Investment Analysis Inventory Date / /
Name (1) / / - -
Full Name Age Birthdate Social Security #
Name (2) / / - -
Address (1)
Street Number City State Zip Code
Address (2)
Home Phone (1) ( ) - Home Phone (2) ( ) -
Work Phone (1) ( ) - Work Phone (2) ( ) -
Occupation (1) Occupation (2)
Employer (1) Employer (2)
Salary (1) $ Salary (2) $
Investment Parameters
I. Investment Purpose (Check one.)
_____ Retirement _____ Child's Education
_____ Build Cash Reserves _____ Build Investment Portfolio
_____ Start a Business _____ Buy a Vacation Home
_____ Reduce Taxes _____ Other (Please specify.)
II. Investment Objective (Prioritize 1, 2, 3....)
_____ Current Income (cash-generating, high-dividend-paying stocks and bonds)
_____ Growth (long-term capital appreciation)
_____ Safety of Principal (stability)
_____ Safety of Principal/Income (protection of investment plus income)
_____ Safety of Principal/Growth (protection of investment plus growth)
_____ Speculation (high risk of loss in exchange for exceptional returns)
_____ Other (Describe.)
III. Time Frame (How long will it be until this money will actually be spent?)
_____ Two years or less _____ Two to five years
_____ Five to ten years _____ Ten years or more
IV. Risk/Return (Check the statement that best describes your expectations.)
_____ Average returns of 5% per year or less and no loss of principal
_____ Average annual returns of 5-7% but with occasional losses of 5-10%
_____ Average annual returns of 7-10% but with occasional losses of 10-20%
_____ Average annual returns of 10-20% but with occasional losses of 20-30%
_____ Average annual returns of more than 20% but with potential loss of 50% or more
Name Date / /
Ability to Invest Assessment This instrument is designed to provide some indication of your ability to actually
"invest" money, in contrast to savings accounts or CDs. Please circle the number in the box with best applies to
each category (row) and total the numbers below to tabulate your score.
__________________________________________________________________________________________
Age Over 70 60-70 50-60 Under 50
1 2 3 4
__________________________________________________________________________________________
Annual 0-25,000 25,000- 50,000- 75,000+
Income 50,000 75,000
1 2 3 4
__________________________________________________________________________________________
Net Worth 0-50,000 50,000- 150,000- 250,000+
150,000 250,000
1 2 3 4
__________________________________________________________________________________________
Time Frame < 2 years 2-3 years 3-5 years 5+ years
(How long will the 1 2 3 4
money be invested?)
__________________________________________________________________________________________
Consumer Debt 50,000+ 25,000- 10,000- <10,000
(Do not include 50,000 25,000
mortgage.) 1 2 3 4
__________________________________________________________________________________________
Percent of pay < 4% 4%-10% 10%-15% 15%+
pay saved annually 1 2 3 4
__________________________________________________________________________________________
Current Liquid None 0-1000 1000-5000 5000+
Cash Reserves 1 2 3 4
__________________________________________________________________________________________
Years with < 1 year 1-5 years 5-10 years 10+ years
Current Employer 1 2 3 4
__________________________________________________________________________________________
Previous Invest- None Some A Great Deal
ment Experience 1 2 3
__________________________________________________________________________________________
_____ Total Score (Add the circled numbers from each category.)
9 - 18 points Low Ability
19 - 27 points Average Ability
28 - 35 points High Ability
Signature (1) Date / /
Signature (2) Date / /