Dresner Financial Planning

[email protected]

2359 Salisbury Rd. Westbury, NY 11590 tel/fax (516) 357-7466

Client Information and Risk Profile Questionnaire _______________

Clients Name

_______________
Date
All information contained in this document will be kept in the strictest confidence unless expressed, written authorization is given by the client.
Securities offered through Goldis Financial Group, Inc. 100 Quentin Roosevelt Blvd. Garden City, NY 11530 (516-357-8900), member NASD & SIPC

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Client Information and Risk Profile Questionnaire

Document Check List

Information from the following documents should be assembled prior to you filling out this questionnaire. Copies of the most recent financial statements and records concerning your: Employer-related retirement/benefit plans (including beneficiary designation form) Employment-related contracts (i.e; pay package, parsonage agreement, accountable plan, employer contract) Individual retirement accounts - including beneficiary designation form - (i.e.; IRAs, KEOGH, SEP, 401(k), 403(b), etc.) Annuities Savings account, checking accounts, CDs Non-retirement investments (i.e.; mutual funds, individual securities) Insurance policies (i.e.; life, health, disability, long-term care, home, vehicle, liability, umbrella) Mortgage(s) and property title(s) Loans (i.e.; personal, automobile, credit cards, notes) Trust agreement and wills Most recent tax return (1040) Any other financial information you think relevant

Effective financial management depends on effective communication. The more we know about you and your financial situation, goals, and opportunities, the better our advice will be.

Dresner Financial Planning

2359 Salisbury Rd.

Westbury, NY 11590

tel/fax (516) 357-7466

[email protected]

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Client Information and Risk Profile Questionnaire

Personal Information
CLIENT Name Birthdate Gender Soc. Sec. No. Address Country of Citizenship Home Phone E-mail SPOUSE

Children/Grandchildren Name Current Savings $ Name Current Savings $ Name Current Savings $ Name Current Savings $ Roth IRA $ Roth IRA $ Roth IRA $ Roth IRA $

M/F Ed. IRA $ M/F Ed. IRA $ M/F Ed. IRA $ M/F Ed. IRA $

Birthdate 529 Savings Plan $ Birthdate 529 Savings Plan $ Birthdate 529 Savings Plan $ Birthdate 529 Savings Plan $

College Year UGMA $ College Year UGMA $ College Year UGMA $ College Year UGMA $ Other $ Other $ Other $ Other $

Dresner Financial Planning

2359 Salisbury Rd.

Westbury, NY 11590

tel/fax (516) 357-7466

[email protected]

Page 4 of 16

Client Information and Risk Profile Questionnaire

Personal Information (continued)

Parents/Grandparents CLIENT Health Mother Father Grandmother Grandfather Age Mother Father Grandmother Grandfather Yes Are you anticipating any major lifestyle changes (i.e., marriage, divorce, retirement, children, moving, etc.)? Are you comfortable with your current cash flow? Do you expect any significant changes in your cash flow? Do you expect any major expenditure in the near future (5 years)? Do you expect to win or lose any legal judgments? Do you have an ownership interest in any business? Do you expect to take care of an elderly (or infirmed) family member? Is your savings portfolio providing an adequate yield? Is your savings portfolio sufficiently liquid? Does your savings portfolio create a tax problem? Are you comfortable with your current diversification? Is your investment portfolio providing adequate income? Are there any investments you are opposed to for any reason? Will you be receiving a significant inheritance? Do you have potential health problems? Do you have adequate medical coverage? Do you have adequate disability coverage? Do you have adequate personal liability coverage? Do you have enough life insurance? Would you like to leave a charitable legacy? Were you previously married?
Dresner Financial Planning 2359 Salisbury Rd. Westbury, NY 11590 tel/fax (516) 357-7466 [email protected]

SPOUSE Health Age

Age at Death Age at Death

Age at Death Age at Death No Uncertain

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Client Information and Risk Profile Questionnaire

Employment Information
Current Employer CLIENT Name Address Business Phone Years Service SPOUSE

