additional income Paying for long-term care Leaving assets to my spouse Leaving assets to my heirs Protecting my family In your own words, what are your main financial concerns? Needs and goals What are your main goals? What do you want your retirement to look like? Do you believe your current investments are sufficient to achieve your financial goals? Please explain: What is your desired annual income in retirement? What is your desired reserve for unexpected retirement expenses? Couples Dual Questionnaire 3

4 Do you have any large purchases or expenditures planned in the next 3-5 years? Purpose: Amount needed: $ Date needed: Yes No Does your employer provide health insurance after you retire? If yes, will your spouse be eligible to continue on the group plan if either of you retires before age 65? Do you have any outstanding debt other than mortgages? Are you taking required minimum distributions? Have you ever worked with an advisor or financial planner before? Please briefly describe your experience: Do you have a financial plan? 2 Section 2 Contact information Preferred title (Mr., Mrs., Ms., Dr., etc.) First name Last name Date of birth: / / U.S. Citizen: Yes No Street address City State Zip code Home phone Work phone Cell phone address Emergency contact name Relationship Phone Couples Dual Questionnaire 4

5 Occupation Working Retired Retirement date: / / Job title (Last, if retired) Employer (Last, if retired) Education Highest level attended Major Name of School Family Other dependents Personal interests Hobbies Pets Favorite charities Volunteer opportunities Social or environmental issues of concern Couples Dual Questionnaire 5

6 Estate plans Do you have the following documents? Yes No Will Living trust (Name of trust) Power of attorney (Please provide copy) Name of estate planning attorney Financial concerns Not concerned Very concerned Please rank according to your level of concern Outliving my money Increasing cost of living Beating the market Maximizing investment return Reducing risk in my portfolio Generating additional income Paying for long-term care Leaving assets to my spouse Leaving assets to my heirs Protecting my family In your own words, what are your main financial concerns? Needs and goals What are your main goals? What do you want your retirement to look like? Do you believe your current investments are sufficient to achieve your financial goals? Please explain: What is your desired annual income in retirement? What is your desired reserve for unexpected retirement expenses? Couples Dual Questionnaire 6

7 Do you have any large purchases or expenditures planned in the next 3-5 years? Purpose: Amount needed: $ Date needed: Yes No Does your employer provide health insurance after you retire? If yes, will your spouse be eligible to continue on the group plan if either of you retires before age 65? Do you have any outstanding debt other than mortgages? Are you taking required minimum distributions? Have you ever worked with an advisor or financial planner before? Please briefly describe your experience: Do you have a financial plan? 2 1 Section 3 Please complete this section together. Name: Name: Joint CASH Checking $ $ $ Savings $ $ $ Money market funds $ $ $ CDs $ $ $ INVESTMENT ASSETS (NONRETIREMENT) Stocks $ $ $ Bonds $ $ $ Mutual funds $ $ $ Annuities $ $ $ INVESTMENT ASSETS (RETIREMENT) Name: Total Your annual contribution Employer s annual contribution IRAs $ $ $ Roth IRAs $ $ $ 401(k) $ $ $ 403(b) $ $ $ Pension $ $ $ Couples Dual Questionnaire 7

8 Name: Total Your annual contribution Employer s annual contribution IRAs $ $ $ Roth IRAs $ $ $ 401(k) $ $ $ 403(b) $ $ $ Pension $ $ $ REAL ESTATE Primary residence Vacation residence Income property Other Titled to Market value Mortgage INCOME SOURCES Name: Name: Preretirement income Wages or salary Projected increase, if any Business income Pension Investment income Other (inheritance, etc.) Retirement income Wages or salary Business income Pension Investment income Social Security Start date: / / Other (inheritance, etc.) INSURANCE Life insurance Insurance company: Name of insured: Term or permanent Term Permanent Term Permanent Employer provided Yes No Yes No Death benefit: Year purchased: Annual premium: Couples Dual Questionnaire 8

9 Yes No Do you have employer-provided life insurance? Will it continue after you retire? Do you have any outstanding debt other than mortgages? Do you carry long-term care insurance? Benefit per month: Do you carry disability insurance? Benefit per month: For financial advisor use only Teachers Insurance and Annuity Association of America-College Retirement Equities Fund (TIAA-CREF), 730 Third Avenue, New York, NY

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