| 1. Name: |
(First)
(Last)
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| 2. Title: |
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| 3. Name of firm or d/b/a, if appropriate: |
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| 4. Office address: |
(Street)
(City)
(State)
(Zip) |
| 5. Email address: |
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| 5a. Web site address (if any): |
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| 6. Office phone: |
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| 7. Date of birth: |
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8. Please list—in order of importance—no more than three specialty areas you yourself practice within financial planning (examples: retirement planning, trust planning, planning for women, etc.):
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9. In what year and in what capacity did you first become a professional wealth advisor?
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10. Please list any professional designations and leadership positions you hold within the financial planning and/or investment management industry, as well as any books or papers you have published (please exclude magazine or newspaper articles in which you are cited as a source).
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11. Have you or your firm (if it consists of 10 or fewer offices) ever been the subject of a complaint to, or investigation by, any regulatory or industry agency not listed above? If the answer is yes, please provide details, including the agency, its city and state, nature of complaint, date and outcome.
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12. Please describe your and your firm’s primary services (e.g. investment advisor, comprehensive financial planner, tax planner, etc.).
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| 13. If you manage client assets, what is the total dollar amount of assets under management at your firm? |
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| 14. What is the size of your median account under management? |
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| Under discretionary management? |
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| 15. What is the minimum amount in investable assets someone must have before you will personally take them on as a client? |
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| 16. What is the current net worth of your own median client, including real estate? |
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| 17. What is the largest net worth, including real estate, of any of the clients for whom you are the primary advisor? |
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| 18. Have you or your firm filed for bankruptcy within the past 10 years? |
Yes
No
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If the answer is yes, please provide us with a full explanation, including any details or mitigating circumstances.
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| 19. Have you or your firm (if it consists of 10 or fewer offices) ever been the defendant in a lawsuit or arbitration proceeding arising out of the business? |
Yes
No
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If the answer is yes, please provide details, including the name of the parties, the court or forum, the date, the docket number, and the outcome.
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20. How did the performance of a recommended portfolio compare to the larger market in 2007?
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