# Saving and Investing Questionnaire

A Roadmap To Your Financial Security Through Saving and Investing

## Personal Information

Full Name
Email Address
Street Address
City
Zip/Postal Code
Phone Number
Occupation
Broker's Name or CRD Number

## Financial Strength

1. What is your total annual income range?
Less than $50,000
$50,000 – $100,000
$100,000 – $250,000
$250,000 – $500,000
Above $500,000
2. What is your estimated net worth?
Less than $50,000
$50,000 – $100,000
$100,000 – $250,000
$250,000 – $500,000
Above $500,000
3. What is the source of the funds you want to invest?
Personal injury or compensation payment
Change in family circumstances (divorce, widowed etc)
Inheritance or gift (including prize money)
Superannuation and/or personal savings
4. How much do you have available for your initial capital investment?
Amount available to invest (USD)

## Time Horizon

1. What is your age?
56 and over
46 – 55
36 – 45
20 – 35
2. What is your primary financial goal?
Wealth preservation
Retirement planning
Wealth accumulation
3. What is the time frame for you to achieve your financial goals?
0 – 5 years
5 – 10 years
10 years or longer
4. How many years do you have till your retirement?
1 – 5 years
6 – 10 years
11 – 15 years
16 – 20 years
Above 20 years

## Financial Goals

1. Which of the following best describes your financial goal?
Preserving principal and earning moderate amount of current income
Generating high amount of current income
Generating some current income and growing assets over an extended timeframe
Growing assets substantially over an extended timeframe
2. How do you expect your standard of living five years from now compared to your standard of living today?
Less than it is today
The same as it is today
Somewhat higher than it is today
Substantially greater than it is today
3. Five years from today, you expect your portfolio value to be:
Portfolio value is not my primary concern, I am more concerned with current income
The same as it is or slightly more than it is today
Greater than it is today
Substantially greater than it is today
4. Generating income from your portfolio is:
A primary concern (only if you are about to retire)
Not important
5. With the income generated from your portfolio, you plan to:
Use it for living expenses
Use some and re-invest some
Re-invest all income

## Risk Tolerance

1. How would you classify your current financial situation?
My financial situation is somewhat unstable
My situation is stable but I need saving to supplement my income
I do not currently need my savings and investments to meet current income requirements. However, this might change
I do not use my savings and investments to meet current income requirements. However, I may need to access funds if an unexpected emergency arises
I have sufficient cash flow to meet my income requirements including emergencies
I am completely secure and I can meet emergency requirements without withdrawing money from my long term investments
2. You have just received a large amount of money. How would you invest it?
I would invest in something that offered moderate current income and was very conservative
I would invest in something that offered high current income with a moderate amount of risk
I would invest in something that offered high total return (current income plus capital appreciation) with a moderate amount of risk
I would invest in something that offered substantial capital appreciation even though it has a high amount of risk
3. Which of the following statements would best describe your reaction if the value of your portfolio were to suddenly decline by 15%?
I would be very concerned because I cannot accept fluctuations in the value of my portfolio
If the amount of income I receive was unaffected, it would not bother me
Although I invest for long term growth, even a temporary decline would concern me
Because I invest for long term growth, I would accept temporary fluctuations due to market influences
4. Which of the following investments would you feel most comfortable owning?
Certificates of deposit
U.S. Government securities
Blue-chip stocks
Stocks of new growth companies
Cryptocurrency
Unsure
5. Which of the following investments would you least like to own?
Stocks of new growth companies
Blue-chip stocks
U.S. Government securities
Certificates of deposit
Cryptocurrency
Unsure
6. Which of the following investments do you feel are the most ideal for your portfolio?
Certificates of deposit
U.S. Government securities
Blue-chip stocks
Stocks of new growth companies
Cryptocurrency
Unsure
7. How optimistic are you about the long-term prospects of the U.S economy?
Very pessimistic
Unsure
Somewhat optimistic
Very optimistic
8. Which of the following best describes your attitude towards investments outside the US?
Unsure
I believe the U.S economy and foreign markets are interdependent
I believe overseas markets provide attractive investment opportunities