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PERSONAL WE ALT H QUES T IONNA IRE
2 Personal wealth questionnaire
The Personal Wealth Analysis represents a comprehensive picture of your current wealth planning circumstances and provides suggestions for improvement. It begins with the Personal Wealth Questionnaire.
Please complete the Questionnaire as fully as possible. Information is the lifeblood of the planning process. The quality and range of the suggestions will only be as good as the comprehensiveness of the picture; with more knowledge about you and your family, your objectives and resources, and your charitable commitments, we are better equipped to offer recommendations for fulfilling these objectives in as appropriate and tax efficient a manner as possible.
There are no “shortcuts” to completing the Questionnaire. But you may choose to give summary or total amounts where indicated (e.g., the lines for “Total Income” and “Total Expenses” in the Cash Flow Information section). And you may elect only to number a few priorities in the various sections, which ask about objectives (e.g., the section on Estate and Charitable Planning Information).
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To help us construct the most accurate representation, please submit copies of the following with this Questionnaire:• Your previous year’s tax return• Your Will and Living Trust, if any• Financial statements from brokerage firms and banks• Benefit statements concerning your retirement plans
If you have not already done so, please provide a biographical outline for you and your family, highlighting:• Information about your family origins (parents and grandparents)• Influential factors in growing up• Education• Activities• Positions held (vocational and avocational)• Current board memberships (for profit and nonprofit)• Sources of wealth
Once your Personal Wealth Questionnaire has been completed, your Private Wealth Advisor will arrange a meeting to review current circumstances and any proposals.
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CLIENT NAME DATE OF BIRTH U.S. CITIZEN? YES NO
SOCIAL SECURITY NUMBER (MANDATORY)
LEAD ACCOUNT NUMBER (TO BE COMPLETED BY FINANCIAL ADVISOR)
ADDRESS
PHONE FAX
E-MAIL ADDRESS
OCCUPATION AND TITLE
BUSINESS ADDRESS
LIFE STATUS SINGLE MARRIED DIVORCED / WIDOWED SIGNIFICANT OTHER
CO-CLIENT NAME DATE OF BIRTH
SOCIAL SECURITY NUMBER U.S. CITIZEN? YES NO
ADDRESS (IF DIFFERENT FROM ABOVE)
PHONE FAX
E-MAIL ADDRESS
OCCUPATION AND TITLE
BUSINESS ADDRESS
PERSONAL INFORMAT ION
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NAMES OF CHILDREN DATE OF BIRTH DEPENDENT? STATE OF RESIDENCE EMOTIONAL MATURITY* FINANCIAL MATURITY*
YES NO
YES NO
YES NO
YES NO
NAMES OF GRANDCHIldren DATE OF BIRTH DEPENDENT? STATE OF RESIDENCE EMOTIONAL MATURITY* FINANCIAL MATURITY*
YES NO
YES NO
YES NO
YES NO
Are all family members in good health? YES NO If No, please explain:
Does any family member have a special need? YES NO If Yes, please explain:
Are any family members or relatives (other than co-client and children) dependent on you for support now, or likely to need support in the future? YES NO If Yes, please explain:
Do you have alimony or child support obligations? YES NO If Yes, please explain:
* Please assess the emotional and financial maturity of family members (1 - 5; 1 = lowest, 5 = highest).
FAMILY INFORMAT ION
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Do you have any special concerns due to current or prior marriage of a family member? YES NO If Yes, please explain:
While married, have you ever lived In a community property state? YES NO If Yes, which state?
Do your children know the history of your family in significant detail?
Do you regularly engage in discussions about what’s important to your family and about your family’s values?
Do you have a family mission statement?
Have you held or do you hold regular family meetings or retreats?
Are you or is any member of your family in an occupation or profession which is frequently the target of lawsuits?
Do you have adolescent or older children who drive and are listed on your automobile policy?
Do you have a swimming pool at your home (or any of your residences)?
Do you have a home on the ocean (or in a recognized flood plain)?
Do you own real estate (e.g., a second or vacation home) in another part of your state or in another state?
Do you have an office in your home?
Do you employ domestic workers in any capacity?
FAMILY INFORMAT ION (CON T INUED)
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Are you planning any major renovation or expansion of your residence?
Do you engage in any hobbies or activities that may cause harm to yourself or to someone else?
Are you on the board of a public company?
Are you on the board of a public charity?
Have you hosted any charitable event in your home in recent months, or do you intend to host any such event?
Do you have a family office?
Do you have an investment partnership; or do you invest directly in your own private equity?
MORGAN STANLEY FINANCIAL ADVISOR BRANCH #
ACCOUNTANT PHONE
ADDRESS
ATTORNEY (TRUSTS & ESTATES) PHONE
ADDRESS
PRIVATE BANKER PHONE
ADDRESS
LIFE INSURANCE AGENT PHONE
ADDRESS
OTHER FINANCIAL ADVISOR PHONE
FIRM
ADVISORS
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PLANNING CONCERNS AND OBJEC T IVES
All planning should begin and end with your personal considerations and aims. To help us better understand yours, please number the following in order of their importance to you, with 1 signifying of greatest importance. If several are of equal concern, you may indicate that by giving the same number to those objectives. Likewise, if any are of little or no value to you, simply leave them blank.
