Annual Financial CheckupStep 1 of 156%Client DescriptionThe left column is your information. The right column is for your spouse.Your NameSpouse's NamePhoneSpouse PhoneEmail Spouse Email Current Mailing Address Street Address City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Date of Birth Month Day YearSpouse Date of Birth Month Day YearYour desired retirement age?Your spouse's desired retirement age?OccupationSpouse OccupationChild(s) Name(s) and Birth Date(s)NameDate of Birth Add RemoveHave you experienced any major life changing event within the last year? Save & Continue (We will send you email link to continue)Combined Gross Income Source(s)Combine Gross Income from both Spouses (Where applicable) BEFORE taxes, 401ks, and other deductions.Annual or Monthly Income?AnnualMonthlyYour WageYour Spouse's WageDividends/InterestSocial SecurityPension/RetirementAlimonyChild SupportOther Total Save & Continue (We will send you email link to continue)Monthly ExpensesAmounts should be calculated as a MONTHLY totalMortgage(s)AutoHome InsuranceAuto InsuranceHealth InsuranceFoodUtilitiesPhone(s)Cable/InternetChild CareEducationEntertainmentPayroll and Income Taxes401k ContributionOther Total Expenses Save & Continue (We will send you email link to continue)Financial Goals and ObjectivesExamples: Prepare for retirement, Save for college, Start a new business, etc.Financial goals in order of importance?What is the year you would like to start this goal?How long will this goal run in years? Add Remove Save & Continue (We will send you email link to continue)ContstraintsWhat type of liquidity do you need in your portfolio? If the goals/objectives above include special liquidity contraints, please list them here and reference the goal .Do you have any regulatory restrictions on investments? Please describe below.Taxes can erode return. The default asset allocation seeks to minimize the eroding effects of taxes and seeks tax efficient investments when available. If you have specific requirements with regard to taxes, or you want your assets managed irrespective of taxes, please specify below.Some investors, based on ethical, moral, religious, or other reasons, choose to restrict managers from investing in certain asset classes or specific assets. Please specify any asset class restrictions or security restrictions below.Please list other investment constraints you think may be applicable to managing your portfolio. Save & Continue (We will send you email link to continue)Risk QuestionnaireCurrent amount of cash reserves capable of supporting typical monthly spending. No cash reserves Less than one month 1-3 months 4-6 months 7-9 months 10-12 months More than 12 monthsHow would you rate your willingness to take on financial risk compared to others? Much Higher Higher Average Lower Much LowerHow easily do you adapt to big changes in your life? Not easily at all Fairly easily Easily Very easilyWhich best describes your philosophy on financial losses? I will take less return if I can avoid loss I will endure some losses if it means I get a positive return The only way to make money is to risk big lossesWhen you think of the word "risk", what comes to mind? Danger Uncertainty ThrillingDo you have "play money" you invest in risky ventures? Yes No Save & Continue (We will send you email link to continue)Which is more important? Job security with low bonus potential Job insecurity with big bonus potentialWhich is more important when investing? Losses Gains Both are equally importantHow risky, as a whole, have your past investments been? Not risky at all – U.S. government debt/Savings Low risk – Corporate blue chip debt Medium risk – Corporate blue chip equity High risk – Small cap growth stocks Extreme risk – Land speculationYour neighbor invested $10,000 in a company a year ago. After he invested, the company announced a huge discovery that increased its stock price 20 times. Your neighbor bought a fancy sports car and a boat with his windfall. How do you feel? Good for him, but it was a risky long shot Man, I wish I would’ve investedIf you had a very bad experience with a hotel chain, would you try that hotel on a future trip? Yes Maybe NoYou are standing at a roulette table and you’ve just seen the ball land on red 8 times in a row. You decide to make a bet on color, do you bet on red or black? Red Black Doesn't matter Save & Continue (We will send you email link to continue)A man from a well known sweepstakes comes to your door and says you won $1,000,000. To add some excitement, he gives you the option of taking the $1,000,000 or flipping a coin in which case you will win $2,200,000 if it lands on heads. Tails you win nothing. What do you do? Take the $1,000,000 Flip the coin Faint under pressureInvestments go up, investments go down. At what level of decline would you begin to feel discomfort? 