PERSONAL WEALTH QUESTIONNAIRE · PDF file• Financial statements from ... 8 Personal wealth questionnaire PLANNING CONCERNS AND OBJECTIVES All planning should begin and end with your

PERSONAL WE ALT H QUES T IONNA IRE

2 Personal wealth questionnaire

The Personal Wealth Analysis represents a comprehensive picture of your current wealth planning circumstances and provides suggestions for improvement. It begins with the Personal Wealth Questionnaire.

Please complete the Questionnaire as fully as possible. Information is the lifeblood of the planning process. The quality and range of the suggestions will only be as good as the comprehensiveness of the picture; with more knowledge about you and your family, your objectives and resources, and your charitable commitments, we are better equipped to offer recommendations for fulfilling these objectives in as appropriate and tax efficient a manner as possible.

There are no “shortcuts” to completing the Questionnaire. But you may choose to give summary or total amounts where indicated (e.g., the lines for “Total Income” and “Total Expenses” in the Cash Flow Information section). And you may elect only to number a few priorities in the various sections, which ask about objectives (e.g., the section on Estate and Charitable Planning Information).

Personal wealth questionnaire 3

To help us construct the most accurate representation, please submit copies of the following with this Questionnaire:• Your previous year’s tax return• Your Will and Living Trust, if any• Financial statements from brokerage firms and banks• Benefit statements concerning your retirement plans

If you have not already done so, please provide a biographical outline for you and your family, highlighting:• Information about your family origins (parents and grandparents)• Influential factors in growing up• Education• Activities• Positions held (vocational and avocational)• Current board memberships (for profit and nonprofit)• Sources of wealth

Once your Personal Wealth Questionnaire has been completed, your Private Wealth Advisor will arrange a meeting to review current circumstances and any proposals.


CLIENT NAME DATE OF BIRTH U.S. CITIZEN? YES NO

SOCIAL SECURITY NUMBER (MANDATORY)

LEAD ACCOUNT NUMBER (TO BE COMPLETED BY FINANCIAL ADVISOR)

ADDRESS

PHONE FAX

E-MAIL ADDRESS

OCCUPATION AND TITLE

BUSINESS ADDRESS

LIFE STATUS SINGLE MARRIED DIVORCED / WIDOWED SIGNIFICANT OTHER

CO-CLIENT NAME DATE OF BIRTH

SOCIAL SECURITY NUMBER U.S. CITIZEN? YES NO

ADDRESS (IF DIFFERENT FROM ABOVE)

PHONE FAX

E-MAIL ADDRESS

OCCUPATION AND TITLE

BUSINESS ADDRESS

PERSONAL INFORMAT ION


NAMES OF CHILDREN DATE OF BIRTH DEPENDENT? STATE OF RESIDENCE EMOTIONAL MATURITY* FINANCIAL MATURITY*

YES NO

YES NO

YES NO

YES NO

NAMES OF GRANDCHIldren DATE OF BIRTH DEPENDENT? STATE OF RESIDENCE EMOTIONAL MATURITY* FINANCIAL MATURITY*

YES NO

YES NO

YES NO

YES NO

Are all family members in good health? YES NO If No, please explain:

Does any family member have a special need? YES NO If Yes, please explain:

Are any family members or relatives (other than co-client and children) dependent on you for support now, or likely to need support in the future? YES NO If Yes, please explain:

Do you have alimony or child support obligations? YES NO If Yes, please explain:

* Please assess the emotional and financial maturity of family members (1 - 5; 1 = lowest, 5 = highest).

FAMILY INFORMAT ION


Do you have any special concerns due to current or prior marriage of a family member? YES NO If Yes, please explain:

While married, have you ever lived In a community property state? YES NO If Yes, which state?

Do your children know the history of your family in significant detail?

Do you regularly engage in discussions about what’s important to your family and about your family’s values?

Do you have a family mission statement?

Have you held or do you hold regular family meetings or retreats?

Are you or is any member of your family in an occupation or profession which is frequently the target of lawsuits?

Do you have adolescent or older children who drive and are listed on your automobile policy?

Do you have a swimming pool at your home (or any of your residences)?

Do you have a home on the ocean (or in a recognized flood plain)?

Do you own real estate (e.g., a second or vacation home) in another part of your state or in another state?

Do you have an office in your home?

Do you employ domestic workers in any capacity?

FAMILY INFORMAT ION (CON T INUED)


Are you planning any major renovation or expansion of your residence?

Do you engage in any hobbies or activities that may cause harm to yourself or to someone else?

Are you on the board of a public company?

Are you on the board of a public charity?

