"Your Best Interest" Financial Services Inc. Asset Allocation Questionnaire

Please take a few minutes of your time to help us to determine the best asset mix for your retirement plan.

Please Enter Your Name   What is your current age? Younger Than 45 45 to 55 55 to 65 65 to 75 Older than 75   When do you expect to start drawing income? Not for at least 20 years In 10 to 20 years In 5 to 10 years Not now, but within 5 years Immediately   What is your goal for this investment? To grow aggressively (gain with regards to losses) To grow significantly(grow a lot) To grow with caution To grow moderately To avoid losing money   Assuming normal market conditions, what would you expect from this investment over time? To generally keep pace with the stock market To slightly trail the stock market, but make a good profit To trail the stock market, but make a moderate profit To have some stability, but make modest profits To have a high degree of stability, but make small profits   Suppose the stock market performs unusually poorly over the next decade, what would you expect from this investment? To lose money To make very little or nothing To eke out a little gain To make a modest gain To be little affected by what happens in the stock market   Which of these statements would best describe your attitudes about the next three years? I don't mind if I lose money I can tolerate a loss (it bothers you but tolerable) I can tolerate a small loss I'd have a hard time tolerating any losses I need to see at least a little return   Which of these statements would best describe your attitude about the next three months' performance of this investment? Who cares? One calendar quarter means nothing I wouldn't worry about losses in that time frame If I suffered a loss of greater than 10%, I'd get concerned I can only tolerate small short-term losses I'd have a hard time stomaching any losses   Please Enter Your Date of Birth mm/dd/yyyy   What is your Companies' Matching Rules (if they match)? i.e. 50% of first 3% of pay   What is your Annual Salary?   What is your Contribution amount (as a percentage or dollar amount)?   In what year or at what age do you expect to retire?   Is there any additional Information we should know