Download New Client Questionnaire

New Client Questionnaire
Please complete the below questionnaire and return a completed copy by email to
[email protected]. It is not required to answer every question, but the more
detailed your profile, the better investment advice you can receive.
Personal Information
Name______________________________
Date of birth_______________
Mailing address____________________________________________________________________
Preferred telephone number _______________________
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Existing Financial Management Profile
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Existing adviser relationship and role of SJBenen in financial planning (select one)
o _____ I am satisfied with my existing adviser, or totally self-directed, and confident I am
getting good advice. I am simply looking to make an allocation to an account managed
by SJBenen as a percentage of my overall portfolio
o _____ I do not have an adviser and I am looking for SJBenen to get me started out on the
path of personal financial planning
o _____ I have an existing adviser and am unsure whether I am getting good advice and
would like SJBenen to help me evaluate and review my current situation
o _____ I am unsatisfied with my adviser and am looking to get out of my existing
relationship and would like SJBenen to help me aid in the transition and take over as my
new adviser
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How would you describe your level of knowledge with regard to finance and investing? (select
one)
o _____ Minimal. I have very little interest in understanding finance and investing, or I
have not had the opportunity to learn.
o _____ Low. I have basic knowledge of finance, such as understanding what stocks,
bonds, and mutual funds are.
o _____ Medium. I have knowledge beyond basic products and I understand
diversification and other financial and investing terminology and strategy.
o _____ High. In addition to understanding most financial products and terminology, I
understand factors that affect the price of stocks and bonds.
o _____ Advanced. I have an in-depth knowledge of most financial products, including
stocks, bonds, and options. I understand overall market risk as well as company-specific
risk.
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Preferences on tax preparation and active trading (select one)
o _____ I send out my taxes to be prepared by a professional every year who is capable of
handling complex 1099 statements from brokerage accounts, or am such a professional,
and am comfortable with an actively traded account with numerous line items to report
at the end of the year
o _____ I do my own taxes (e.g. on Turbotax) and I prefer not to have many line items to
input. I highly value simplicity in my tax return and would feel uncomfortable having to
deal with a complex 1099 form.
o _____ While I do have a professional who prepares my taxes every year, I nonetheless
want a very simple 1099 statement at the end of the year and do not want a lot of active
trading on my account
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What types of accounts or assets do you currently own? (Select all that apply)
o _____ Taxable brokerage accounts
o _____ Savings accounts and/or CDs
o _____ IRA
 Please indicate what type (Traditional, Roth, SEP, SIMPLE, inherited, other)
o _____ Employer-sponsored plans
 Please indicate what type (401k, 403b, 457, pension, deferred compensation,
RSUs, options, profit sharing, other)
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_____ Life Insurance
 Please indicate what type (term, whole with cash value, variable, ILIT, other)
_____ Annuities
 Please indicate what type (fixed, variable, other)
_____ Education Savings Account for a beneficiary child, such as 529 or Coverdell ESA
_____ Peer to peer lending, such as Prosper or LendingClub
_____ Treasury securities held in bearer form or on Treasurydirect.gov
_____ Real estate
 Please indicate (Primary home, vacation home, directly owned rental real estate)
_____ Physical bullion or other valuable collectibles
_____ Trusts
 Please indicate what type (simple, complex, charitable, other)
_____ Ownership interest in non-publicly-traded limited partnership(s) or private
placement(s)
_____ Small business owner
_____ Other, please specify ______________________________________________________
What types of debt do you have outstanding at the present time? (Select all that apply)
o _____ Mortgage
o _____ Home Equity Line of Credit
o _____ Credit Card Debt
o _____ Student Loans
o _____ Back taxes owed
o _____ Personal debt originated by friends, family, or acquaintances
o _____ Loans for durable goods you purchased (e.g. auto loan)
o _____ Margin loans at securities brokerage firms
o _____ Small business loan that is personally guaranteed by you
o _____ Other, please specify ______________________________________________________
Income & net worth
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What is your current annual household income (adjusted gross income from line 37 of your
federal tax return, form 1040):
o _____ Under $100,000
o _____ $100,000 to $250,000
o _____ $250,000 to $500,000
o _____ $500,000 to $1,000,000
o _____ Over $1,000,000
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What is your liquid net worth: (Excluding primary residence)
o _____ Under $100,000
o _____ $100,000 to $250,000
o _____ $250,000 to $1,000,000
o _____ $1,000,000 to $5,000,000
o _____ Over $5,000,000
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What is the combined value of your residence(s) and other significant illiquid assets:
o _____ Under $100,000
o _____ $100,000 to $250,000
o _____ $250,000 to $1,000,000
o _____ $1,000,000 to $5,000,000
o _____ Over $5,000,000
Risk tolerance & investment parameters
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Acceptable percentage of principal loss in a short term period? (less than 1 year)
o _____ Up to 5%
o _____ Up to 10%
o _____ Up to 15%
o _____ Up to 20%
o _____ Up to 25%
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What is your desired annual rate of return?
o _____ 0-2.5%
o _____ 2.5-5%
o _____ 5-7.5%
o _____ 7.5-10%
o _____ 10%+
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Which of the following statements best describes your investment objectives?
o _____ My highest priority is to preserve my investments and I am willing to accept
minimal return in order to do so
o _____ I seek to generate income from my investments and am interested in investments
that have historically demonstrated a low degree of risk of loss of principal value
o _____ I seek to grow the principal value of my investments over time and, in pursuit of
these gains, am willing to invest in securities that have historically demonstrated a
moderate degree of risk to loss of principal value
o _____ I seek to accelerate somewhat the growth of the principal value of my investments
over time and, in pursuit of these gains, am willing to invest in securities that have
historically demonstrated a moderate to above average degree of risk of loss of principal
value
o _____ I seek a significant appreciation of the principal value of my investments and, in
pursuit of these gains, am willing to accept a greater degree of risk by investing in
securities that have historically demonstrated a high degree of risk of loss of principal
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How would you respond in the event of a decline in the value of your investments?
o _____ I would sell my investments immediately if they were to suffer substantial declines
o _____ Although declines in investment value make me uncomfortable, I would wait one
to two quarters before adjusting my portfolio
o _____ I can endure significant declines in the value of my investments and would wait at
least one year before adjusting my portfolio
o _____ Even if my investments were to suffer a significant decline over several years, I
would continue to follow my long-term investment strategy and not adjust my portfolio
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o
_____ I would increase the amount invested in my portfolio in anticipation of an increase
in value
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Which of the following scenarios would make you more uncomfortable?
o _____ Making an investment and watching it decline in value
o _____ Selling an investment and watching it increase in value
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During the decline in stock market values that took place from 2007 through 2009, what action
did you take with respect to your investments?
o _____ Sold all equity holdings
o _____ Moderately decreased equity holdings
o _____ No changes
o _____ Moderately increased equity holdings
o _____ Significantly increased stock holdings
o _____ Not applicable
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In general, how did you feel about the decline in stock market values from 2007 through 2009?
o _____ High level of anxiety
o _____ Moderate level of anxiety
o _____ Acceptance that short-term losses are part of investing and assurance that the risk I
took was reasonable given the potential long-term gains of my investments
o _____ Indifference
o _____ Excited to be able to invest in assets that had declined in value
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Other financial planning and/or account management parameters
In this section, discuss your specific needs or preferences. You are encouraged to email, call, or meet
your adviser in person to discuss this section. This is an opportunity to delve into the specifics of your
particular situation and to formulate a plan that exactly fits for you.
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