Have you hosted any charitable event in your home in recent months, or do you intend to host any such event?

Do you have a family office?

Do you have an investment partnership; or do you invest directly in your own private equity?

MORGAN STANLEY FINANCIAL ADVISOR BRANCH #

ACCOUNTANT PHONE

ADDRESS

ATTORNEY (TRUSTS & ESTATES) PHONE

ADDRESS

PRIVATE BANKER PHONE

ADDRESS

LIFE INSURANCE AGENT PHONE

ADDRESS

OTHER FINANCIAL ADVISOR PHONE

FIRM

ADVISORS


PLANNING CONCERNS AND OBJEC T IVES

All planning should begin and end with your personal considerations and aims. To help us better understand yours, please number the following in order of their importance to you, with 1 signifying of greatest importance. If several are of equal concern, you may indicate that by giving the same number to those objectives. Likewise, if any are of little or no value to you, simply leave them blank.

Maintaining a comfortable lifestyle through my / our retirement years

Optimizing the use of loans to maximize net worth

Minimizing Income Tax & Capital Gains TaxDiversifying large single stock and stock option positions, or other liquid assets

Generating adequate capital to run and grow my own business

Ensuring that family members with special needs are well cared for

Positioning as many of my assets for my family as I can while minimizing Estate & Gift Tax

Involving my children and grandchildren in philanthropic pursuits

Supporting my interests in and commitments to charitable causes

Beginning or adding to my art collection or dealing with other collectibles

Planning for business succession Creating a legacy that will help to keep my children and grandchildren productive

Protecting my family’s assets from creditors and litigation

Protecting the value of my assets using hedging techniques


ASSE T SUMMARY

Summary Balance Sheet Total Assets: Total Liabilities: Note: You may provide complete statements for all accounts in each of the following areas, in lieu of completing the section, but you must provide the information on ownership (C, S, J, CP).

CASH & CASH EQUIVALENTS (Use The Worksheet On Page 13 To Enter Holdings In A Retirement Account.)

INCLUDING CHECKING, SAVINGS, MONEY MARKET, CDS CLIENT (C) CO-CLIENT JOINT (J) COMMUNITY PROPERTY (CP) MORGAN STANLEY ASSETS*

* Please indicate with a “P” those assets held at Morgan Stanley and any of its affiliates.

STOCKS, BONDS, MUTUAL FUNDS (Use The Worksheet On Page 14 To Enter Holdings In A Retirement Account.)

STOCKS

NAME # SHARES COST BASIS DATE OFACQUISITION

CURRENTVALUE CLIENT (C) CO-CLIENT JOINT (J) COMMUNITY

PROPERTY (CP)MORGAN STANLEY

ASSETS*

BONDS

NAME FACE AMOUNT % COST BASIS DATE OF

ACQUISITIONCURRENT

VALUE CLIENT (C) CO-CLIENT JOINT (J) COMMUNITY PROPERTY (CP)

MORGAN STANLEY ASSETS*



MUTUAL FUNDS

NAME FACE AMOUNT % COST BASIS DATE OF

ACQUISITIONCURRENT

VALUE CLIENT (C) CO-CLIENT JOINT (J) COMMUNITY PROPERTY (CP)

MORGAN STANLEY ASSETS*


STOCKS, BONDS, MUTUAL FUNDS

OTHER PUBLICLY TRADED SECURITIES CLIENT (C) CO-CLIENT JOINT (J) COMMUNITY PROPERTY (CP) MORGAN STANLEY ASSETS*

* Please indicate with a “P” those assets held at Morgan Stanley and any of its affiliates. Note: Is any stock subject to Section 83(b) election? Yes No

STOCK OPTION HOLDINGS (SUBMIT STATEMENTS)

DESCRIPTION OR NAME DATE OF GRANT TYPE OF GRANT NO. OF SHARES EXPIRATION DATE EXERCISE PRICE VESTING

DETAILS

INCENTIVE

NONQUALIFIED

INCENTIVE

NONQUALIFIED

INCENTIVE

NONQUALIFIED

INCENTIVE

NONQUALIFIED

INCENTIVE

NONQUALIFIED

INCENTIVE

NONQUALIFIED

Please detail any legal restrictions (e.g., Rule 144) that apply to your ability to market securities freely.

