New Client Questionnaire

Family Information

Client

 

Spouse

Contact Info

Employment - Client

Employment - Spouse

Children

First/Last Name Address DOB M/F Marital Status Telephone/E-Mail Special Needs?

Investments

Real Estate

Primary Residence Secondary Residence Investment Property Investment Property
Property Name:
Address 1:
Address 2:
City:
State:
Zip:
Property Type: (Residence, Non-Residence)
Current Value:
Mortgage Balance:
Owner: (Client, Spouse, Joint, etc.)

Taxable Investments and 529 Plans

(1)
(2)
(3)
(4)
(5)
Asset Name:
Current Value:
Owner: (Client, Spouse, Joint, etc.)
Beneficiary:

Qualified Retirement
(401(k), IRA, Money Purchase, Profit Sharing, 403(b), Pension, SEP, Other)

(1)
(2)
(3)
(4)
(5)
Asset Name:
Type: (Traditional 401(k), Roth401(k), IRA, Money Purchase, ProfitSharing, Traditional 403(b), Roth403(b), Pension, SEP, Other)
Current Value:
Owner: (Client, Spouse)
Beneficiary:

Contributions to Retirement Plan

General Contribution Information
Client Spouse
Contributions Based On: (All Earned Income, Salary)

Employee Annual Contributions (For 401(k) or 403(b))

Client Spouse
Type: (Percent of Salary, Match Percent, Fixed Amount, Maximum)
Percent:
Dollar Amount:

Employer Annual Contributions (For 401(k), Money Purchase, 403(b), SEP, or Profit Sharing)

Client Spouse
Type: (Percent of Salary, Match Percent, Fixed Amount, Maximum)
Employer Percent Match of Employee Contribution:
Dollar Amount:

Annuities (Fixed/Variable)

(1)
(2)
(3)
(4)
(5)
Asset Name:
Asset Type: (Fixed / Variable)
Type of Funds: (Qualified, NQ, Tax Free)
Current Value:
Owner: (Client, Spouse, Joint, etc.))
Beneficiary:

Insurance

Life Insurance

(1)
(2)
(3)
(4)
Policy Name & Carrier:
Policy Type: (Whole Life, VWL, Term, UL, VUL, Group, Other)
Term Ends at Retirement: (Group Life Only) (Yes / No)
Insured: (Client, Spouse, Survivorship, etc.)
Owner: (Client, Spouse, Joint, etc.)
Beneficiary: (Client, Spouse, Survivor,etc)
Current Death Benefit:
Annual Premium:

Long Term Care

(1)
(2)
(3)
Policy Name & Carrier:
Insured: (Client, Spouse, Joint)
Benefit Amount:
Period for Benefit Amount: (Annually, Quarterly, Monthly, Weekly, Daily):
Owner: (Client, Spouse, Joint)
Annual Premium:

Disability

(1)
(2)
(3)
Policy Name & Carrier:
Policy Type: (Group Short Term, Group Long Term Personal Short Term, Personal Long Term, Other)
Insured: (Client, Spouse)
Benefit Type: (Fixed Amount, Percent Of Salary)
Benefit Amount:
Period for Benefit Amount: (Annually, Quarterly, Monthly, Weekly, Daily):
Owner: (Client, Spouse, Joint)
Annual Premium:

Income/Retirement

Salary & Bonus

(1)
(2)
(3)
(4)
Salary / Bonus Name:
Annual Amount:
Owner: (Client, Spouse, Joint)
Self-Employment? (Yes / No)

Retirement Dates

Semi-Retirement Date/Age w/Expected Income Full Retirement Date/Age
Client:
Spouse:

Social Security (disregard if supplying Social Security statements)

Client Spouse
Retirement Benefit at Age 62:
Retirement Benefit at Full Retirement Age:

Living Expenses - All values are net after-tax in today's dollars

Current Monthly Standard of Living:
Semi-Retirement Monthly Standard of Living (if applicable):
Retirement Monthly Standard of Living:

Client's Monthly Standard of Living in Event of:

Spouse's Death Before Retirement:
Spouse's Death in Retirement:

Spouse's Monthly Standard of Living in Event of:

Client's Death Before Retirement:
Client's Death in Retirement:

Wills, Estate Documents and Gifting

Check All Documents That Are Currently In Place

Will Rev Trust Irr Trust ILIT FLP Planned Gifts CLT CRT Buy/Sell Other
Client
Spouse

Objectives

Retirement/ Investment

Rate the importance of each item according to the following scale: Low Med High
Your retirement goals
Directing a portion of your personal savings or investment portfolio to a tax advantaged vehicle
Having all of your portfolios consolidated and analyzed to make sure your overall plan is on track
Matching your risk tolerance to that of your investment portfolio
Reviewing your investment performance against that of an index
Reviewing your investment performance against your plan
Reviewing alternative retirement methods
Minimizing the taxes on your investment accounts
Reviewing techniques to save income tax and estate taxes on deferred money
Asset protection in the result of serious illness
Protecting assets in the event that you require long term care in the future
Receiving adequate income in the event of disability during your working years
Planning for income for your spouse in the event of your premature death
Generating a guaranteed retirement income stream
Planning for income for your children in the event of your premature death