5% 10% 20% 30% 40% 50% or morePortfolios of assets have an expected range of returns. Which portfolio would you prefer? Portfolio A 0% --- +3% Portfolio B -5% --- +5% Portfolio C -10% --- +15% Portfolio D -20% --- +25% Portfolio E -40% --- +40% Save & Continue (We will send you email link to continue)How have your investments changed over the years? Less risky now More risky now No change in riskHow stable is your income? Very stable Stable Not stableIs your income sufficient to meet your current lifestyle? Yes NoWould you be willing to accept the risk of a retirement lifestyle that is less than your current lifestyle if there was an equal chance your retirement lifestyle would be better than your current lifestyle? Yes NoWhich best categorizes your desire to leave money to children, relatives, and/or charity after you die? I would like to pass a significant estate when I die I would like to pass an estate when I die, but I want to enjoy it now too You can’t take it with you when you go and I plan on spending every last dime Save & Continue (We will send you email link to continue)Personal Financial StatementThe Personal Financial Statement is Optional. Do you want to disclose the following information or submit what you have? Fill out the Personal Financial Statement Skip the Personal Financial StatementLiquid Assets - Can be quickly and easily converted into cashComplete the following with the current value for each. Click the "+" sign to add additional rows.Cash - CheckingFinancial InstitutionBalance Add RemoveCash - SavingsFinancial InstitutionBalance Add RemoveCash - OthersFinancial InstitutionBalance Add RemoveInvestment Accounts - Non-Retirement/529BrokerageBalance Add RemoveEmployer StockCompanyBalance Add RemoveOther Liquid Investments - Non-RetirementDescriptionBalance Add Remove Save & Continue (We will send you email link to continue)Non-Liquid Assets - Can not be easily sold and converted into cashComplete the following with the current value for each. Click the "+" sign to add additional rows.Retirement - 401kBrokerageBalance Add RemoveRetirement - Traditional IRABrokerageBalance Add RemoveRetirement - Roth IRABrokerageBalance Add Remove529 College SavingsBrokerageBalance Add RemoveOther Misc. Non-Liquid AssetsDescriptionBalance Add Remove Save & Continue (We will send you email link to continue)Personal PropertyClick the "+"sign to add additional rows to any section.Primary Residence & Other Real Estate ValueAddressMortgage BalanceYears RemainingInterest RateMinimum PaymentMarket Value Add RemoveReceivablesDebtorMaturity DateAmount Owed Add RemoveLife Insurance Surrender ValueInsurerInsuredSurrender Value Add Remove Save & Continue (We will send you email link to continue)LiabilitiesClick the "+"sign to add additional rows to any section.Credit CardsIssuerInterest RateMinimum PaymentCurrent Balance Add RemoveAuto LoansLenderInterest RateMinimum PaymentCurrent Balance Add RemoveOther Short-Term DebtIssuerInterest RateMinimum PaymentCurrent Balance Add Remove Save & Continue (We will send you email link to continue)LiabilitiesClick the "+"sign to add additional rows to any section.Student Loan(s)IssuerInterest RateMinimum PaymentCurrent Balance Add RemoveTaxes PayableAgencyTax YearCurrent Balance Add RemoveOther Long-Term DebtDescriptionMinimum PaymentCurrent Balance Add Remove Save & Continue (We will send you email link to continue)Annual Client MeetingWhat Works Best For You?Best method(s) to meet? In person at Edgar Investment Office In person at your requested location Remote (Zoom/WebEx)Select AllBest day(s) to meet? Monday Tuesday Wednesday Thursday Friday Saturday SundaySelect AllBest time(s) to meet? Morning Afternoon EveningSelect All Save & Continue (We will send you email link to continue) For the Full Policy Statement, Click Here. For the Full Form ADV, Click Here.