ASSE T SUMMARY (CON T INUED)


HOMES

PRIMARY HOME MARKET VALUE DATE COST BASIS REMAINING MORTGAGE

OWNER C J

S CP

REVOCABLE TRUST

OTHER

ORIGINAL TERM DATE FIXED % / ADJ RATE % MONTHLY P & I

SECONDARY OR VACATION HOME MARKET VALUE DATE COST BASIS REMAINING MORTGAGE

OWNER C J

S CP

REVOCABLE TRUST

OTHER

ORIGINAL TERM DATE FIXED % / ADJ RATE % MONTHLY P & I

Do you plan to buy or sell any homes in the next 12 months? Yes No

INVESTMENT REAL ESTATE

DESCRIPTION OWNER* MARKET VALUE

REMAINING MORTGAGE INTEREST RATE COST BASIS ANNUAL INCOME CASH EXPENSES WHAT ARE YOUR PLANS

FOR THIS PROPERTY?

C J S O

C J S O

C J S O

C J S O

C J S O

OTHER INVESTMENTS AND ASSETS (SUBMIT STATEMENTS)

Including Partnerships, LLCs, Precious Metals, Futures, Venture Capital, Notes Receivables, Hedge Funds, Privately Held Securities, Exchange Funds, Collectibles and Personal Property

DESCRIPTION OWNER* YEAR PURCHASED COST BASIS ANY REMAINING

INSTALLMENTSCURRENT VALUE IF

KNOWNCURRENT

CASH FLOWANNUAL TAXABLE

INCOME (LOSS) PROJECTION

C J S O

C J S O

C J S O

C J S O

C J S O

* O=Other, e.g., Family Limited Partnership or LLC


CLOSELY HELD BUSINESS INTEREST OR PROFESSIONAL PRACTICE

NAME OF BUSINESS

INDUSTRY / PROFESSION YEAR ESTABLISHED

STRUCTURE (C CORP., S CORP., LLC, PARTNERSHIP)

DO YOU HAVE MORE THAN ONE CLASS OF SHARES OR UNITS?

YES NO EXPLAIN

LENGTH OF OWNERSHIPPERCENTAGE OF OWNERSHIP CLIENT % CO-CLIENT %

NAMES AND RELATIONSHIPS OF OTHER OWNERS

ANNUAL REVENUES

PROFITABILITY?

YES NO

NUMBER OF EMPLOYEES COMPANY DEBT INDICATE AMOUNT PERSONALLY GUARANTEED

DO YOU BORROW PERSONALLY TO SUPPORT THE BUSINESS? YES NO HAVE YOU PLEDGED ANY BUSINESS ASSETS TO BACK BUSINESS PURPOSE LOANS? YES NO

VALUE OF COMPANY OWNED REAL ESTATE COST BASIS OF COMPANY OWNED REAL ESTATE

ESTIMATED VALUE OF BUSINESS HAVE YOU HAD A VALUATION DONE? YES NO IF SO, WHEN?

DO YOU HAVE A BUY-SELL AGREEMENT? YES NO IF SO, IS IT TRIGGERED BY DEATH DISABILITY BOTH

IS THE AGREEMENT FUNDED? YES NO EXPLAIN:

IS THERE A BUSINESS SUCCESSION PLAN? YES NO

DO YOU HAVE KEY EMPLOYEES WHOSE LOSS WOULD BE DETRIMENTAL TO THE CONTINUED PROFITABILITY OF THE BUSINESS? YES NO

IS THE AGREEMENT FUNDED? YES NO IF SO, WITH WHAT TYPE OF INVESTMENT?



PLAN DESCRIPTION

PRESENT VESTED INTEREST

INSURANCEPROCEEDS AT DEATH BENEFICIARY

ANNUAL EMPLOYER CONTRIBUTION

ANNUAL EMPLOYEE CONTRIBUTION HOW INVESTED

PROJECT MONTHLY RETIREMENT INCOME

IRA C $ $ $ $ $

C $ $ $ $ $

C $ $ $ $ $

S $ $ $ $ $

S $ $ $ $ $

S $ $ $ $ $

KEOGH C $ $ $ $ $

S $ $ $ $ $

PENSION C $ $ $ $ $

S $ $ $ $ $

PROFIT SHARING C $ $ $ $ $

S $ $ $ $ $

401(K) C $ $ $ $ $

S $ $ $ $ $

EMPLOYEESTOCK PLANS

C $ $ $ $ $

S $ $ $ $ $

TAX-SHELTEREDANNUITY 403(B)

C $ $ $ $ $

S $ $ $ $ $

NON-QUALIFIED DEFERRED

COMPENSATION

C $ $ $ $ $

S $ $ $ $ $

Is your succession plan to:

Sell business in years?

Pass to family heirs?

Go public?

Do you wish to treat all family members equally?

Leveraged recapitalization?

Other?

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

If so, to whom?

