Broker Check

Portfolio Review Form (Code)


Your Name*:
[text* your-name]
[text your-age 5/]
[select retired "Yes" "No"]

[text address]
[text city 15/]
[text state 4/]
Zip/Postal Code:
[text zip 10/]

Telephone #
([text areacode 3/])[text prefix 3/]-[text lastfour 4/]
Email Address*:
[email* email-336]

Your Employer:
[text employer]
Company Address:
[text companyaddress]
[text position]

Spouse or Partner's Name:
[text spousename]
[text spouseage 5/]

[text spousecompany]
Company Address:
[text spousecompanyaddy]
[text spouseposition]

Telephone #
([text spouseareacode 3/])[text spouseprefix 3/]-[text spouselastfour 4/]
Email Address:
[email spouseemail]


[text child1]
[text child1-age 5/]
[text child2]
[text child2-age 5/]

[text child3]
[text child3-age 5/]
[text child4]
[text child4-age 5/]

ANNUAL HOUSEHOLD INCOME (please check one):

[radio annualincome "$0 to $100,000" "$100,001 to $200,000" "$200,001 to $500,000" "$500,001 to $1,000,000" "$1,000,001 to $5,000,000" "Over $5,000,000"]


[radio networth "$0 to $100,000" "$100,001 to $250,000" "$200,001 to $500,000" "$500,001 to $1,000,000" "$1,000,001 to $5,000,000" "$5,000,001 to $10,000,000" "$10,000,001 to $25,000,000""Over$25,000,000"]


Which of the following objectives are most important to you? (Please rank the examples below 1-8, 1 being the most important)

[select principal include_blank "1" "2" "3" "4" "5" "6" "7" "8"] Protecting original principal
[select taxes include_blank "1" "2" "3" "4" "5" "6" "7" "8"] Avoiding taxes (capital gains & estate taxes)
[select wealth include_blank "1" "2" "3" "4" "5" "6" "7" "8"] Accumulating wealth to fund financial independence at age [text wealthage 3/]
[select income include_blank "1" "2" "3" "4" "5" "6" "7" "8"] Providing income for current lifestyle
[select assets include_blank "1" "2" "3" "4" "5" "6" "7" "8"]  Accumulating assets for a child’s education who is now age [text assetage 3/]
[select estate include_blank "1" "2" "3" "4" "5" "6" "7" "8"]  Maximizing Estate for benefit of heirs and other beneficiaries
[select giving include_blank "1" "2" "3" "4" "5" "6" "7" "8"] Maximizing charitable giving
[select anothergoal include_blank "1" "2" "3" "4" "5" "6" "7" "8"]  Accumulating wealth for another financial goal in [text anotheryears 3/]years. (explain below)


Which of the below listed services would you consider valuable for Elm Tree Capital or our trusted partners to provide to you as a client?

[checkbox servicesdesired "Financial Planning" "Investment Management" "Estate Planning" "Insurance Analysis & Recommendation" "Trust Services" "Tax Planning & Preparation" "Charitable Gift Planning" "Personal Bookkeeping/Bill Paying" "Business Brokerage"]


Investment Knowledge:
 [select investmentknowledge "None  ‪" "Limited  ‪" "Moderate  ‪" "Extensive"]

How many years have you been investing for?
[text yearsinvesting 10/]

Do you consider yourself a Long Term or Short Term investor?
[select longshort "Long Term" "Short Term"]

How do you make your investment decisions? Check all that apply

[checkbox investmentdecisions "I closely watch the markets and consult various resources" "I like watching the market, but it takes too much time and effort" "I invest for the long-term and check my portfolio infrequently" "I work with a Financial Advisor or Broker who helps make the decisions" "I do not have an interest or the time to make investment decisions"]

Describe your relationship with your Financial Advisor (“FA”).  Check all that apply

[checkbox advisorrelationship "I do not have an FA, but am looking for one" "I do not have an FA and would not use one" "I do not have an FA, but am interested in seeing how one can help with my financial situation" "I have a favorable relationship with my FA and plan to work with him or her for years to come" "I have a favorable relationship with my FA, but want to diversify some of my assets with another FA " "I have a poor relationship with my Financial Advisor" "I am only interested in a fee-based Financial Planner and will handle the investments myself"]

How would you like Elm Tree Capital LLC to help you with your portfolio?  Check all that apply

[checkbox needhelp "I need help improving my investment returns" "I do not have the time to monitor my portfolio" "I need to use my portfolio to supplement my income" "I understand that my portfolio deserves constant attention, but I do not want to spend the time monitoring it" "I generally am nervous with my portfolio and don’t want to deal with the anxiety of looking at it" "I uncomfortable with the market volatility and dynamics and want a professional to manage it for me" "I am not sure what I need for investment returns and guidance on establishing an effective investment strategy"]


Which profile do you fit (please select one)

Conservative: I am more concerned with capital preservation than keeping up with or exceeding the average rate of inflation. I understand the potential likelihood that my portfolio’s purchasing power may erode over the long-term due to its inability to match or exceed the average rate of inflation.

Moderate: I prefer a blend of current income and growth of my principal. I understand this may entail volatility and potential loss of principal, but has a greater likelihood of outperforming the average rate of inflation over the long-term.

Aggressive: I want growth of my principal to support my retirement years. I understand that the pursuit of greater growth may entail a greater potential loss of principal.

ESTATE PLANNING:  Check Yes , No or NA for each

I have a will?
[select mywill "Yes" "No" "N/A"]
My spouse or partner?
[select spousewill "Yes" "No" "N/A"]

I have a trust?
[select mytrust "Yes" "No" "N/A"]
My spouse or partner?
[select spousetrust "Yes" "No" "N/A"]

I have a Durable Power of Attorney?
[select mypoweratty "Yes" "No" "N/A"]
My spouse or partner?
[select spousepoweratty "Yes" "No" "N/A"]
I have a Health Care Proxy?
[select myhealthproxy "Yes" "No" "N/A"]
My spouse or partner?
[select spousehealthproxy "Yes" "No" "N/A"]
I have a Living Will?
[select mylivingwill "Yes" "No" "N/A"]
My spouse or partner?
[select spouselivingwill "Yes" "No" "N/A"]

When did you last draft these documents?
Enter year:
[text estateplanningyear 4/]

INSURANCE PLANNING:  Check all that apply

[checkbox insuranceplanning "I have performed an insurance analysis." "I have Term Insurance " "I have Permanent Insurance (i.e. Whole Life, Universal Life, Variable Universal Life)" "I have Long-Term Care Insurance"]

PROFESSIONAL ADVISORS:  Check all that apply

[checkbox myadvisors "I have an Accountant or CPA" "I have an Estate Planning Attorney" "I have a Financial Advisor or Broker" "I have a fee-only Financial Planner" "I have an Insurance Advisor" "My Account/CPA is also my Financial Advisor/Financial Planner"]

Please let us know if you have any other questions or comments:

[textarea comments 100/10]

For security purposes, please enter the verification number you see to the right of the box: [captchar captcha-518 10/][captchac captcha-518]

Please note, the form will not submit until all required fields are complete. Fields marked with an * are required. Incomplete fields will be highlighted in red.

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