First Name
Last Name
Phone Number (work)
 1. What is your age?
 Over 65
 51 - 65
 41 - 50
 31 - 40
 30 and under
 2. What is your annual household income (before tax)?
 Less than $50,000
 $50,001 - $100,000
 $100,001 - $150,000
 Over $150,000
 3. Your investment time horizon is ...
 Less than 3 years
 3-5 years
 5-10 years
 10+ years
 
 4. Currently your main objective for this investment account is to ...
 Maintain the purchasing power of your original investment
 Generate regular cash flow to meet ongoing expenses
 Grow your account and draw regular income from the account
 Grow your account and not draw any income from the account
 Aggressively grow your account to maximize its value
 
 5. The following best describes my need for current income from investments...
 I require a high amount of current income
 I require some current income
 I require a modest degree of current income (interest plus dividends)
 I do not require any current income
 
 6. Even though I feel growth investments have the highest potential for returns  over the long-term,    I still prefer lower, predictable returns.
 Strongly agree
 Agree
 Neutral
 Disagree
 Strongly disagree
 
 7. Given your financial goals, how much volatility are you willing to assume to  achieve your  portfolio’s expected return?
 Low volatility, since you require positive returns each year
 Low to medium volatility, such as negative returns in 1 of every 8 years
 Medium volatility, such as negative returns in 1 of every 6 years
 Medium to high volatility, such as negative returns in 1 of every 5 years
 High volatility, such as negative returns in 1 of every 4 years
 
 8. How much temporary decline in your investment portfolio could you tolerate  over a one-year  period?
 0%
 -5%
 -10%
 -15%
 More than -15%
 9. Which of the following statements best describes your reaction if the value  of your portfolio  suddenly declined by 15%?
 I would be very concerned because I cannot accept fluctuations in the value of  my portfolio
 I invest for long-term growth but would be concerned about even a temporary  decline
 If the amount of income I received was unaffected, it would not bother me
 I invest for long-term growth and accept temporary changes due to market  fluctuation
 10. Assuming that your portfolio decreased in value over a one year period,  consistent with other  investments of its kind in a year when markets are  performing poorly overall, you decide to ...
 Cut your losses, sell your investments and hold cash or purchase GICs with  your entire account  balance
 Hold on to half of your account as it is invested, and sell the other half to hold  cash or purchase GICs
 Watch the portfolio, and if performance does not improve in 6 months, you will  reassess the situation
 Hold the portfolio and make no changes, you understand that markets can  have a number of  consecutive poorly performing years
 Invest additional money in the markets to take advantage of lower current cost
 11. What do you expect the overall average return on your investment portfolio  to be over the  long term, before tax and inflation?
 0% - 2%
 1% - 3%
 4% - 7%
 5% - 9%
 More than 9%
 12. If you could increase your chances of improving your investment returns  by taking more risk,  would you ...
 Be unlikely to take more risk.
 Be willing to take a little more risk with some of your overall portfolio
 Be willing to take a lot more risk with some of your overall portfolio
 Be willing to take a lot more risk with your entire portfolio
 13. Choose a scenario that best describes the way you monitor investments.
 I look forward to reviewing my portfolio on a daily basis
 I make it a point to review my portfolio regularly and at least once a month
 I review my portfolio on a quarterly basis
 I only review my portfolio once a year
 14. Now is a great time to invest in the market.
 Strongly disagree
 Disagree
 Neutral
 Agree
 Strongly agree
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  Contact Information  
Polson Bourbonniere Financial
100 - 7050 Woodbine Ave.
Markham, Ontario L3R 4G8
Tel: 416.498.6181 or 905.413.7700
Toll Free: 1.800.263.0120
Fax: 905.305.0885

info@pbfinancial.com


 
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