Salary Parsonage Amount Exceed Last Years Parsonage Amount? Previous Employers

$ $ Y N
by how much $

(annually) (annually)

Year Contract Expires Accountable Plan Exceed Last Years Accountable Plan Amount? $ Y by how much $ N

CLIENT Name Location Years Service CLIENT Name Location Years Service CLIENT Name Location Years Service

SPOUSE

SPOUSE

SPOUSE

To add additional employers, use page 9

Dresner Financial Planning

2359 Salisbury Rd.

Westbury, NY 11590

tel/fax (516) 357-7466

[email protected]

Page 6 of 16

Client Information and Risk Profile Questionnaire

Retirement Information
CLIENT Desired Age S.S. Eligible S.S. Estimate Life Expectancy Name $ Current Balance $ Annual Contribution $ Allocation Eq. % Fixed % Cash % $ Y /mo. N @ age $ Y /mo. N @ age SPOUSE

Annuities

1st Beneficiary 2nd Beneficiary IRA $ Eq. % Fixed % Cash %

1st Beneficiary 2nd Beneficiary (2nd )IRA $ Eq. % Fixed % Cash %

1st Beneficiary 2nd Beneficiary Roth IRA $ Eq. % Fixed % Cash %

Year Converted 1st Beneficiary 2nd Beneficiary L/T Disability Income L/T Care Policy Desired after tax retirement income $ Premiums $ Y in todays dollars Benefit /mo $ N in todays dollars

Dresner Financial Planning

2359 Salisbury Rd.

Westbury, NY 11590

tel/fax (516) 357-7466

[email protected]

Page 7 of 16

Client Information and Risk Profile Questionnaire

Estate Information
Will Living Will Executor Alternate Power of Atty. Executor Alternate Revocable Trust Irrevocable Trust Life Insurance Employer Provided Owner Beneficiary Personally Insured Owner Beneficiary Personally Insured Owner Beneficiary $ face $ cash value $ face $ cash value $ $ cash value Y Y N N Y Y N N Y N last reviewed Y N last reviewed CLIENT Y N Y N last reviewed last reviewed SPOUSE Y N Y N last reviewed last reviewed

Home/Car Insurance Amount Home 2nd Home Rental Property 1st Car 2nd Car $ $ $ $ $ Deductible $ $ $ $ $

Dresner Financial Planning

2359 Salisbury Rd.

Westbury, NY 11590

tel/fax (516) 357-7466

[email protected]

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Client Information and Risk Profile Questionnaire

Asset & Liability Information

Personal Assets Primary Residence Ownership Mortgage Bal./Rate Home Equity Loan/Rate Secondary Residence Ownership Rental Property Ownership Mortgage Bal./Rate $ % $ Notes/Mtgs. Owed You $ $ $ $ % % Current Value $ Automobile 1 Automobile 2 Second Mtg. Bal./Rate Current Value $ % % % $ $

Auto Loan Balance/Rate $ Auto Loan Balance/Rate $

Business Interest Owned $

Current Value Checking Acct. Money Mkt. Stocks/Funds Muni Bonds/Funds Other Securities $ $ $ $ $ Saving Acct. CDs US Govt Issues Corp Bond/Funds $ $ $ $

Personal Liabilities Card Name Credit Cards Amount $ $ $ Notes/Loans You Owe Alimony/Child Support $ $ % Rate % % %

Dresner Financial Planning

2359 Salisbury Rd.

Westbury, NY 11590

tel/fax (516) 357-7466

[email protected]

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Client Information and Risk Profile Questionnaire

Advisors
Name Address/Phone

Attorney

Accountant

Insurance Agent

Stockbroker

(We will not contact your advisors without your prior approval.) Space for Additional Information:

Dresner Financial Planning

2359 Salisbury Rd.

Westbury, NY 11590

tel/fax (516) 357-7466

[email protected]

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Client Information and Risk Profile Questionnaire

Risk Profile
1. What is the approximate value of this investment portfolio? 2. What percentage of your total investments does this portfolio represent? 3. Is there an immediate or near-term (i.e., within 5 years) need for income from this portfolio(s)? If yes, when will the income be needed? 4. Will significant cash withdrawals of principal and/or contributions be made over the next five years? If yes, please attach a schedule. 5. Is this a taxable or partially taxable portfolio? If yes, what tax rate should be used for planning purposes? 6. What is the portfolios Investment Time Horizon?
Investment Time Horizon refers to the number of years you expect the portfolio to be invested before you must dip into principal. Alternatively, how long will the objectives stated for this portfolio continue without substantial modification?

