Managed Account Application

and Investor Profile Questionnaire

The-Adviser.com

Our Reputation is Never for Sale

100% UNBIASED

100% OBJECTIVE

100% INDEPENDENT

100% CONFIDENTIAL

AMERICA’S INDEPENDENT-ADVISER

1-800-ADVISER

Follow our easy instructions.

STEP 1 / Complete Application and Questionnaire
Our Managed Account Application is designed into several easy to-fill out sections:
Terms of ServiceThis document describes our services and acts as our engagement letter
BackgroundYou provide information such as name, age, children, plans and goals
RetirementYou provide retirement goals and objectives
Risk ProfileWe use this section to help determine your risk level.
HoldingsWe use this section to review your current investment holdings.
Note
Quicken & Microsoft Money users can attach a printout of your net worth & portfolio holding report. You can provide original or copies of your last brokerage and retirement holdings. With delivery of your investment statement, The-Adviser.com will return all original information.
STEP 2 / Review
Please double-check your application and questionnaire to ensure that it is filled out to the best of your knowledge. Remember - all information is confidential and will never be sold to any third parties. We only use it to enable your Financial Adviser to suggest an investment strategy and to provide specific-buy-sell-hold recommendations.
STEP 3 / Send
Your completed application can be sent to
The Independent Adviser Corporation
9 Willets Avenue
Syosset NY 11791
Fax to 516-682-8295.
From the time we receive your application, we have a target turnaround time of 24 Hours. If you have any questions relating to the status of your account, at any time, please contact our account department at .
Personal Section
First name
Middle initial
Last name
Social security number / Information is used
Birth date / for security
Mother’s maiden name / purposes
Street address
City
State
Zip Code
Telephone number
E-mail address
Current occupation / The-Adviser.com does not
Current annual salary / sell, distribute or give any
Years at present job / information to any third parties

First Name______

Last Name______

Street Address______

City and State______

Zip Code______

Telephone Number______

Current occupation______

Current annual salary______

Years at present job______

Total years worked at all jobs______

Family Information

Are you married, engaged or have a relationship with someone that you are planning to support through retirement? If no, skip this question. If yes, indicate the following:

Spouse’s First Name ______

Spouse’s Last Name ______

Spouse’ occupation ______

Spouse’ current annual salary ______

Years at present job ______

Total years worked at all jobs ______

Do you have any children? If no, skip this question. If yes, indicate the following,

How many children do you have?______

How many of them are between 1 month and 5 years old ? ______

How many of them are between 5 years and 15 years old? ______

How many of them are between 15 years and 21 years old? ______

How many of them are older than 21?______

Will you provide support for your children’s education? ______

Describe eventuating family situations (i.e., grandchildren you support, live in mother, etc.)

______

______

______

______

Financial Planning Objective

Indicate the following relative importance of each of the following:

Short Term Long Term

Very Important Important Not Very Important Important Not

I like to save regularly

I like to minimize my personal tax rate

I like to make gifts to charity

I like to make gifts to relatives

Investment Strategies

Indicate the following relative importance of each of the following:

Short Term Long Term

Very Important Important Not Very Important Important Not

I like dividends or interest to spend

or reinvest

I like the ability to quickly convert my

investments into liquid cash

I like capital appreciation over the long term

I like my investments safe with little or no danger

of losing my principal

I like my investments to minimize tax

I like to make riskier investments in hopes of

obtaining higher than average returns

Short Term Goals

Describe short term goals in order of priority (1 to 3 years) (i.e., Purchase of house, car, etc.)

______

______

______

______

______

Describe long term goals in order of priority (i.e., Purchase of house, save for kid’s college, etc..)

______

______

______

______

Retirement Planning Section

YouSpouse (Other)

Indicate yearly contribution in $ to 401(K) plan

Indicate total yearly savings except for 401(k) plan

Indicate amount in $ of any pensions you will receive

Indicate amount of $ in tax-deferred annuities, if any

Do you know how much social security benefits you will

receive? If so, indicate yearly amount in $

Will you move to another place upon retirement?

Describe short term goals in order of priority (1 to 3 years) (i.e., Purchase of house, car, etc.)

______

______

______

Describe long term goals in order of priority (i.e., Purchase of house, save for kid’s college, etc..)

______

______

______

Other Information (see instructions or attach other information as you like)

______

______

______

Key Retirement Questions

Expected retirement age______

Desired retirement age______

Do you plan to work part time when retired? ______

What do you plan to do when retired? (travel, fish, buy vacation home, etc..)

______

______

______

______

Real Estate Section

Do you own a home? ______

Value of home______

Will you sell your home to

fund retirement? ______

Other information (see instructions or attach other information as you like)

______

______

______

Business Section

Do you own a business? ______

Value of business if sold today______

INVESTMENT SECTIONS (See Instructions And Or Attach Recent Account Statements

List Market Value Of Current Investments

Bonds______

Stocks______

Mutual Funds______

Bank Deposits______

Annuities______

Trusts______

Emergency Funds______

Total Value______

List Approximate % Allocation Of Investments

Us Or Domestic______

International______

Must Equal 100%

Approximate % Allocation Of Investments

High Risk______

Growth______

Income______

Index Funds______

High Risk______

Must Equal 100%

Indicate whether or not you believe the following?

My current investments are too aggressive

I should have earned more money in the current market than I have?

I previously made investment decisions because a friend recommended them to me?

Are you participating in the following programs?

Dependent care account

Medical Deferral tax accont