Profile Questionnaire

Basic Information

Tell us about yourself. If you have a spouse or partner, please include their information as Client B.

Client A

Full Name *

Please enter Client A's name.

Nickname

Birth Date

Client B (if applicable)

Full Name

Nickname

Birth Date

Addresses

Residence Address *

Please enter your residence address.

City *

Required

State *

Required

Zip *

Required

Mailing address is the same as residence

Mailing Address

City

State

Zip

Contact Information

Select which phone and email should be the primary contact for the household.

Client A's Phone Primary phone

Client A's Email *

Please provide an email — we'll send a confirmation when your submission is received.

Primary email

Client B's Phone Primary phone

Client B's Email Primary email

Referral & Assets

How did you hear about us?

Investible asset size

Employment

Client A's Job Title

Employer Full Name

# of Years

Retirement Date

Client B's Job Title

Employer Full Name

# of Years

Retirement Date

Goals & Priorities

Help us understand what you want your wealth to accomplish.

Retirement Goals

Planned retirement age

Desired retirement income

Legacy for heirs

Investment Objectives

What are your major objectives? (select all that apply)

Current and future income Keeping ahead of inflation Preserving capital Increasing return Building wealth

Financial Goal Priorities

Rate each item from 1 (low priority) to 10 (high priority).

GoalLow ← → High

1

2

3

4

5

6

7

8

9

10

Investor Experience & Interests

Your investing background and personal interests help us understand you holistically.

Years of Investing Experience

Stocks

Mutual Funds

Bonds

Variable Annuities

REITs

Options

Fixed Annuities

I expect to start drawing income from this investment:

Not for at least 20 years Not now, but within 15 years In 10–20 years In 5–10 years Immediately

Personal Interests

For each interest, indicate whether it applies to Client A, Client B, or Both.

Risk Profile

Each client should answer separately. Different risk tolerances between partners are common.

Return & Liquidity Expectations

Reasonable rate of return — Client A

Reasonable rate of return — Client B

Short-term cash needed — Client A

Short-term cash needed — Client B

% comfortable with market risk — Client A

% comfortable with market risk — Client B

Risk Tolerance

On a scale of 1 (ultra conservative) to 10 (very aggressive), what is your risk tolerance?

Client A — Risk tolerance

Client B — Risk tolerance

Acceptable Loss

What percentage or dollar amount of your money would you be OK with losing?

Client A

OR

Client B

OR

Family Assets & Liabilities

This comprehensive summary helps you assign realistic values to your personal assets and liabilities. All figures are approximate.

Income & Expenses

Annual Income — Client A

Annual Income — Client B

Social Security / Defined Benefit — Client A

Social Security / Defined Benefit — Client B

Annual Expenses (household)

Qualified Retirement Accounts

Qualified accounts include IRAs, 401(k), SEP, 403(b), Roth IRA, etc.

Institution

Owner

Type

Approx. Value

Total:

$0

Nonqualified Retirement Accounts

Nonqualified accounts include CDs, Annuities, Mutual Funds, Money Markets, Stocks, Bonds, etc.

Institution

Owner

Type

Approx. Value

Total:

$0

Checking, Savings & Money Market (Nonqualified)

Institution

Type of Account

Approx. Value

Residence & Other Real Estate

Property

Description

Amount Owed

Current Value

Primary

Secondary

Other

Insurance

Details on existing life and long-term care coverage.

Life Insurance

Types: Term, Universal Life (UL), Whole Life (WL), Equity Indexed Universal Life (EIUL). Purpose: retirement income, family protection, legacy, etc.

Insured / Carrier

Type

Year

Death Benefit

Premium / Mode

Cash Surrender

Loan Taken

Purpose

Long-Term Care Insurance

Insured

Carrier

Year

Premium

Premium Mode

Elimination Period

Planning & Protection

Your current estate setup, financial situation, and protection coverage.

Estate Planning Documents

General

Protection

Estate Planning

Beneficiaries & Final Questions

List your beneficiaries and share any questions you have for our team.

Beneficiaries

Your information is transmitted over an encrypted connection. Add up to four beneficiaries.

Full Name

Relationship

Birth Date

SSN

Questions for Us

Please list any questions you may have

By submitting, you confirm the information above is accurate to the best of your knowledge. A completed PDF will be sent to C2 Private Wealth.

Welcome to Your Profile Questionnaire

Basic Information

Goals & Priorities

Investor Experience & Interests

Risk Profile

Family Assets & Liabilities

Insurance

Planning & Protection

Beneficiaries & Final Questions

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