Client Profile Information Form
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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