Risk Tolerance Questionnaire Form

Risk Tolerance Questionnaire

Thank you for taking the time to answer these questions. The following questions are about your Investment Objectives and Risk Tolerance in order to help our Team at Providence Wealth Management, LLC successfully determine the appropriate strategy for you moving forward based upon your stated goals and objectives.
Name*

First NameLast Name
Email*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth*

MonthDayYear
Advisor Name*
Advisor Email*
example@example.com
1. My primary financial goal is:*

Preserving my assetsLeaving a legacyMaximizing my incomeGrowing my assets
2. When it comes to investments and financial decisions, I consider myself:*

Not very knowledgeableSomewhat knowledgeableKnowledgeableAn expert
3. On the road to retirement, I am:*

Retired, I made it!Less than 5 years away5 to 10 years awayMore than 10 years away
4. My attitude toward investing is:*

A small loss would concern meI understand investing has some risks but I am conservativeI am growth oriented and I understand the market goes up and downI am aggressive and I want to grow my assets. If my investment loses value I may invest more
5. Include all sources, my current household income is:*

Under $50,000$50,000 - $99,999$100,00-$249,000$250,000-$499,000$500,000 or more
6. During retirement, I will rely on investment income:*

HeavilyModeratelySomewhatNot at all
7. Social Security, a pension and some other forms of retirement cash flow are fairly stable income sources. I consider my retirement income sources to be:*

I don't have retirement income sourcesUnstableSomewhat stableVery stable
8. Not including my primary residence, my net worth is:*

Below $250K$250,000 - $499,999$500,000 - $999,999$1,000,000 - $1,999,999Over $2,000,000
9. Historically, inflation averages 2-3 percent per year. Relative to inflation, I would like my investments to:*

Keep pace with inflation with minimal riskModerately outpace inflation with some long-term riskSignificantly outpace inflation with moderate long-term riskMaximize performance with substantial long-term risk
10. If I invested $250,000 for 5 years, I would be most comfortable with the following best and worst case scenario:*

Worst: $270,000 -- Best $300,000Worst: $250,000 -- Best $330,000Worst: $230,000 -- Best $375,000Worst: $200,000 -- Best $450,000
11. If my investments lost 20 percent of its value, I would:*

Immediately sell the investmentChange to a more conservative investment optionStay the courseAdd to the investment while its value is down
Color of Money Risk Score:
Digital Signature*
Date*

MonthDayYear
Date
Risk Capacity: Quick Assessment Tool

For Internal Use Only
1. What is the client's investment time horizon for the majority of these assets?

Less than 5 years5-10 yearsMore than 10 years
2. How would a 30% market decline impact the client's financial situation?

Severe impact - would significantly compromise essential spending needsModerate impact - would require adjustments to discretionary spendingMinimal impact - sufficient reserves and flexibility to weather the decline
3. How would you characterize the client's financial flexibility?

Limited flexibility - high fixed expenses relative to total resourcesModerate flexibility - balanced mix of fixed and discretionary expensesHigh flexibility - significant discretionary expenses that could be reduced if needed
4. How would you characterize the client's earning capacity or income stability?

Limited or declining earning capacity/fixed incomeModerate earning capacity/relatively stable incomeStrong earning capacity/very stable or growing income
5. How would you assess the client's overall financial resources relative to their needs?

Resources barely meet or may fall short of long-term needsResources are adequate to meet projected needsResources significantly exceed projected needs
6. Does the client have additional financial resources or safety nets beyond this portfolio?

Few or no additional resourcesSome additional resources (pensions, other assets, family support)Substantial additional resources (significant other assets, strong family support, etc.)
Color of Money Risk Score (from above)
Based on client inputs
Risk Capacity Indicator Score
Based on advisor inputs
Directional Risk Capacity Indicator*
Prepopulated by score (Low: <11, Average: 11-14, High: >14), but you may override
Additional Risk Capacity Notes
Please enter any supporting notes, especially if you are overriding the automatically-generated result.
Date

MonthDayYear
Date
Phone Number
OLD FIELDFormat: (000) 000-0000.
Should be Empty:

Risk Tolerance Questionnaire

Risk Capacity: Quick Assessment Tool