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Confidential Client Profile

To plan for the future, we need to know where you stand financially today. These questions will help you define your investment goals, risk temperament, available resources and target rate of return. Please complete the following questionnaire to help us determine which asset allocation mix best suits your needs. Please answer each question by completing each blank or marking the circle that best fits your situation. We will structure and manage your investment portfolio based on the facts and preferences you provide below and through ongoing discussions with your investment adviser.

Client Name: _________________________________

Soc Sec#____________________________________ Date of Birth: ____________

Spouse Name: ________________________________

Soc Sec#____________________________________ Date of Birth:____________

Address: ___________________________________________ Ph#(H):_________________

Client Employer: ____________________________ Occupation: ____________________

Ph#(O):_________________

Spouse Employer: __________________________ Occupation:________________________

Ph#(O):_________________

Client Drivers License #____________________________ Expiration Date:____________

Spouse Drivers License # ___________________________ Expiration Date:_____________

Client E-mail: ___________________________________

Spouse E-mail: ___________________________________

Children: Name:_________________________DOB:________SSN:___________________

Name:_________________________DOB:________SSN:___________________

Do you have:

a written estate plan? ○ Yes ○ No

Long-term care insurance? ○ Yes ○ No

Client Salary: _______________________ Retire Age_________

Spouse Salary: ______________________ Retire Age__________

Over the next several years, you expect your annual household income to:

○ Increase moderately ○ Decrease moderately ○ Stay about the same

○ Increase substantially ○ Decrease substantially

What are important goals for us to include in planning for your future?

________________________________________________________________________________

1. What is your projected time horizon for this portfolio?

○ Up to 3 years ○ 6 – 10 years

○ 3 - 5 years ○ More than 10 years

○ Never, pass it on to heirs

2. If withdrawals are anticipated over the next five years, what

percentage of this portfolio do you expect might be needed?

○ No anticipated need

○ Slight-less than 5% per year

○ Moderate-between 5% - 10% per year

○ Heavy-more than 10% per year

○ All of the assets will probably be needed within 5 years

3. What is your primary purpose for investing? (Mark all that apply.)

○ Retirement

○ Long-term wealth accumulation

○ Education

○ Estate (probably will not need during retirement)

○ Income

○ Grow assets faster than inflation

○ Emergency Needs

○ Maximize return over a specific time period

○ Major Purchase

○ Charitable Giving

○ Other

4. Investment risk can be viewed in many different ways. Please check

any of the following that most closely define your view of risk.

○ The possibility of not achieving a targeted rate of return

○ The loss of buying power over a long period of time

○ Wide swings in the market value of your portfolio over short periods of time

○ Loss of principal

5. If the value of your portfolio decreased by 20% in one year, how would you react?

○ I would be very concerned and would find another way to invest my money

○ I would be somewhat concerned and would reconsider the aggressiveness of my portfolio

○ I would not be concerned about the temporary fluctuation in my portfolio

6. If the stock market increased by 15% while the value of your portfolio, which is composed

primarily of bonds and cash, increased by 4% in one year, what would be your reaction?

○ I would replace the bond and cash portions of my portfolio with stocks.

○ I would add more stocks to my portfolio but stocks would not make up the majority of the

portfolio.

○ I would not change my portfolio.

7. What is the maximum percentage you would be willing to lose in any one year in your portfolio?

A general (but not guaranteed) proposition for investing is that, over time, higher returns correspond

with greater risks.

○ 0 ○ 10 ○ 20 ○ 40

○ 5 ○ 15 ○ 30

8. Select the choice that best represents how you feel about the following statement: "My portfolio should

be managed for the long run and the volatility is less important than the end result."

○ I agree ○ I disagree

○ I am willing to accept some variability of return, but never any loss of capital

○ I am willing to accept a reasonable amount of annual fluctuation

and an occasional year of negative return, in the interest of building capital

9. The long-term present rates of return for stocks, bonds, t-bills, and inflation are:

Stocks: 10.3%; Bonds: 5.5%; T-bills: 3.7%; Inflation: 3.1%.

Real wealth is only achieved by earning rates higher than the inflation rate.

What is your long-term return objective above inflation?

○ 1- 2% ○ 2- 4% ○ 4 - 6% ○ Over 6%

10. With the exception of the “Great Depression” of the early 1930’s, the worst case “time to recovery”

(buying right before a large loss and holding until the loss is recovered) has been 4 years for stocks,

2 years for corporate bonds and 1 year for U.S. Treasury Bills. Knowing this and that it is practically

impossible for us to protect you from ever having a loss, if your long-term rate of return is achieved, an

appropriate time in which to recover the loss is:

○ 1 Year ○ 2 – 3 years

○ 1 – 2 years ○ More than 3 years

11. Generally, risk and return are directly related – the more return required, the more volatility/risk to be

tolerated. However, taking great risks does not guarantee superior returns, just as low returns aren’t

always a product of little risk. Please mark the single choice in the appropriate box on the chart below

that best describes your need for return vis-à-vis your tolerance for risk.

12. You have established your investment time horizon and considered the risk and return issues

important to successful investing. Which one of the following investment objectives most closely meets

your needs and circumstances?

○ Aggressive Growth – Growth of capital through investments in common

stocks and/or mutual funds. No income considerations. Maximize long

term growth with little or no concern for volatility or short term

risk.

○ Growth – Growth of capital through investments of common stocks

and/or mutual funds. Little or no income considerations.

○ Conservative Growth – Growth of capital through a blend of investments in common stocks

and/or mutual funds. Some income, volatility, and short term risk considerations.

○ Income – Growth of capital through investments in common stocks, mutual funds, and fixed

income securities. Income, volatility, and short term portfolio risk are primary considerations.

○ Capital Preservation – Income and safety are the primary emphasis achieved through investments

in fixed-income and money market securities.

Please specify investment concerns or restrictions, if any, on the reverse page.

______________________ ___________________________ _____________________

Client’s Signature Client’s Printed Name Date

______________________ ___________________________ _____________________

Client’s Signature Client’s Printed Name Date

______________________ ___________________________ _____________________

Financial Adviser’s Financial Adviser’s Date

Signature Printed Name

This Confidential Client Profile should accompany your advisory agreement.

Advisory services are provided through Adviser Financial Group, Inc. Registered Investment Advisor.