Client Profile Information Form

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Personal Information

Client Profile Information Form

Client

Co-Client

Full Name

Nickname

Date of Birth

Gender

M ?F

Gender ? M ? F

Marital Status

Single ? Married Divorced ? Widowed

Single ? Married Divorced ? Widowed

Maiden Information

Last Name:

Last Name:

Citizenship

? U.S. Citizen ? Other:

? U.S. Citizen ? Other:

Birthplace

City/State:

City/State:

Social Security Number

Identification

ID Type: Drivers License ? Passport Other:

ID Type: Drivers License ? Passport Other:

ID#:

ID#:

Exp Date:

State Issued:

Exp Date:

State Issued:

Employment Status

Employed Unemployed

Self-Employed Homemaker

Retired Student

Employed Unemployed

Self-Employed Homemaker

Retired Student

Occupation/Job Title

Length of Employment

Company Name & Address

Legal Address

Mailing Address

(if different from legal address)

Home Phone Work Phone Cell Phone E-mail Are you each other's primary beneficiary?

Yes ? No

Additional Family Details & Legacy Planning

Who are your current beneficiaries, if any, on your accounts? P = PRIMARY / C = CONTINGENT

P Name: C Relationship:

DOB: SSN:

P Name: C Relationship:

DOB: SSN:

P Name: C Relationship:

DOB: SSN:

P Name: C Relationship:

DOB: SSN:

? INVESTMENT PROFESSIONALS, INC.

CLIENT PROFILE INFORMATION FORM - PAGE 1 OF 5

CONFIDENTIAL

Additional Family Details & Legacy Planning (Continued)

Who are your children and/or grandchildren?

Name: Relationship: Name: Relationship: Name: Relationship: Name: Relationship: Name: Relationship:

DOB: SSN: DOB: SSN: DOB: SSN: DOB: SSN: DOB: SSN:

Age: Age: Age: Age: Age:

Do you have a current estate plan?

? Y ? N Have you reviewed your current beneficiaries recently? ? Y ? N

Do you have any trusts? Do you have power of attorney setup?

? Y ? N Do you have any wills?

?Y ?N

Who is your estate planning attorney?

?Y ?N

Financial Information

Employment

Client

$

$

Pension/Retirement

$

$

Social Security Benefits (if currently taking)

$

$

INCOME

Rental Property

$

$

Royalties

$

$

Other:

$

$

Other:

$

$

Qualified Accounts (Traditional, Roth, SEP, SIMPLE, 401(k), 403(b), 457)

$

$

Type:

$

$

Type:

$

$

INVESTMENT ASSETS

Type:

$

$

Type:

$

$

Type:

$

$

Non-Qualified Accounts

$

$

Type:

$

$

Type:

$

$

Type:

$

$

Type: ? INVESTMENT PROFESSIONALS, INC.

$

$

CLIENT PROFILE INFORMATION FORM - PAGE 2 OF 5

Co-Client

CONFIDENTIAL

Financial Information (Continued)

Client

Liquid Net Worth

$

$

NET WORTH

Net Worth

$

$

Tax Bracket

$

$

Client

Equities

$

$

Options

$

$

Fixed Income

$

$

Mutual Funds

$

$

UITs

$

$

ETFs

$

$

Real Estate

$

$

Insurance (Cash Value)

$

$

Variable Annuities

$

$

Fixed Annuities

$

$

Precious Metals

$

$

Commodities & Futures

$

$

Cash

$

$

CDs

$

$

Bank Accounts

$

$

Unlisted Bank Stock

$

$

Alternative Investments

$

$

Other:

$

$

Other:

$

$

Other:

$

$

Primary Bank Other Bank

Client

What is your investment experience?

? INVESTMENT PROFESSIONALS, INC.

CLIENT PROFILE INFORMATION FORM - PAGE 3 OF 5

Co-Client Co-Client

Co-Client

CONFIDENTIAL

Lifestyle Expectations, Goals and Concerns

Lifestyle Goals are above and beyond what you need to pay for basic expenses. Rate the importance of each Goal on a scale of 10 1. This will identify your goals by Needs (10, 9, 8), Wants (7, 6, 5, 4), and Wishes (3, 2, 1).

COMMON GOALS

? Travel ? New Car ? Funding College

? Home Improvement ? Major Purchase ? New Home

? Wedding ? Wealth Transfers ? Gifts / Donation

Travel Funding College Other: Other: Other: Other: Other: Other: Other: Other: Other: Other: Other:

Importance 10 1

$ $ $ $ $ $ $ $ $ $ $ $ $

Goal Amount

Year

Details

Retirement Expectations, Goals and Concerns

Retirement Goals are above and beyond what you need to pay for basic expenses. Rate the importance of each Goal on a scale of 10 1. This will identify your goals by Needs (10, 9, 8), Wants (7, 6, 5, 4), and Wishes (3, 2, 1).

RETIREMENT EXPECTATIONS: What do you most look forward to?

Active Lifestyle

Importance 10 1

$

Goal Amount

Year

Quiet Lifestyle

$

Opportunity to Help Others

$

Moving to a New Home

$

Work by Choice

$

Time to Travel

$

Start a Business

$

Time with Friends & Family

$

Less Stress - Peace of Mind

$

Other:

$

Other:

$

Other:

$

Details

? INVESTMENT PROFESSIONALS, INC.

CLIENT PROFILE INFORMATION FORM - PAGE 4 OF 5

CONFIDENTIAL

Retirement Expectations, Goals and Concerns (Continued)

Retirement concerns are above and beyond what you need to pay for basic expenses. Rate the importance of each Goal on a scale of 10 1. This will identify your goals by Needs (10, 9, 8), Wants (7, 6, 5, 4), and Wishes (3, 2, 1).

RETIREMENT CONCERNS: What most concerns you?

Not having a paycheck

Importance 10 1

$

Goal Amount

Running out of money

$

Suffering investment losses

$

Leaving money to others

$

Cost of health care or long-term care

$

Current or future health issues

$

Dying early

$

Living too long

$

Getting ill

$

Being bored

$

Parents needing care

$

Other:

$

Other:

$

Other:

$

Year

Details

Retirement Questionnaire

At what age would you like to retire? How willing are you to retire later? Are you eligible for Social Security Benefits? If so, what is your benefit amount? (estimate) What is your desired annual income during retirement? Total Monthly Expenses Today? Total Monthly Expenses in Retirement?

Client

? Yes ? No $ $ $ $

Co-Client

? Yes ? No $ $ $ $

How you completed the Riskalyze Risk Questionnaire? If not, please contact your financial advisor.

? Yes ? No

All information provide in this documents will remain confidential and only be used for planning purposes to better know our clients. Details of the IPI Privacy policy are provided after account opening and can be made available upon request.

? INVESTMENT PROFESSIONALS, INC.

CLIENT PROFILE INFORMATION FORM - PAGE 5 OF 5

CONFIDENTIAL

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