$_____________ ______________% Y N

___________ Yrs. Y N

_____________%

Please mark your choice: 3 years 5 years 10 years More than 10 years
Note: If you have indicated less than 10 years, please state when the funds will be needed.

______________ ______________ ______________ ______________

7. My (our) goal for this portfolio(s) is an annual return of: This is based on an expected inflation rate of:

_____________ % _____________ %

8. For each of the following attributes, circle the number that most correctly reflects your level of concern. The more important, the higher the number. You may use each number more than once. Capital preservation Growth Low volatility Inflation protection Current cash flow Aggressive growth Most Important 6 5 4 6 5 4 6 5 4 6 5 4 6 5 4 6 5 4 Least Important 3 2 1 3 2 1 3 2 1 3 2 1 3 2 1 3 2 1

Dresner Financial Planning

2359 Salisbury Rd.

Westbury, NY 11590

tel/fax (516) 357-7466

[email protected]

Page 11 of 16 9. Asset Class Constraints (Optional)

Client Information and Risk Profile Questionnaire Provide Any Asset Class Limitations Min. Max _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____ _____

T-bills, CDs, money market Government bonds Corporate bonds Municipal bonds Foreign bonds High yield bonds Domestic equities S&P500 Domestic equities OTC Foreign equities Real estate 10. What percentage of your investment are you likely to need within five years? 11. Up to what percentage of this portfolio can be invested in long-term investments (i.e., over five years)?

________________ % ________________ %

12. Investment risk means different things to different people. Please rank the following statements from 1 (the statement that would worry you the most) to 4 (the statement that would worry you the least). Most I would be very concerned if I did not achieve the return on my portfolio that I expected (i.e., my target rate of return). I would be very concerned if my portfolio was worth less in real dollars because of inflation erosion. I would be very concerned with short-term volatility (i.e., if my portfolio dropped substantially in value over one year) I would be very concerned with long-term volatility (i.e., if my portfolio dropped in value over a long period of time (i.e., five years and longer). 1 1 1 2 2 2 3 3 3 Least 4 4 4

Dresner Financial Planning

2359 Salisbury Rd.

Westbury, NY 11590

tel/fax (516) 357-7466

[email protected]

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Client Information and Risk Profile Questionnaire

13. Except for the Great Depression, the longest time investors have had to wait after a market crash or significant decline, for their portfolio to return to its earlier value, has been 4 years for stock and 2 years for bond investments. Knowing this, and that its impossible to protect yourself from an occasional loss, answer the following question: If my portfolio produces a long-term return that allows me to accomplish my goals, I am prepared to live with a time to recover of: Less than 1 year Between 1 and 2 years Between 2 and 3 years More than 3 years If you select the first or second option above, are you prepared to substantially reduce your goals? 14. Please check the statement that reflects your preference: I would rather be out of the stock market when it goes down than in the market when it goes up (i.e., I cannot live with the volatility of the stock market). I would rather be in the stock market when it goes down than out of the market when it goes up (i.e., I may not like the idea, but I can live with the volatility of the stock market in order to earn market returns). __________ __________ __________ __________ Y N

__________

__________

15. Several portfolio performance projects are listed below. Assuming that inflation averages 3.5%, check the portfolio that most nearly reflects your goal for your portfolio. Overall Risk Level Low/Low Mod/Low Mod/Low Mod/Low Mod/Mod High/Mod High/Mod High/Mod
*

