Data Gathering Questionnaire

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1 Data Gathering Questionnaire

2 Personal Information Personal Information Name Date of Birth / / M F / / M F Employment Employed Retired Employed Retired Employment Income State of Residence Children and Grandchildren Resources Name Date of Birth Relationship Social Security Benefits Are you eligible? Yes No WEP Yes No WEP Enter amount per month per month Other Retirement Income Current or Expected (Do not include income such as interest and dividends from investments) Start End Inflation Start End Income Income Date Date % Date Date Qualified Investment Accounts (401(K), 403(b), 457, IRA, Roth, etc.) Value Additions/Year Inflation % Non-Qualified Investment Accounts (Bank, CD, Brokerage, Mutual Funds, 529, Annuity, etc.) Value Additions/Year What is current allocation? Equity % Fixed Income % Cash % Alternatives % Unsure:

3 Other Assets (Home, Auto, Personal Property, Future Asset, Second House, Business) Value Ownership (Name, Jointly Held, Trust) Liabilities (Mortgage, Credit Cards, Auto Loan, etc.) Balance Owed Monthly Payment Interest Rate Term Date Loan Began Risk Preference What type of investor are you? Select one based on your willingness to accept investment risk? Less Risk More Risk Very Conservative Conservative Moderate Aggressive Very Aggressive Lifestyle Goals Before and After Retirement Retirement Age When would you like to retire? Enter your Ideal Age--the earliest age you might like to retire. Then enter your Acceptable Age--which is the latest you could retire and still be satisfied. Finally, indicate how willing you are to delay retirement. Retirement Age Ideal Age Acceptable Age Ideal Age Acceptable Age Very Willing Very Willing How willing are you to Somewhat Willing Somewhat Willing retire later? Slightly Willing Slightly Willing Either can retire first Only Client 1 can retire first Who can retire first? Both retire in the same year Only Client 2 can retire first.

4 Lifestyle Goals First, enter any pre-retirement Goals that will be funded with withdrawals from your Investment Portfolio. Then, think about all the Goals you would like to attain during your Retirement. Include what you need, like buying a new car every few years; what you want, like taking nice trips every year; and even what you wish you could do, like helping your kids, grandkids or favorite charity. Make each need, want or wish a separate goal, with a description, an annual cost and how often it will occur. Then put a number from 1-10 (10 being the highest) in the box next to each Goal to indicate its importance. Needs Wants Wishes Car(s) Travel Major Purchase College/ Private School Leave Bequest Gift or Donation Home Improvement Wedding/ Celebration Health Care Costs New Home Start a Business Provide Care Anything Else (Other) Now that you ve identified your Lifestyle Goals, it s time to create a Goal for your basic Retirement Living Expenses. Retirement Living Expenses Everyone must pay the bills. This Goal is for your basic day-to-day living expenses during retirement (e.g., food, clothes, utilities, etc.). By making this amount of separate Goal, you can see what it takes to pay-the-bills for the rest of your life. This should make your Retirement more secure and leave you free to enjoy spending money to fulfill your Retirement Lifestyle Goals. Importance Ideal Amount Acceptable Amount 10 per year per year Emergency Fund Yes No Which Account? Estate Plan Yes No Last Update?

5 Additional Documentation Required In addition to the detail listed on the preceding pages, please provide us with a copy of each of the following: Most recent draft of your estate planning documents Last two years federal and state income tax returns Coverage page detailing all insurance coverage (homeowners, auto, disability and life) Social Security benefit statements Investment statements detailing holdings and values (Brokerage, mutual funds, bond accounts, checking and savings, 401k, 403b, pensions, IRAs, Roth accounts) Liability statements (mortgages, credit cards, student loans, home equity loans) Most current pay stubs detailing tax withholding A list of your goals and objectives

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