Suitability Questionnaire

CLIENT PROFILE QUESTIONNAIRE

Investment Advisers are required by law to act in the best interest of their clients and to determine the suitability of their service based on the financial needs, investment experience, and financial objectives and risk tolerance of their clients.
Accordingly, we request that you provide us with the following confidential information that will only be used by Islamorada Investment Management (IIM).

CLIENT PROFILE

Your Full Name

YOUR FINANCIAL SITUATION

Current Annual Income:

Your approximate annual household income is:

Less than $30,000$30,000 to $75,000$75,000 to $150,000Over $150,000

Tax Bracket

0% to 15%15% to 30%Over 30%

Net Worth:

Your approximate household net worth excluding your primary residence is:

Less than $50,000$50,000 to $250,000$250,000 to $500,000$500,000 to $1,000,000Over $1,000,000

YOUR INCOME REQUIREMENTS

Are you dependent on this account to meet any current income requirements?

YesNo

When do you need to start receiving income from your investments?

Now2 - 5 years from now5 - 10 years from nowMore than 10 years from now

What is your current income requirement from this portfolio?

0% - 2%2% - 4%More than 4% and I realize that my principal will most likely be affected

YOUR INVESTMENT EXPERIENCE

Investment History:

Have you ever invested in the following:

CD's, Money Market, or Fixed AnnuitiesDomestic Stocks or Stock FundsInternational Stocks or Stock FundsBonds or Bond FundsVariable Annuities or other Insurance ProductsOptions, Commodities, Futures, etc.Precious Metals or CollectiblesReal Estate or Oil/Gas Limited Partnerships

Investment Activity:

To what extent do you follow the markets?

Not at allSomewhatVery Closely

YOUR INVESTMENT OBJECTIVES

Based on your overall financial goals, which of the following best describes your investment:

Capital Appreciation: Maximize long-term returns while accepting the likelihood of short- term losses in my account. Recommended minimum is over five years.Capital Appreciation plus some Income: Accept some market risk but cushion losses in market declines. Recommended minimum investment period is over five years.Current Income: Generate current income while limiting losses to principal. Recommended minimum investment period is three to five years.Capital Preservation: Preserve capital while seeking growth at a rate equal to inflation. Recommended minimum investment period is three to five years.

RISK TOLERANCE

Given your tolerance for risk and understanding that investments fluctuate in value, which of the following statements would best describe your reaction if the value of your portfolio were to decline by 5% - 10% over a short period of time:

Extremely Concerned: I cannot accept even temporary loss of principal. But I recognize the need for my investments to grow. I am willing to sacrifice higher returns and liquidity in exchange for safety of principal.Concerned: But I recognize that short-term losses are a normal investment risk, and I can tolerate one or two quarters of negative returns.Somewhat Concerned: But I am more interested in my total return over a three to five year period.Not Concerned: I am primarily interested in achieving my long-term investment goals.

Where would you rate yourself on this scale:

1 - Minimize losses and I am willing to take less return5 - A balanced investment mix with fluctuations and growth of assets10 - Maximum accumulation of assets regardless of short term fluctuations

Check the box that you feel best describes you:

I would rather accept a lower rate of return than subject my investment to short-term volatility.I invest for long-term growth, but would be concerned about a temporary decline.I invest for long-term growth and understand that there are changes due to market fluctuations.I am willing to accept some day-to-day fluctuations in the value of my investment in exchange for a higher potential return over the long run.I am a growth oriented long-term investor seeking a maximum return on my investments.If the amount of my income I received were unaffected, it would not bother me to see fluctuations.

TIME HORIZON

What is the shortest length of time you are able to commit to investing these assets without liquidating a substantial portion (buying a house, college education, starting a business)? Historically, the longer the time horizon, the more predictable the overall return becomes since short-term fluctuations tend to cancel each other out. (Note: If you are planning for retirement at 65 and you are 55, your time horizon would include 20 years in retirement for a total of 30 years.)

0 - 3 years: IIM services are probably not suitable for you, and IIM may not agree to provide service.3 - 5 years5 - 10 yearsMore than 10 years

Purpose of Investment:

My primary financial goals for investments managed by IIM

Emergency Savings: Money that would be needed for the first six months of living expenses in an emergency. (If the funds invested with IIM would be needed for this purpose, our services are probably not suitable for you.)Home PurchaseEducation FundingDependent CareRetirementNursing Home CareLong Term Accumulation

PORTFOLIO RESTRICTIONS:

Are there any restrictions for your portfolio?

YesNo

I have read the above and understand the long-term nature of Islamorada Investment Management and accounts they manage. I acknowledge that, while in no way am I legally bound for any time period, and that I can terminate the investment management services at any time, I can reasonably expect to keep assets under management for a period of at least 3 - 5 years in order to realize the full benefits of the service.

 

Furthermore, I affirm that the information furnished herein is materially correct and may be relied upon by Islamorada Investment Management in making any investment recommendation. To the extent that I do not furnish the foregoing information, IIM is relieved of its obligation to consider such information in its determination of investment suitability. I agree to notify IIM of any material change in my personal situation or financial needs. I acknowledge and understand that any statements of financial goals or objectives by me does not make or imply any guarantee by Islamorada Investment Management as to the attainment of such goals or objectives.

 

I RECOGNIZE THAT THIS IS A LONG-TERM INVESTMENT PROGRAM AND IS NOT SUITABLE AS A SHORT-TERM TRADING VEHICLE

Digital Signature of Client

Date:

Draw Signature

Second Digital Signature if Joint Tenant

Date:

Draw Signature