Client Risk Assessment Questionnaire - Summit Wealth Management

Purpose of Document/Questionnaire

To create the proper portfolio to help achieve your goals and objectives, it is necessary to understand the time horizon for this investment program, as well as your long- term goals and expectations. It is also important to understand and document your level of comfort with the risk associated with this investment program, as well as your financial ability to accept this risk. The Client Risk Assessment Questionnaire is one of the first steps in creating the proper portfolio, determining the best asset mix for an investment and documenting your risk profile. Please indicate your answers to the questions below.

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- Step 1 of 5

First Name *

Middle Initial

Last Name *

Date of Birth *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone

Work Phone

Cell Phone

Personal & Financial Profile

What is the average age of the income earners in your household? *

Less than 35
36 to 45
46 to 55
56 to 65
65 or higher

What is your approximate net worth or net Liquid Assets (not including primary home)? *

$0 to $250,000
$250,000 to $500,000
$500,000 to $1M
$1M to $3M
$3M to $5M
Over $5M

Approximately how much debt do you have as a percentage of your net liquid assets (incl. mortgages) *

10% or less
11% to 20%
21% to 40%
41% to 60%
More than 60%

How much Life Insurance coverage do you have (household)? *

None
$0 to $50,000
$51,000 to $150,000
$151,000 to $250,000
Over $250,000

How many years-worth of investment experience do you have? *

None
1 to 3 years
4 to 6 years
7 to 10 years
Over 10 years

What best describes your investment attitude? *

Very conservative
Somewhat conservative
Moderate
Somewhat aggressive
Very aggressive

Protecting my portfolio is more important to me than high returns. *

Strongly disagree
Disagree
Somewhat agree
Agree
Strongly agree

What is your expected total return (capital appreciation + income) on these assets in any given year? *

3% to 7%
8% to 12%
13% to 17%
17% or more

Short-Term Risk Assessment

A chart shows the greatest 1-year loss and the highest 1-year gain on 3 different hypothetical investments of $10,000. Given the potential gain or loss in any 1-year, I would invest my money in… *

Minimal volatility
Moderate volatility
Most volatility

year? your money

During market declines, I tend to sell portions of my riskier assets and invest the money in safer assets. *

Strongly agree
Disagree
Somewhat agree
Agree
Strongly agree

I would invest in a mutual fund or ETF (exchange-traded fund) based solely on a brief conversation with a friend, co-worker, or relative. *

Strongly disagree
Disagree
Somewhat agree
Agree
Strongly agree

Generally, I prefer an investment with little or no ups and downs in value, and I am willing to accept the lower returns these investments make. *

Strongly agree
Disagree
Somewhat agree
Agree
Strongly agree

Which of these statements would best describe your attitudes about the next three months’ performance of your investments?

Who cares? One calendar quarter means nothing
I would not worry about losses in that time frame
If I suffered a loss greater than 10%, I would be concerned
I can tolerate only small short-term losses
I would have had a hard time stomaching any losses

I deliberately set aside a portion of my income every month/year for investment purposes. *

Strongly disagree
Disagree
Somewhat agree
Agree
Strongly agree

If I owned a bond investment that lost 4.0% in two months, I would… *

Sell all the remaining investment
Sell a portion of the remaining investment
Hold onto the investment and sell nothing
Buy more of the remaining investment

If I owned a stock that loses 31.0% of its value in 3 months, I would *

Sell all the remaining investment
Sell a portion of the remaining investment
Hold onto the investment and sell nothing
Buy more of the remaining investment

Long-Term Risk Assessment

Which of these statements would best describe your attitudes about the next three years’ performance of this investment? *

I do not mind if I lose money
I can tolerate a loss
I can tolerate a small loss
I want to see at least a little return
I want to avoid losing money

Desired or estimated years to retirement (average if joint) *

Over 20 years
16 to 20 years
11 to 15 years
6 to 10 years
Within 5 years

Suppose the stock market performs unusually poor over the next decade. What would you expect from this investment? *

To lose money
To make a modest gain
To make very little or nothing
To make a little gain
To be little affected by what happens in the stock market

When making a long-term investment, I plan to keep the money invested for… *

1-2 years
3-4 years
5-6 years
7-8 years
More than 8 years

As I withdraw money from my investments, I plan to spend it over a period of… *

2 years or less
3-5 years
6-10 years
11-15 years
More than 15 years

I intend to pass all the money I can onto an heir(s) *

Strongly disagree
Disagree
Somewhat agree
Agree
Strongly agree

Assuming normal market conditions, what would you expect from this investment over time? *

To generally keep pace with the stock market
To slightly trail the stock market but make a good profit
To trail the stock market, but make a moderate profit
To have some stability, but make modest profits
To have a high degree of stability, but make a small profit

Over the next few years, you expect the rate of inflation to: *

Decrease substantially
Decrease moderately
Stay the same
Increase moderately
Increase substantially

Other Considerations

What are your primary sources of income? (check any that apply) *

Employment / Work / Wages
Pension
Social Security
Investment / Rental Properties
Securities portfolio
Trust(s)
Insurance payouts/distributions
Other

Other Income Source(s)

From which industry to you derive this income? *

Technology
Home or Commercial Building
Industrial / Manufacturing
Financial
Retail
Health Care
Professional
U.S. Government / Municipal / State
Other

Other Industry(ies)

Select the investment vehicles closest to those you currently own (check all that apply) *

Individual Stocks
Individual Bonds
Stock Mutual Funds and/or ETFs
Bond Mutual Funds and/or ETFs
Options
Annuities