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672 Ridge Hill Drive, Suite A1New Braunfels, TX 78130
Phone: (830) 609-6986Fax: (830) 620-1203www.ciswealth.com
ConfidentialPersonal & Financial
Profile
Just as you would interview us for a long-term relationship, we will evaluate the information you provide to determine how our services fit your needs and objectives. For our existing client's benefit, we will accept only a limited number of new clients so that we can continue to provide the highest level of service possible for everyone. Therefore we will require a completed confidential profile prior to an in-office appointment.
03082007
Securities offered through Girard Securities, Inc.Member FINRA,SIPC
Investment Advisory Services offered through Christian Investment Advisors,
a registered investment advisor not affiliated with Girard Securites, Inc.
FAMILY INFORMATION:
Nick Name AgeYour Legal Name Birthdate Social Security #
Spouse's Legal Name Nick Name BirthdateAge Social Security #
Residence Address StateCity Zip Code
StateMailing Address (If different than above) City Zip Code
E-mail AddressCell #Home Phone #
Website OtherPrintReferred By:
1.)
3.)
2.)
4.)
OCCUPATION:
Your Job Title Work Phone # Retirement Date# of YearsEmployer (last, if retired)
Spouse's Job Title Work Phone # Retirement Date# of YearsEmployer (last, if retired)
Your Employment Address
Spouse's Employment Address
Page 1
Your Drivers License Number * Expiration Date Spouse's Drivers License Number* Expiration Date
Children/Beneficiary's Information : **Please attach a separate sheet for additional children or beneficiaries
Legal Name Birth Date Social Security #
Legal Name Birth Date Social Security #
Legal Name Birth Date Social Security #
Legal Name Birth Date Social Security #
Dependent ? Yes No
Dependent ? Yes No
Dependent ? Yes No
Dependent ? Yes No
Are you a U.S. citizen? Yes No Is your spouse a U.S. citizen? Yes No
This comprehensive, personal planning summary is designed to help you take inventory and assign realistic values to your personal assets and liabilities. It is the essential first step in organizing a sensible plan for your future.
Confidential Personal Profile For CIS Wealth Management Group
StateCity Zip Code
StateCity
5.)
Legal Name Birth Date Social Security #Dependent ? Yes No
6.)
Legal Name Birth Date Social Security #Dependent ? Yes No
Relation:
Relation:
Relation:
Relation:
Relation:
Relation:
Spouse's Cell #
*Please provide a photocopy *Please provide a photocopy
Spouse's Email
How did you hear about CIS?
Anniversary Date
Please check your preferred contact method
Zip Code
Page 2
(Please list an investment only one time)Investments & Assets
Value Of Traditional IRAs:
Value Of Roth IRAs:Value Of 401ks w/Current Employer:
Value Of 403bs:Value Of SEP & SIMPLE IRAs:
Value Of Pension Plans:
Value Of Vacation Homes:
Value Of Personal Home:
Value Of Businesses Owned:
Total Estimated Family Investments & Assets:
You: Spouse:
Total:
You: Spouse:
Total:
Value Of Fixed Annuities:
Value Of Mutual Funds:Value Of Stocks: (not in Brokerage)
Value Of Bonds:Value Of CDs:
Value Of REITs:
Value Of Money Markets:
Value Of Limited Partnerships:
Value Of 529/Education IRAs:Value Of Hedge Funds:
Joint:
QUALIFIED RETIREMENT PLAN INVESTMENTS & ASSETS (IRA, 401(k), 403(b))
NON-RETIREMENT INVESTMENTS & ASSETS (Not in any type of IRA or account listed above)
Value Of Other Retirement Plans:
Value Of Land/Investment Real Estate:Value Of Rental Properties:
Value Of Collectibles, Gold, Coins, etc:
Value Of Other Assets:__________________
Value Of Brokerage Accounts:
Value Of Variable Annuities:
Trust/Other:
Value Of Fixed Index Annuities:
Value Of Managed Futures:
Value Of Savings:
Value Of Energy (Oil & Gas):
Value Of Other Investments:
OTHER INVESTMENTS & ASSETS
Value Of Other Business Investments:
Owned by:
Value Of 401ks w/Former Employer(s):
Total:
Value Of Life Ins. Cash Value:
Value Of Automobiles:
(Please list equity only, i.e. after loans are paid off)
Total Automobile Debt:
Total Credit Card Debt:
Personal Loans:
Total Mortgage Debt:
Business Loans:Other:
SHORT TERM & LONG TERM
Family Liabilities
Estimated Total Liabilities:
Estimated Total Assets:(From previous page)
Estimated Total Net Worth:
INCOME
Earned Income
Investment Income
Social Security
Total
EXPENSES
Monthly Annually
Your Income Your Spouse's Income
Monthly Annually
Please give approximate total monthly expenses
[Fixed] Taxes, mortgage, property insurance, property taxes, utilities, phone and cable, car payments, auto insurance, life & health insurance premiums...
