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IPS Intake Form

0

"*" indicates required fields

Type of Portfolio*

Individual / Family

Trust / Organization

How many investors is this IPS for?*

Investor 1

Name*

First Last

Email*

Phone*

Address*

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

Investor 2

Name

First Last

Email

Phone

Address

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

Investor 3

Name

First Last

Email

Phone

Address

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

Investor 4

Name

First Last

Email

Phone

Address

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

Other Parties

Should anyone else receive a copy of this IPS?

Tax Advisor

Attorney

Other

Tax Advisor

Firm Name

Name

First Last

Email

Phone

Address

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

Attorney

Firm Name

Name

First Last

Email

Phone

Address

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

Other

Relation

Firm Name

Name

First Last

Email

Phone

Address

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

Account Information

Enter all accounts about which this IPS will be concerned.

How many accounts need to be entered?

Account 1

Account Title*

Account Number

Custodian

Approx Value

Account 2

Account Title

Account Number

Custodian

Approx Value

Account 3

Account Title

Account Number

Custodian

Approx Value

Account 4

Account Title

Account Number

Custodian

Approx Value

Who will be able to make decisions for this portfolio?

Name

Role or Capacity

Name

Role or Capacity

Notes

Decision Making Process

Any single authorized decision maker may act alone, without limitation

Decisions are authorized only when a majority of the decision makers approve

All authorized decision makers must agree unanimously in order to direct future policy.

Other

If you have identified more than one decision maker above, in what combination are they authorized to make decisions?

Investment Objectives

Primary Objective

Is there a specific investment return goal for your portfolio?

Yes

Desired rate of return

Desired rate of return above inflation

Rate of Return > CPI

Time Horizon

What is your investment time horizon? This refers to the number of years you expect the portfolio to be invested before substantial withdrawals will be made from the portfolio.

When will distributions be required from this portfolio?

Withdrawals are not expected to be needed from this portfolio any time soon

Withdrawals will begin immediately

Withdrawals will be needed in the forseeable future

Withdraws will be made every

Month

Quarter

6 months

Year

Withdrawals will be needed to begin in approximately

3 years

5 years

10 years

More than 10 years

Other

For immediate withdrawals, how will the annualized amount of those be calculated?

Fixed amount

As a percentage of the portfolio

Annual withdrawal amount

Percentage of portfolio withdrawal

How often with the withdrawal be recalculated?

End of the prior year

Beginning of each current year

Other

Risk Tolerance

Conservative

Moderately Conservative

Moderate

Moderately Aggressive

Aggressive

Riskalyze Risk Number

Six Month Return Range

Asset Allocation

*The top level (Fixed Income, Equity, Alternative/Sector Investments) should total 100%
*The sub-asset class should total the amount of each primary asset class

Fixed Income

Short Term Bonds

Intermediate Term Bonds

Equity

Domestic Multi Cap Core

International Multi Cap Core

International Emerging Markets

Alternative/Sector Investments

Real Estate Securities/REITs

Commodities/Natural Resources

Investment Objectives and Circumstances

Please describe your investments goals/objectives for this protfolio and any circumstances which should be taken into consideration

The investor has ranked among the broad possibilities

Safety/Capital Preservation (without respect to inflation)
Capital Preservation (adjusted for inflation)
Growth
Liquidity
Current Income
Other (please explain)

Notes

Tax Considerations

Do you pay federal or state income taxes?

Yes

No

What is your top marginal federal tax bracket?

What is your top marginal state tax bracket?

What tax considerations should be kept in mind in managing this portfolio?

The portfolio is entirely tax deferred or tax free

Client has tax loss carry-forwards which can be utilized to reduce future taxes

Client would like this portfolio to be managed to minimize taxes

Other

Other details

Describe how the portfolio will be managed to improve it's tax efficiency

Investment Policy Items

Cash Holdings

No minimum liquidity needs (cash is handled separately)

A minimum percentage of the portfolio should be in cash

A minimum amount needs to be held in cash

Minimum dollar amount in cash

Minimum percentage of portfolio in cash

For how long do these need to apply?

Do you want to impose any portfolio restrictions or constraints?

Yes

No

Details

Describe any socially responsible concerns or other issues that you would like to see reflected in this portfolio

How often should the IPS be revisited?

Annually

Every two years

Every three years

Every four years

Every five years

How frequently would you like to meet to discuss these investments?

Weekly

Monthly

Quarterly

Semi-Annually

Annually

Never

Comments

Comments

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

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307 Main St, Frisco, CO 80443
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