Expected Compounded Return 6.5% 7.5% 7.7% 8.0% 8.3% 8.5% 9.0% 9.5%

Expected Annual Range of Returns* -2.0% -3.0% -4.0% -4.5% -5.0% -6.0% -7.0% -8.0% To To To To To To To To 13.0% 16.0% 19.0% 20.0% 21.0% 22.0% 24.0% 25.0%

Worst Case ** -4.0% -9.0% -10.0% -11.0% -13.0% -14.0% -20.0% -24.0%

These estimates are based on a statistical measure of one standard deviation. This means that based on the assumptions used in developing these projections, the portfolio returns will fall within these ranges 2 out of every 3 years. ** Worst case is used to describe the worst annual return that a portfolio is likely to experience 90% of the time

Dresner Financial Planning

2359 Salisbury Rd.

Westbury, NY 11590

tel/fax (516) 357-7466

[email protected]

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Client Information and Risk Profile Questionnaire

16. Choose (a) or (b) (a) You win $80,000 (b) You have an 80% chance of winning $100,000 (or a 20% chance of winning nothing). Choose (a) or (b) (a) You lose $80,000 (b) You have an 80% chance of losing $100,000 (or a 20% chance of losing nothing). 17. How do you react to unexpected bad financial news? Always overreact Frequently overreact Rarely overreact Almost never overreact Never overreact 18. Once you have made an investment decision, how sure do you usually feel that your choice was correct? Very unsure Somewhat unsure Somewhat sure Very sure 19. When you think of risk in an investment context, which of the following words comes to your mind first? Danger Uncertainty Opportunity Thrill 20. How easily to you adapt to unfavorable financial changes in your life? Very uneasily Somewhat uneasily Somewhat easily Very easily 21. Have you ever borrowed money in order to make an investment (other than a home mortgage loan)? Y N 22. Compared to other investors, how sophisticated are you about investing money? Very unsophisticated Somewhat unsophisticated Somewhat sophisticated Very sophisticated

Dresner Financial Planning

2359 Salisbury Rd.

Westbury, NY 11590

tel/fax (516) 357-7466

[email protected]

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Client Information and Risk Profile Questionnaire

23. You have just reached the $10,000 plateau on a TV game show. Now you must choose between quitting with the $10,000 in hand or betting the entire $10,000 in one of three alternate scenarios. Choose one: The $10,000 you take the money and run A 50% chance of winning $50,000 A 20% chance of winning $75,000 A 5% chance of winning $100,000 24. How long does it take you to make an important financial decision? Very long time Long time Average amount of time Short time Very short time 25. What degree of risk have you assumed on your investments in the past? Very small Small Medium Large Very large 26. Do you consider yourself reflective or impulsive when making investment decisions? Very reflective Somewhat reflective Neither reflective or impulsive Somewhat impulsive Very impulsive 27. How much investing experience do you have with stocks, bonds or mutual funds? None A Little Some A Fair Amount A Great Deal

Dresner Financial Planning

2359 Salisbury Rd.

Westbury, NY 11590

tel/fax (516) 357-7466

[email protected]

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Client Information and Risk Profile Questionnaire

28. Your investment advisor expects inflation to return and suggests that you invest in hard assets such as real estate and cable TV, which have historically outpaced inflation. Your only financial assets are long-term bonds. What do you do? Ignore the advice and hold onto the bonds Ask your friends and relatives for their advice and do what they suggest Sell the bonds, putting half into hard assets and the other half into money market funds Sell the bonds and put all the proceeds into hard assets Sell the bonds and put all the proceeds into hard assets, and borrow additional money so you can buy even more hard assets 29. How do you rate your willingness to take investment risks in comparison to the general population? Extremely low risk taker Very low risk taker Average risk taker High risk taker Very high risk taker Extremely high risk taker 30. To what extent to you actively follow the markets? None A Little Somewhat Fairly Closely Very Closely 31. How do you obtain your financial information? Please Identify Newspapers Magazines TV/Cable Radio Internet Friends/Relatives ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________

Dresner Financial Planning

2359 Salisbury Rd.

Westbury, NY 11590

tel/fax (516) 357-7466

[email protected]