Estate

Rate the importance of each item according to the following scale: Low Med High
Distributing assets equally to your children
Protecting your assets transferred to your children from creditors, divorce, and bankruptcy
Reviewing your insurance portfolio
Reviewing different methods of meeting your estate tax liabilities
Minimizing estate taxes
Charitable planning to your estate's planning
Contributing annually to charity
Gifting to your children if it doesn't interfere with your financial independence
Planning for your grandchildren's education
Reviewing your current will structure to eliminate unnecessary taxes
Protecting your residence and/or vacation home from estate taxes
Having your estate in trust for your spouse in order to protect your children's inheritance

Risk Tolerance

If you own a home, do you have more than 30% equity?

No

Yes

Which of the following best describes your current employment situation?

Full-Time

Part-Time

Retired

Unemployed

Have you invested in Equities?

No

Yes

Have you invested in Fixed Incomes?

No

Yes

Have you invested in Mutual Funds?

No

Yes

Have you invested in Options, Futures, or Derivatives?

No

Yes

How would you describe your level of investment knowledge?

None

Limited

Good

Extensive

How much investment experience do you have?

None

Limited (1 to 3 years)

Good (3 to 5 years)

Extensive ( > 5 years)

Which of the following best describes your primary financial goal for this investment?

My goal is preserving the real (inflation-protected) value of my investment; I am not concerned with out-performing the market.

My goal is generating current income; I am not concerned with growing the value of my investment.

My goal is a combination of generating current income and growing the value of my investment.

My goal is growing the value of my investment, and I am willing to tolerate losses in some years.

What is the time horizon for your investment?

1-3 years: these investments need to remain very liquid.

3-5 years: I can only tolerate a small amount of volatility.

5-10 years: I can tolerate a moderate amount of volatility.

Over 10 years: these assets are invested for the long term and can tolerate short-term fluctuations in value.

The assets considered for investment are what percentage of your total investable assets?

More than 75%

50-75%

25-50%

Less than 50%

Please choose the phrase that best describes the degree to which you will rely on these assets.

These investments are critical to my current and future financial well-being; I have few other assets or sources of current and future income

While these assets are a significant portion of my wealth, I have other assets and additional sources of current and future income

While these investments are an important portion of my wealth, I have considerable additional assets and other significant sources of current and future income

This investment is fairly small in relation to my overall wealth and my other sources of current and future income

How likely is it you will need to withdraw a significant portion of these assets prior to your planned time horizon to pay for a home, education, or some other purpose?

There is little or no chance

It is possible, but not likely

There is a strong chance

I will definitely be withdrawing these assets

If you do expect to withdraw a significant portion of your account, when is it likely to be?

Not applicable

Within 5 years

Within 5-10 years

More than 10 years from now

If you made a long-term investment of $100,000, how much of a loss in a single year would you withstand before selling?

5% ($5,000)

10% ($10,000)

20% (20,000)

I would not sell my investment based on a single-year loss

Suppose that, over a 2 or 3 year period, your portfolio has lost value. What action would you take?

Transfer my investments to another investment manager of similar strategy that I believe is more skilled

Move my investments to a more conservative portfolio to avoid losing more money

Maintain my present disciplined, long-term strategy

Develop a more aggressive strategy to recover my losses

Assume your investment horizon is more than 10 years. During the second year of investment, your portfolio declines to less than its initial value. Where would you place your reaction along the following scale? (Check one)

A/ I never want to see the value of my I would be disappointed by this kind of I don't pay attention to short-term investments decline

B/ I never want to see the value of my I would be disappointed by this kind of I don't pay attention to short-term investments decline

C/ I would be disappointed by this kind of loss, but I need a balanced, diversified portfolio to reach my long-term goals.

D/ I would be disappointed by this kind of loss, but I need a balanced, diversified portfolio to reach my long-term goals.

E/ I don't pay attention to short-term fluctuations in market value because I am investing for growth, and I will not need my money until the end of my investment time horizon

F/ I don't pay attention to short-term fluctuations in market value because I am investing for growth, and I will not need my money until the end of my investment time horizon

From the Investor Profiles form, are you...

Type 1  Type 2   Type 3   Type 4   Type 5   Type 6   Type 7  

Professional Contacts

Advisors

Advisor Type
(Accountant, Attorney, etc.)		 First/Last Name Company Address Phone, Fax, Email
Do you have an Estate Planning Attorney? Yes No Would you like us to recommend someone? Yes No
Do you have a CPA? Yes No Would you like us to recommend someone? Yes No
Is your Attorney a key decision maker for you? Yes No Is your CPA a key decision maker for you? Yes No

Notes:

Contact Details

StoneCrest Wealth Management Inc
118 S Kyrene Road, Suite 4
Chandler, AZ 85226
Toll Free: 800-852-2860
Phone: 602-258-9400
Fax: 602-258-9300
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

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