If no, explain:

Explain:

Do you have a company-sponsored retirement plan? YES NO

Please repeat for each business interest. (Attach extra pages, if necessary.)

RETIREMENT PLANS

What level of income (in today’s dollars) do you anticipate needing at retirement? PRE-TAX AFTER-TAX $

After retirement, is your goal to spend down your capital or preserve your wealth for your children and heirs? TOTALLY DEPLETE PARTIALLY DEPLETE PRESERVE

What is your planned retirement age? CLIENT: CO-CLIENT:


ANNUITIES

FIXED POLICY 1 POLICY 2

OWNER(S)

INSURED(S)

BENEFICIARY(IES)

DATE PURCHASED

ORIGINAL PREMIUM

SURRENDER VALUE

FIXED POLICY 1 POLICY 2

OWNER(S)

INSURED(S)

BENEFICIARY(IES)

DATE PURCHASED

ORIGINAL PREMIUM

SURRENDER VALUE

LIFE INSURANCE

LIFE INSURANCE POLICY 1 POLICY 2 POLICY 3

OWNER(S)

INSURED(S)

BENEFICIARY(IES)

DEATH BENEFIT

CASH VALUE

ANNUAL PREMIUM

TYPE OF INSURANCE

DATE PURCHASED

DATE OF LAST POLICY REVIEW

ISSUING INSURANCE COMPANY

DATE POLICY TRANSFERRED TO TRUST, IF APPLICABLE



INDIVIDUAL LONG TERM DISABILITY

Complete the following if Client #1 or Client #2 is insured under an individual long term disability policy.

POLICY 1 POLICY 2

ANNUAL EARNED INCOME

ANNUAL PREMIUM AMOUNT

MONTHLY BENEFIT AMOUNT

POLICY ELIMINATION PERIOD

POLICY BENEFIT PERIOD

COST OF LIVING ADJUSTMENT RIDER


LONG TERM CARE

Complete the following if Client #1 or Client #2 is insured under a long term care insurance policy.

POLICY 1 POLICY 2

NAME OF POLICY OWNER

ANNUAL PREMIUM AMOUNT

DAILY BENEFIT AMOUNT



INFLATION ADJUSTMENT RIDER



GROUP LIFE INSURANCE

Complete the following for each life insurance policy of which Client #1 or Client #2 is the insured. Please specify if the beneficiary is a trustee of an irrevocable life insurance trust.

POLICY 1 POLICY 2

INSURED

BENEFICIARY(IES)

DEATH BENEFIT

CASH VALUE

ANNUAL PREMIUM

TYPE OF INSURANCE


GROUP DISABILITY INSURANCE

Complete the following if Client #1 or Client #2 is covered by group long term disability insurance.

POLICY 1 POLICY 2

MONTHLY PREMIUM AMOUNT

MONTHLY BENEFIT AMOUNT




WHO PAYS THE PREMIUMS? (YOU OR YOUR COMPANY)

OTHER INSURANCE

HEALTH COVERAGE YES NO PROPERTY / CASUALTY YES NO

PERSONAL EXCESS LIABILITY YES NO IF YES, HOW MUCH?



L IAB IL IT IES

MORTGAGE DEBT

PROPERTY TITLE NAME TOTAL DEBT MATURITY LENDER

NOTES PAYABLE AND OTHER NON-MORTGAGE DEBT

(include loans, margin debt, taxes currently due, taxes on assets sold beyond 1 year)

TYPE* CURRENT OUTSTANDING AMOUNT TOTAL CREDIT MATURITY COLLATERAL LENDER

*D= Demand; R=Revolving Credit; T=Term Loan; M=Margin Credit; C=Credit Card; A=Auto; X=Taxes Due; O=Other; P=Promissory


CONTINGENT LIABILITIES

Do you have any outstanding letters of credit or surety bond? YES NO Amount:

Are you a guarantor or endorser of any debt of a third party? YES NO Amount:

Are you contingently liable on any lease or contract? YES NO Amount:

Are there any lawsuits, claims or judgments pending against you (including divorce)? YES NO Amount:

Have any of your debts, debts guaranteed by you or debts of a company or partnership 20% or more owned by you been discharged through bankruptcy or settled for less than the amount owed? YES NO Amount:

Do you have any other contingent liabilities such as “cash calls”? YES NO Amount:

Are any of your tax obligations past due? YES NO Amount:

Is the IRS auditing or contesting any prior tax returns? YES NO Amount:

