Personal Review Outline

We strongly advise that you invest your time before you invest your money.  This Personal Review Outline (PRO(st)) presents an opportunity to do so.  The purpose of this review is to assist us in understanding your financial concerns.  By addressing your specific objectives, we can help plan a financial strategy that is tailored to all your needs.

General Information
*Required Fields      
Male Female Married      

*First Name:   *Last:

Spouse's Name:

Social Security Number: If Existing Client, Enter Account Number:
*Your Birthdate:   Your Occupation:
Spouse Birthdate: Spouses Occupation:
Your Employer: Business Telephone:
*Home Street Address:   *Home Telephone:  
City: State: *Zip Code:  
E-mail Address:  
Investment Concerns and Objectives
 
1. What kind of investor are you?
2. What kind of investor are you in regards to your retirement assets?
3. Check any of these items that are of special importance:
Providing for Retirement     Meeting Educational Expenses     Reducing Income Taxes   
Protection Against Disability/Death     Saving for a Major Purchase     Leisure Activities

INCOME:  Dividend and interest income that is paid to you now.
GROWTH: Value of Asset increases over time with little or no current income

Check the box that represents the balance of growth and income that you want to achieve in your portfolio.
100% Growth
0% Income


80% Growth
20% Income


60% Growth
40% Income


40% Growth
60% Income


20% Growth
80% Income


0% Growth
100% Income

Growth     Income

I have not yet established the growth-income ratio best suited to achieve my goals.
For income investments, I prefer

Annual Household Income and Income Taxes
   
Yours Spouse's
$ /yr   $ /yr Earned Income
  /yr     /yr Social Security Benefits
  /yr     /yr Pension and Ret. Plan Income
  /yr     /yr Taxable Interest/Dividends
  /yr     /yr Tax-free Interest
  /yr     /yr Partnership Income (Loss)
  /yr     /yr Income from Self-Employment
  /yr     /yr Other Income

1. Taxable Income Form 1040 Line 38 $
2. If you expect to spend a large sum drawn from your present assets soon,
please estimate amount: $
3. If you expect to receive a large sum soon, please estimate amount: $

Debts (Excluding Mortgages)
       
Margin Loans: $  
Life Insurance Loans:    
Lines of Credit    
Other Debts:    
     
     
     
     
     
       
Please enter mortgages in Real Estate section.
If you now rely on income from securities investments to meet living expenses, how much do you need annually? $
Review of Investments (Excluding IRAs and Keoghs)

Retirement Plan Assets should be entered here.

Do you have a central assets account?
No   Yes, with (Name of Financial Institution)
Taxable Money Market Funds $
Tax-free Money Market Funds $
Checking, Savings, Other Cash Assets $

Certificates of Deposit

Total Holdings $

Amount

Maturity Mon./Year
$
$
$
$
U.S. Treasury Bills

Total Holdings $

Amount

Maturity Mon./Year

$

$

$

$
Stocks
     
Common Stock
Total Market Value $		 Preferred Stock
Total Market Value $		 Utility Stock
Total Market Value $
   
Company Name No. of Shares
Bonds
     
Zero Coupon Municipal Bonds
Total Market Value $		 Mortgaged-Backed Securities
Total Market Value $		 Zero Coupon Government Bonds
Total Market Value $
Other Municipal Bonds
Total Market Value $		 Corporate Bonds
Total Market Value $		 Other Government Bonds
Total Market Value $
     
Issuer No. of Bonds Face Value
Mutual Funds
     
Block Funds
Total Market Value $		 Municipal Bond Funds
Total Market Value $		 Corporate Bond Funds
Total Market Value $
U.S. Government Bond Funds
Total Market Value $		 Other Growth Funds
Total Market Value $		 Other Income Funds
Total Market Value $
     
Issuer No. of Bonds Face Value
Unit Trusts
     
Stock Unit Trusts
Total Market Value $		 Municipal Bond Unit Trusts
Total Market Value $		 Corporate Bond Unit Trusts
Total Market Value $
U.S. Government Unit Trusts
Total Market Value $		 Other Growth Unit Trusts
Total Market Value $		 Other Income Unit Trusts
Total Market Value $
     
Trust Name No. of Units  
 
 
 
 
 
 
 
 
 
 
Limited Partnerships
     
Real Estate
Amount Invested $		 Oil/Gas
Amount Invested $		 Cable TV
Amount Invested $
Other Partnerships
Amount Invested $		    
     
Partnership Name Face Amount $
Partnership Name Face Amount $
Life Insurance
     
List Your Policies List Your Spouses Policies  
  Amt of Death Benefit Cash/Investment Value Amt of Death Benefit Cash/Investment Value
Universal Life $ $ $ $
Variable Life $ $ $ $
Whole Life $ $ $ $
Term Life $ $ $ $
Single prem. Life $ $ $ $
Do you have a will? Yes  No    
If Yes, has it been reviewed recently? Yes  No    
Does spouse have a will? Yes  No    
If Yes, has it been reviewed recently? Yes  No    
Additional Assets
       
Market Value Type of Investment Market Value Type of Investment
$ Futures/Commodities $ Employer Stock Options
$ Listed Puts and Calls $ Deferred Compensation
$ Retirement Plan(s) (non-IRA/Keogh) $ Other Assets
$ Annuities    
  Annuities:
 Fixed  Variable
held in:
 IRA or  Non-IRA		    
Business Interests
     
Description % You Own Mkt. Val. of Your Share
% $
Do you or your spouse plan to sell your business soon? Yes  No

Real Estate

Market Value Mortgage Balance  
$ $ Primary Residence
$ $ Vacation Property
$ $ Investment Properties
Review of IRAs and Keoghs
         
  Your IRA Spouse's IRA Keogh Other (410(k))
Savings/Money Market Funds $ $ $ $
Certificates of Deposit $ $ $ $
Zero Coupon Gov't Bonds $ $ $ $
Other Government Bonds $ $ $ $
Income Funds/Unit Trusts $ $ $ $
Corporate Bonds $ $ $ $
Stocks $ $ $ $
Annuities $ $ $ $
Fixed  Variable        
Other (Income-Oriented) $ $ $ $
Other (Growth-Oriented) $ $ $ $

Retirement Planning

Are you retired now? Yes  No
If No, at what age do you plan to retire?
Is your spouse retired now? Yes  No
If No, at what age does spouse plan to retire?

Educational Funding

List names of individuals for who you plan to provide educational funding.

Name Age Amount Presently Invested
$
$
$
$
$
$
Other Financial Concerns

Are you interested in...

evaluating retirement plan distribution options? Yes  No
providing for children's education? Yes  No
borrowing opportunities (line of credit, home equity loan, etc.)? Yes  No
using the services of a professional money manager Yes  No

Do you...

manage the cash or investments of a business? Yes  No
need guidance in the sale of restricted stock or in the exercise of employer stock options?Yes  No
currently manage, or are you the beneficiary of a trust?Yes  No
want to or have you established a trust? Yes  No

On whom do you rely most for investment advice?
Number in order of importance (i.e. "1" most important, "8" least important).

Financial Consultant Lawyer Financial Planner Myself/Friend
Accountant Banker Insurance Agent Other Broker

Who prepares your tax returns:
   Telephone Number:

Does this person do tax planning for you? Yes  No