PlanRock IPQ

Investment Policy Statement - Questionnaire

Please fill out the following Investment Policy Questionnaire per investment account as a new client. Please, also fill out this Investment Policy Questionnaire each time your goals and objective change per investment account. Directions: Please answer each question based on your circumstances, click submit
Account Title*
Type of Account*
Email*
example@example.com
Account Number (Enter NA if new account)*
What is the goal for this Account?*
Please describe the goal as much as possible.
1. What is the time frame for your goal? If you have reached your goal (i.e. in retirement) please answer A.*

A. Less than 3 yearsB. 3 to 5 yearsC. 5 to 9 yearsD. 10 to 14 yearsE. 15 years or more
2. What is your need for growth of principal?*

A. I do not need growth. Safety of principal is more important. (Conservative)B. I need to keep up with inflation over time. (Conservative to Moderate)C. I need growth, but do not care to take too much risk. (Moderate)D. I need growth, I prefer to keep up with or slightly less than the stock market over time. (Moderate to Aggressive)E. I need growth, I prefer to keep up with the stock market over time. (Aggressive)F. I need growth, I prefer to beat the stock market over time. (Aggressive-Speculative)
3. What is your income or dividend needs from your investments (this account)?*

A. Not ImportantB. Important
4. What is your preference for reinvesting or not reinvesting dividends?*

A. Reinvest all dividendsB. Do not reinvest all dividendsC. Only reinvest a portion of my dividends (Please list below the securities you do not want to reinvest dividends)D. I do not have a preference. If you don't have a preference PlanRock will only reinvest dividends if you answered "A" to question 3
5. What is your preference for reinvesting or not reinvesting realized capital gains by mutual funds or ETFs?*

A. Reinvest all realized capital gainsB. Do not reinvest all realized capital gainsC. Only reinvest a portion of my capital gains (Please list below the securities you do not want to reinvest capital gains - Only apply to mutual funds or ETFs)D. I do not have a preference. If you don't have a preference PlanRock will reinvest all capital gains.
6. Select the maximum decline you are willing to accept to reach your goals for growth of principal over time. Upside or downside performance is not guaranteed.*

A. -5% **Example: $100,000 decline to $95,000. (Conservative)B. -10% **Example: $100,000 decline to $90,000. (Conservative to Moderate)C. -20% **Example: $100,000 decline to $80,000. (Moderate)D. -30% **Example: $100,000 decline to $70,000. (Moderate to Aggressive)E. -40% **Example: $100,000 decline to $60,000. (Aggressive)F. -50% **Example: $100,000 decline to $50,000. (Aggressive-Speculative)
7. What is your preference with the following investment instruments?*

A. Individual diversified stocks and/or bonds – Ability to see individual holdingsB. Mutual Funds – Commingled with other investors, actively managedC. ETFs (Exchange Traded Funds) – Traded on an exchange, passively or actively managed, low cost and tax efficientD. No preference – PlanRock will migrate toward ETFs due to their tax efficient and low-cost nature
8. What is your preference with the approach to management of your investments?*

A. Strategic (An approach that sets a target allocation to various asset classes and investment factors. The portfolio is rebalanced back to the target periodically based on market movements in attempt to capture valued added performance over time)B. Tactical (A more active approach that shifts between various asset classes or investment factors based on technical or fundamental factors in attempt to capture value added performance over time.)
9. What is your preference as it relates to your preferred investment strategies? This applies only to your stock or equity portion of your investment portfolio. Your Advisor can help you with this question if necessary.*

A. I have no preference. PlanRock Wealth Strategies will choose High Dividend if there is a need for income, otherwise Multi-Factor Broad Market will be chosen.B. Dividend stock focusC. Multi-Factor Broad Market stock focusD. High Beta Growth Stock focusE. Values Stock focusF. Alternative to Stocks or BondsG. Fixed Income OnlyH. Capital Efficient Equity, Balance or Income (Based on Risk Level)I. Enhanced Tactical Balanced (only moderate and moderate to aggressive)J. Enhanced Permanent Portfolio (Only moderate and moderate to Aggressive)K. Alternative Multi-Asset (Only moderate and moderate aggressive)L. Alternative Hedge Equity (Only moderate to aggressive and aggressive)M. Advisor and client will determine investment strategy
10. What is your preference for domestic investments or global investments?*

A. Domestic Investments OnlyB. Global Investments (Domestic, Developed and Emerging Market Countries)C. I have no preference. (PlanRock Wealth Strategies will choose global investment diversification if appropriate)
11. Please enter any additional notes, instructions, restrictions or preferences below. Enter a cash pad if necessary. **If and when objections change please fill out another Investment policy questionnaire with new guidelines.
13. Based on your objectives above your overall Risk Tolerance is as follows: (The percentage of conservative or fixed income assets will based based on your stated risk tolerance objectives)
14. Who is your PlanRock Wealth Strategies Financial Advisor?
Please date and sign this Investment Policy Statement - Questionnaire below
Date

MonthDayYear
Date
Name

First NameLast Name
Signature

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By placing your name in the Full Name box and/or electronically drawing your signature and pressing submit, you confirm that the answers to the above questions are based your goals and objectives. You also wish to have your investments for this account to be managed accordingly. You also understand that this form is not a guarantee of any results or that your goals and objectives will be met. Past performance does not guarantee future results.
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Investment Policy Statement - Questionnaire

Please date and sign this Investment Policy Statement - Questionnaire below