PLEASE DETAIL YOUR ATTITUDES TOWARDS DEBT AND LIQUIDITY

I dislike debt and want to be debt-free. YES NO

I use loans to take advantage of opportunities. YES NO

I use loans aggressively to maximize my net worth. YES NO

I have sufficient cash reserves for unexpected needs. YES NO

I would sell liquid assets rather than borrow to meet my needs. YES NO

Do you have any upcoming capital needs or large expenses (in the next 12 months)? YES NO How much?:

L IAB I L I T I ES (CON T INUED)


CASH FLOW INFORMAT ION (Please submit most recent tax return)

FEDERAL INCOME TAX BRACKET % STATE INCOME TAX BRACKET % OTHER INCOME TAX BRACKET (E.G., CITY TAXES) %

FILING STATUS SINGLE MARRIED MARRIED, FILING SEPARATELY HEAD OF HOUSEHOLD

Note: If you wish, you may elect to provide totals only for income and expenses. It is preferable, however, to provide as much information as possible for purposes of cash flow analysis.

INCOME PRE-RETIREMENT IN RETIREMENT

CURRENT INCOME

WAGES

INVESTMENT INCOME

BUSINESS INCOME

RENTAL INCOME

OTHER

SOURCES & AMOUNTS OF RETIREMENT INCOME

QUALIFIED PLAN / PENSION INCOME

INVESTMENT INCOME

BUSINESS INCOME

RENTAL INCOME

OTHER

TOTAL INCOME

EXPENSES PRE-RETIREMENT IN RETIREMENT

CURRENT EXPENSES

MORTGAGE(S)

AFTER-TAX LIVING EXPENSES

ANNUAL GIFTING

CHARITABLE GIFTING

RETIREMENT EXPENSES

MORTGAGE(S)

AFTER-TAX LIVING EXPENSES

ANNUAL GIFTING

CHARITABLE GIFTING

TRAVEL

TOTAL EXPENSES

Note: Will there be any extraordinary expense or income item over coming years (e.g., purchase of a luxury boat, redesign of home)? Yes NoIf so, please give approximate amount __________________ and year __________________ .


Do you have a will? YES NO If Yes, when was it last updated?

Who is named as executor / executrix?

Does your will provide for the creation of a trust at your death? YES NO

If so, what type of trust is it? (e.g., credit shelter, marital)

Who is named as trustee? Successor trustee?

If your will includes any specific bequests to an individual or institution other than a co-client, please list the name(s) and amount(s) (and asset(s)).

Do you have a living trust? YES NO If Yes, who is trustee? Successor trustee?

What is type? What is market value?

Are you the income or principal beneficiary of a trust established by someone else? YES NO Explain:

Are you currently gifting to children, grandchildren or other individuals? YES NO If Yes, please list.

ESTATE & CHARITABLE PLANNING INFORMAT ION

DONOR RECIPIENT AMOUNT DATE OF GIFT

Is the gift Outright? in Trust? Have you filed gift tax returns? YES NO If Yes, please include copy.

Do you currently make contributions to charity? YES NO If Yes, amount of annual cash contributions Amount of long term capital gain property


What are your primary objectives in gifting to charity? (please number with 1 being the highest priority)

Provide Current Gift to Charity(ies)

Provide Future Gift to Charity(ies)

Provide Gift to Charity(ies) at Death

Reduce or Postpone Capital Gains Taxes on Assets

Increase Income from Current Assets

Reduce Income Taxes

Provide Income for Children or Others

Reduce Estate Taxes

If income is an objective for you or another family member, as part of your charitable gifting, please prioritize among the following.

Start Income Immediately

Start Income in _________ Years

Start Income at Retirement ( _________ )

Start Income for Parents or Grandparents in ________ Years

Start Income for Co-Client at Donor’s Death

Start Income for Children ____________

Do you have an asset which you would like to gift to family members in the future (at a discount in value), while donating some of the growth and income to charity now? YES NO

If so, do you believe the asset will appreciate significantly in the future? YES NO

Are you interested in involving family members in your charitable giving commitments? YES NO

If Yes, would these commitments amount to a substantial sum? (e.g., over $1,000,000.00) YES NO

Do you have a charitable trust? YES NO

If Yes, what kind of trust is it? If Yes, please include copy.

What is the Fair Market Value? What is the Annuity or Unitrust payout?


NOTES

PWM7025347 2012-PS-358-03/2012 © 2012 Morgan Stanley Private Wealth Management, a division of Morgan Stanley Smith Barney LLC. Member SIPC. 7252204 10/12

Documents

PERSONAL WEALTH QUESTIONNAIRE · PDF file• Financial statements from ... 8 Personal wealth questionnaire PLANNING CONCERNS AND OBJECTIVES All planning should begin and end with your