Questionnaire - Sylvia Panek - Natural Investments

Help us understand your current financial situation, goals, values, and tolerance for risk. We will use this information to develop your personalized financial and investment advice. You can save your form at any stage and complete it later by clicking the, “Save and Complete Later” link at the bottom of the page.

All information is held in the utmost confidentiality and will not be shared except as authorized by you or required by law.

"*" indicates required fields

I. Personal Information

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address

Same as Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home (Landline) Phone

Marital Status*

Single

Married / Partnered

Divorced

Widowed

Client 1

Name*

First Last

Date of Birth*

Social Security Number

Citizenship(s)*

Cell Phone*

E-mail*

Employment Status*

Employed

Self-Employed

Retired

Homemaker

Not Currently Employed

Employer*

Occupation*

Annual Income*

Actual or Expected Retirement Age*

Business Address*

Same as Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone*

Preferred Mode(s) Of Communication*

Phone

E-Mail

Mail

In Person

Client 2

Add 2nd Client

Name*

First Last

Date Of Birth*

Social Security Number

Citizenship(s)*

Cell Phone*

E-mail*

Employment Status*

Employed

Self-Employed

Retired

Homemaker

Not Currently Employed

Employer*

Occupation*

Annual Income*

Actual Or Expected Retirement Age*

Business Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone*

Preferred Mode(s) Of Communication*

Phone

E-Mail

Mail

In Person

Do You Have Children And/Or IRA Beneficiaries?*

Yes

Beneficiary First Name	Beneficiary Last Name	Actions

There are no Entries.

II. Financial Information

Annual Household Income (all sources)*

Annual Household Expenses*

Approx. Market Value Of Your Home (if Owned)

Mortgage Balance

Total Value Of All Savings & Investments*

Brief Description & Value of Other Assets (Such As Real Estate) And/Or Debts

Accredited Investor Qualification*

Yes

Do you have an individual or joint net worth of over $1 million, not including the value of your primary residence; OR do you have income exceeding $200,000 in each of the two most recent years or joint (with your spouse) income exceeding $300,000 for those years, and a reasonable expectation of exceeding the same income level this year?

Do You Have A Tax Preparer?*

Yes

Tax Preparer First Name*

Tax Preparer Last Name*

Tax Preparer Phone Number*

Tax Preparer E-mail*

III. Investment Information

Current Investment Advisor (if any)

Investment Accounts

Account Type	Approximate Value	Actions

There are no Entries.

What Is The Current Investment Approach For Your Portfolio?*

Very low risk (All bonds)

Low risk (Mostly bonds)

Medium risk (Balanced)

High risk (Mostly stocks)

Very high risk (All stocks)

Specify Which Accounts If Needed

What Changes Would You Like To See In How Your Investments Are Managed?

What Qualities Do You Seek In An Investment Advisory Relationship?

When, & How Much, Do You Expect To Contribute To And/Or Withdraw From Your Investment Accounts?

Please specify which accounts.

Indicate Any Investment Restrictions Or Other Important Information (Aside From Social And Environmental Concerns) That You Wish Us To Take Into Account In Managing Your Portfolio. Unless You Indicate Otherwise, We Assume There Are No Restrictions On Our Services, Other Than To Manage Your Portfolio In Accordance With Your Designated Investment Objectives.

Indicate Your Estimation Of Where You Would Place Your Overall Investment Objectives And Tolerance For Risk (See Key Below).

Conservative: The primary goal of this portfolio is to preserve the value of principal and generate income. The investor is willing to take small risks in order to generate income. This portfolio consists of approximately 80% bonds and 20% stocks.1. Conservative: The primary goal of this portfolio is to preserve the value of principal and generate income. The investor is willing to take small risks in order to generate income. This portfolio consists of approximately 80% bonds and 20% stocks.
Income & Growth: This portfolio emphasizes safety and income, with a secondary goal of growth. The investor is willing to accept short term losses in return for a degree of long term growth. This portfolio is invested in approximately 70% bonds and 30% stocks.
Balanced: This portfolio combines the goals of stability and/or income with capital appreciation. The investor is willing to accept losses for more than one year while seeking a measure of long term growth. This portfolio is comprised of approximately 50% each of stocks and bonds.
Growth: The primary goal of this portfolio is to increase in value over many years, with a secondary focus on stability and generating income. The investor is prepared to incur losses during bear markets, which can last for several consecutive years. This portfolio can experience periods of significant volatility, resulting in meaningful up and down swings in value. It is invested approximately 70% in stocks and 30% in bonds.
Aggressive Growth: The goal of this portfolio is to increase in value over many years through capital appreciation. The investor is prepared to sustain significant losses during bear markets, which can last for several consecutive years. This portfolio can experience periods of extreme volatility, resulting in wide up and down swings in value. It is invested in 80%+ stocks and under 20% bonds.

Additional Comments About Your Personal Or Household Risk Tolerance.

IV. Socially Responsible Investing

Why Are You Interested In Socially Responsible Investing? What Questions Do You Have About It?

Tell Us More About Your Values. What’s Important To You, And Why?

Investment Screening: Natural Investments generally recommends investments that have passed multiple Environmental, Social, and Governance (ESG) screens. When possible and appropriate, we recommend investments that have been selected for their leadership in areas such as renewable energy, gender equality, community development, human rights, corporate accountability, and environmental stewardship.

If, in addition to our rigorous investment screening process, you have any areas of special care or concern in which you wish to seek or avoid investments, please specify them below. We cannot guarantee our ability to customize your portfolio based on these preferences.

Would You Like To Invest More In Higher Risk Sectors Such As Renewable Energy, Resource Efficiency, And Other Emerging Green Sectors Of The Economy?*

Yes

Would You Like To Avoid Investing In Businesses That Are Engaged In Fossil Fuel Exploration, Production, Distribution, And Servicing?*

Yes

No Need

V. Acknowledgement & Signatures

By signing below, I acknowledge that I have answered all questions completely and honestly, and provided an accurate assessment of my personal and financial situation to the best of my knowledge.

I acknowledge that it is my responsibility to promptly inform Natural Investments in writing of any changes in the information I have provided here or my personal or financial situation or investment objectives, or if I would like to add, remove, or modify any reasonable restrictions to the investment advisory services being provided to me.

Past performance is not indicative of future results. Different types of investments involve varying degrees of risk. It should not be assumed that the future performance of any investment or strategy, including the investments and strategies recommended or undertaken by Natural Investments, will be profitable. Therefore, I acknowledge that this questionnaire does not make or imply any guarantee of the attainment of my investment objectives.

My typed name below shall be considered to have the same legal effect as my written signature.

Client 1 Signature*

The name entered shall be considered to have the same legal effect as my written signature.

Date*

Client 2 Signature*

The name entered shall be considered to have the same legal effect as my written signature.

Date*

Comments

This field is for validation purposes and should be left unchanged.

Sound Investments for a prosperous planet

Questionnaire – Sylvia Panek

I. Personal Information

Client 1

Client 2

II. Financial Information

III. Investment Information

IV. Socially Responsible Investing

V. Acknowledgement & Signatures