Just like when you go to a physician for either a 'check-up' or with an ailment, you can expect a series of questions / analysis.

Planning and analyzing your financial future is not that much different.

It is not necessary to spend a lot of time digging through your records or providing us exact figures.

Just answer the questions to the best of your ability.

This will give us a better idea as to your current needs and future goals.


Financial & Suitability Profile

Contact Information:
Zip Code:   
Home Phone:   
Work Phone: 
Your Age:        Spouse's Age:
Number of children:   Number of grandchildren: 

Your Philosophies on Money Management, Taxes & Financial Planning:
Which best describes your overall activity in the past 12 months?

Which best describes your overall attitude towards investing and risk?  
I am generally willing to accept:

 Wide price fluctuations in return for maximum long-term gains
 Moderate price fluctuations for conservative gains
 Virtually no price fluctuations for a guarantee of principal and income

What is your employment status? 

Your Occupation: 
Your Spouse:     
Desired Age of Retirement: 
Your Spouse:               

Gross household income last year? 

My Federal Tax Bracket is: 
My State Tax Bracket is:   

General awareness level of stock/bond market activites: 

Do you own mutual funds?   Yes    No  

If yes, do you spend or reinvest the earnings?   Spend    Reinvest

I reallocate my portfolio:  time(s) per year.

Your favorite money managers are:   

Which investment newsletters/periodicals do you subscribe to: 

What type of investments do you generally prefer:

Are you contributing to Qualified Retirement Plan?  Yes    No 
If so, what type: 

You are accustomed to average returns on your investments of:

Who do you rely upon for financial input or advice? 
Your primary concerns are: 
Asset Protection & Estate Planning Information:
Do you have a Will?   Yes    No   
Do you have a Living Trust?   Yes    No 
Do you have a Long Term Care Policy?   Yes    No

Do you have a Disability Insurance Policy?   Yes    No
Have you established a Uniform Gift to Minors Trust?   Yes    No
Do you have an Irrevocable Trust?   Yes    No

Do you have a Family Limited Partnership?   Yes    No
Are you an income beneficiary of a family trust?   Yes    No
Are you currently gifting?   Yes    No

Do you have a handicapped family member?   Yes    No
Are you working with an estate planning specialist or attorney?   Yes    No    
Are you in a second or third marriage?   Yes    No

Do you have children from a previous marriage?   Yes    No
Do you own life insurance?   Yes    No	

My health is: 
My spouse's health is: 
Assets / Current Holdings:
Residence  $ 
Other real estate interests  $ 

Non-Tax Qualified Assets (Non IRA)
Annuities  $ 
Liquid Assets  $ 
Mutual Funds  $ 
Stocks  $ 
Bonds  $ 
Other  $ 
Tax-Qualified Assets (IRA, 401k, Pension)
Annuities  $ 
Liquid Assets  $ 
Mutual Funds  $ 
Stocks  $ 
Bonds  $ 
Other  $ 
Business Interests  $ 
Personal Property (Collectibles, art, coins, etc.)  $ 
Life Insurance total cash value  $ 
Other  $ 
Estimated gross estate value  $ 
Liabilities (mortgages, notes, etc.)  $ 
Net Estate Value  $ 

Additional Comments/Questions:








Copyright 1998 Fielder Financial Management, Ltd.
All Rights Reserved.

Securities offered through Fortune Financial Services, Inc. member FINRA, SIPC.  Fielder Financial Management, Ltd. not affiliated with Fortune Financial Services, Inc.  Mark Fielder, Financial Professional, CA. Insurance Lic. # 0690576.