Questionnaire

QUESTIONNAIRE

Faith Investment Services - Confidential

Our normal process when someone wants an appointment with one of our advisers is to ask for the completion of this questionnaire. This helps you gather everything in one place and get prepared to talk about your situation. Since our consultations are no-cost and no-obligation, this is one way we know that you have "skin in the game" for the appointment. It also helps us to get a big-picture look at your situation so that when you come in or we have a teleconference, we can simply listen to you! That is pretty important to us!

We understand that there may information that you can't or don't want to provide initially. However, this is a very secure process and the more you provide, the better we can help. This can't be saved and continued, but you can fill in part and then come back and fill in the rest in a new questionnaire. We'll put the two submissions together in the background as long as you provide name, birthdate, and email.

PERSONAL INFORMATION

The first part will ask for information about you. Next section is for spouse. Third section is shared contact information. If anything isn't applicable, just leave it blank.

Name:*

First NameLast Name

Birth Date*

MonthDayYear

Social Security Number

please use dashes

Cell Phone Number

Area CodePhone Number

Preferred Email for you*

example@example.com - indicate work or personal

Other Email for you, if applicable

example@example.com - indicate work or personal

Driver's License #, State, and expiration date

License # State Exp Date

Occupation & Employer

Occupation or title Employer

Projected date (or year or age) of retirement

This section is for spouse (if applicable).

Spouse Name:

First NameLast Name

Spouse Birth Date

MonthDayYear

Spouse Social Security Number

please use dashes

Spouse Cell Phone Number

Area CodePhone Number

Preferred Email for spouse

example@example.com - indicate work or personal

Other Email for spouse, if applicable

example@example.com - indicate work or personal

Driver's License #, State, and expiration date for spouse

License # State Exp Date

Spouse Occupation & Employer

Occupation or title Employer

Spouse projected date (or year or age) of retirement

This is household information -- home address, phone, advisers you use, anniversary, etc.

Home Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone Number (if applicable)

Area CodePhone Number

Legal Advisor:

Tax Advisor:

Wedding Anniversary

Date

When we meet together, you may want to bring some of the following items to the first meeting (if applicable):

retirement plan statements
investment account statements
current wills
last year's tax returns
insurance contracts (life, health, disability, long term care, homeowners, automobile, liability, etc.)
group employee booklet

If you want us to look at any of those things in advance, please upload them below.

Do you have any documents you want us to review before meeting:

Upload a File

BENEFICIARIES

BENEFICIARIES (children or significant individuals to whom you might leave an inheritance) You can enter up to 5 here, but others can be entered at the end.

Name:

First NameLast Name

Birth Date

MonthDayYear

Social Security Number

please use dashes

Relationship

Name:

First NameLast Name

Birth Date

MonthDayYear

Social Security Number

please use dashes

Relationship

Name:

First NameLast Name

Birth Date

MonthDayYear

Social Security Number

please use dashes

Relationship

Name:

First NameLast Name

Birth Date

MonthDayYear

Social Security Number

please use dashes

Relationship

Name:

First NameLast Name

Birth Date

MonthDayYear

Social Security Number

please use dashes

Relationship

FINANCIAL INFORMATION

This section asks for income from various sources for your household

Rows	Annual for Client	Annual for Spouse
Salary
Self-Employment
Interest/Dividends
Pensions/Annuities
Social Security
Rental Property (net proceeds)
Alimony
Other

This section asks for assets. This is anything you own such as houses, vehicles, IRAs, bank accounts, etc.

Rows	What it is worth	How much do you owe (include home equity loan if applicable on house)	whose name is it in
Current residence
Other personal home
Vehicle #1
Vehicle #2
Vehicle #3
Business you own
Rental properties
Other

More assets - these generally don't have loans but if you have borrowed against them, please list that in liabities (debts) below.

Rows	What it is worth	whose name is it in
Checking
Savings
CDs
life insurance that has cash value
IRAs
IRAs
Roth IRAs
Roth IRAs
other investments
other investments

This section asks for other liabilities. This is long-term debt that you have that isn't connected to one of your assets. These are things like credit cards with unpaid balances, student loans, co-signing, etc.

Rows	How much do you owe (or have co-signed for)
Credit cards total - DON'T count those you pay in full each month
Loans against insurance or investments
Home Equity LINES (not an actual flat payment Home Equity Loan - but a line that you can "dip into" for short-term borrowing) Put Home Equity Loans with your house above
Student loans you actually are responsible for
Student loans you have co-signed for but hope not to have to repay yourself
Payday loans or money borrowed from family
Other liabilities

Personal values are a reflection of your beliefs. Who a person votes for, how a person worships, and what parents teach their children are all obvious reflections of a person's values. How a person invests their money is just as reflective...

We have the ability to help you invest according to your values and avoid things that are contrary to your values. Before we make any recommendations, we want to know what is important to you. Please answer the brief survey below by marking those areas you would want us to avoid:

ABORTION - This considers companies that manufacture or distribute abortion-causing drugs or contraceptives which can function as an abortion agent, hospitals that perform elective abortions and/or health care plans which cover abortions voluntarily. Other abortion issues considered include corporate contributions to organizations that perform or promote abortions and distributors of contraceptives which can function as an abortion-causing agent.PORNOGRAPHY - This considers companies that manufacture pornography in any format and/or operate adult clubs. Other pornography issues that may cause a company to be excluded include pornography distribution, hosting of pornographic websites, profiting from the sale of pornographic banner ads and advertisers in pornographic magazines.GAMBLING - This considers companies that operate casinos, lotteries and/or manufacture commercial gambling equipment.LESBIAN, GAY, BI-SEXUAL, TRANSGENDER ADVOCACY - This considers companies whose philanthropy, corporate practices, and/or products and services support the advancement of the LGBTQ political agenda. Examples would include companies who provide substantial financial support to radical political organizations such as GLAAD or Human Rights Campaign or which provide employee benefits to homosexual partners of employees when not required to do so by law, or which target advertising specifically to the gay/lesbian media.

Room to add any information (extra beneficiaries, explanation, tax issues you have questions about, etc.)

You can print this before you hit submit if you'd like OR we will gladly print a copy for you and give it to you at your first appointment. Thank you for investing in your financial future! We look forward to meeting with you soon.