[Variable] Food, tithe/giving, transportation, gas, entertainment, clothing, medical expenses (doctor, dentist, prescriptions), auto and home maintenance, miscellaneous items...
Family Income & Expenses Statement
Page 3
Estimated Fixed:
Estimated Variable:
Estimated Total:
Pension Income
(Please list all income sources)
Examples:
Other: ____________
GENERAL:
UncertainAre you anticipating any major lifestyle changes?
(i.e., marriage, divorce, retirement, moving, etc.)
Yes No
If so, what changes are you expecting?UncertainNoYesAre you comfortable with your current cash flow?
Do you anticipate any significant changes in your cash flow?
Do you anticipate any major expenditures in the near future?
UncertainYes No
UncertainYes NoIf so, what expenditures are you expecting?
RETIREMENT PLANNING:
At what age would you like to be able to retire?What minimum income do you need (in today's dollars)?
NoYesAre you covered by any company retirement plans?Type of company pension plan?
PROTECTION:
ESTATE PLANNING:
NoYesDo you have updated/adequate wills?Have you established any trusts? Yes No
UncertainNoAre you the beneficiary of any trusts? YesUncertainNoYesWill you be receiving a significant inheritance?
UncertainYes NoUncertainHave you provided adequate estate liquidity for your heirs? NoYes
Page 4
UncertainUncertain
Are you or a member of your immediate family employed by a bank, insurance company, investment advisor or broker/dealer? Yes No
If Yes. Name: Name of Firm:
Have you or a member of your immediate family been a corporate officer, director or owner of 10% or more of any public corporation within the past three months? Yes No
If Yes. Name: Corporation:
Miscellaneous
UncertainDo you have any potential health problems?
Do you have Disability Insurance?
Do you have Long Term Care Insurance?
Yes No
Yes UncertainNoUncertainYes No
Uncertain
Do you have an emergency fund (money set aside in savings)?
NoYes
UncertainNoYes
Yes No
Uncertain
Do you have life insurance?
Are you currently retired? NoYes
Do you have Health Insurance?
Concerns & Objectives
Uncertain
If yes, estimate amount.Have you taken estate taxes into consideration?
If not, at what age do you expect to retire?
Besides term, which carries no cash value, what is the total cash surrender value of all your permanent policies?
When were your life insurance policies issued?
Type of insurance? Check all that apply: Term Whole Universal Variable Universal
Total death benefit amount of all policies?
Life Insurance:
You: Spouse:
You: Spouse:
Page 5
Name:_________________________________________ Date:______________
Date:Signature:
Please list any industry, sector, social or company specific restrictions that you would like to restrict on your accounts. CIS will work diligently to help you to fulfill this request whenever possible:
Common Restrictions Examples:
Aerospace & DefenseBeverages - BrewersBeverages - Wineries & DistilleriesElectronic Gaming & MultimediaGamblingResorts & Casinos
List Others: (Industry or Stock Name/Ticker)
Date:Signature:
BiotechnologyDrug Manufacturers - MajorDrug Manufacturers - Specialty & GenericPharmaceutical RetailersTobaccoInternet Content & Information
A complete list of industries is available upon request.
Page 6
Personal and Moral Investment Restrictions
Low Risk High RiskTolerance Tolerance
Rate your overall risk tolerance levelon a scale of 1 to 10 6 7 8 101 2 3 94 5
Investment Experience Which types of investments have you owned and how many years experience investing?
Stocks
Bonds
Mutual Funds
Annuities
Margin
Options
Partnerships
Other Please explain
(Number of years)
(Number of years)
(Number of years)
(Number of years)
(Number of years)
(Number of years)
(Number of years)
Investment Experience
Page 7
Expected overall rate of return annually net of exp enses___________%
ADVISORS: Do you have a preferenceor a commitmentto this advisor?
Current Financial Advisor's Name Firm Name City/State
Attorney's Name Firm Name City/State
Accountant's Name Firm Name City/State
Firm NameInsurance Agent's Name City/State
Yes No
Yes No
Yes No
Yes No
City/State
Yes No
Present Family Advisors
Banker's Name Primary Bank Name
Document Checklist; Items to Bring to Your Initial Appointment
From Your RecordsBank Checking, Savings, CDs, & IRA Statements
Broker or Mutual Fund Latest monthly or quarterly statements
Annuities Latest monthly or quarterly statements and copy of policy/contract
Insurance Latest premium notice or annual statement, life insurance policy description in-force illustration for cash value-life insurance, long term care policy description, Employer Pay stubs, pension plan description, statement of 401(k) and/or other benefits
Personal files Monthly budgets, 2 years of tax returns, trust documents and other estate planning documents
Neither Girard Securities, Inc. nor Christian Investment Advisors nor its representatives offer tax or legal advice. Please consult your tax or legal professional before taking any action.
Risk Tolerance