Maintaining a comfortable lifestyle through my / our retirement years
Optimizing the use of loans to maximize net worth
Minimizing Income Tax & Capital Gains TaxDiversifying large single stock and stock option positions, or other liquid assets
Generating adequate capital to run and grow my own business
Ensuring that family members with special needs are well cared for
Positioning as many of my assets for my family as I can while minimizing Estate & Gift Tax
Involving my children and grandchildren in philanthropic pursuits
Supporting my interests in and commitments to charitable causes
Beginning or adding to my art collection or dealing with other collectibles
Planning for business succession Creating a legacy that will help to keep my children and grandchildren productive
Protecting my family’s assets from creditors and litigation
Protecting the value of my assets using hedging techniques
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ASSE T SUMMARY
Summary Balance Sheet Total Assets: Total Liabilities: Note: You may provide complete statements for all accounts in each of the following areas, in lieu of completing the section, but you must provide the information on ownership (C, S, J, CP).
CASH & CASH EQUIVALENTS (Use The Worksheet On Page 13 To Enter Holdings In A Retirement Account.)
INCLUDING CHECKING, SAVINGS, MONEY MARKET, CDS CLIENT (C) CO-CLIENT JOINT (J) COMMUNITY PROPERTY (CP) MORGAN STANLEY ASSETS*
* Please indicate with a “P” those assets held at Morgan Stanley and any of its affiliates.
STOCKS, BONDS, MUTUAL FUNDS (Use The Worksheet On Page 14 To Enter Holdings In A Retirement Account.)
STOCKS
NAME # SHARES COST BASIS DATE OFACQUISITION
CURRENTVALUE CLIENT (C) CO-CLIENT JOINT (J) COMMUNITY
PROPERTY (CP)MORGAN STANLEY
ASSETS*
BONDS
NAME FACE AMOUNT % COST BASIS DATE OF
ACQUISITIONCURRENT
VALUE CLIENT (C) CO-CLIENT JOINT (J) COMMUNITY PROPERTY (CP)
MORGAN STANLEY ASSETS*
* Please indicate with a “P” those assets held at Morgan Stanley and any of its affiliates.
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MUTUAL FUNDS
NAME FACE AMOUNT % COST BASIS DATE OF
ACQUISITIONCURRENT
VALUE CLIENT (C) CO-CLIENT JOINT (J) COMMUNITY PROPERTY (CP)
MORGAN STANLEY ASSETS*
* Please indicate with a “P” those assets held at Morgan Stanley and any of its affiliates.
STOCKS, BONDS, MUTUAL FUNDS
OTHER PUBLICLY TRADED SECURITIES CLIENT (C) CO-CLIENT JOINT (J) COMMUNITY PROPERTY (CP) MORGAN STANLEY ASSETS*
* Please indicate with a “P” those assets held at Morgan Stanley and any of its affiliates. Note: Is any stock subject to Section 83(b) election? Yes No
STOCK OPTION HOLDINGS (SUBMIT STATEMENTS)
DESCRIPTION OR NAME DATE OF GRANT TYPE OF GRANT NO. OF SHARES EXPIRATION DATE EXERCISE PRICE VESTING
DETAILS
INCENTIVE
NONQUALIFIED
INCENTIVE
NONQUALIFIED
INCENTIVE
NONQUALIFIED
INCENTIVE
NONQUALIFIED
INCENTIVE
NONQUALIFIED
INCENTIVE
NONQUALIFIED
Please detail any legal restrictions (e.g., Rule 144) that apply to your ability to market securities freely.
ASSE T SUMMARY (CON T INUED)
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HOMES
PRIMARY HOME MARKET VALUE DATE COST BASIS REMAINING MORTGAGE
OWNER C J
S CP
REVOCABLE TRUST
OTHER
ORIGINAL TERM DATE FIXED % / ADJ RATE % MONTHLY P & I
SECONDARY OR VACATION HOME MARKET VALUE DATE COST BASIS REMAINING MORTGAGE
OWNER C J
S CP
REVOCABLE TRUST
OTHER
ORIGINAL TERM DATE FIXED % / ADJ RATE % MONTHLY P & I
Do you plan to buy or sell any homes in the next 12 months? Yes No
INVESTMENT REAL ESTATE
DESCRIPTION OWNER* MARKET VALUE
REMAINING MORTGAGE INTEREST RATE COST BASIS ANNUAL INCOME CASH EXPENSES WHAT ARE YOUR PLANS
FOR THIS PROPERTY?
C J S O
C J S O
C J S O
C J S O
C J S O
OTHER INVESTMENTS AND ASSETS (SUBMIT STATEMENTS)
Including Partnerships, LLCs, Precious Metals, Futures, Venture Capital, Notes Receivables, Hedge Funds, Privately Held Securities, Exchange Funds, Collectibles and Personal Property
DESCRIPTION OWNER* YEAR PURCHASED COST BASIS ANY REMAINING
INSTALLMENTSCURRENT VALUE IF
KNOWNCURRENT
CASH FLOWANNUAL TAXABLE
INCOME (LOSS) PROJECTION
C J S O
C J S O
C J S O
C J S O
C J S O
* O=Other, e.g., Family Limited Partnership or LLC
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CLOSELY HELD BUSINESS INTEREST OR PROFESSIONAL PRACTICE
NAME OF BUSINESS
INDUSTRY / PROFESSION YEAR ESTABLISHED
STRUCTURE (C CORP., S CORP., LLC, PARTNERSHIP)
DO YOU HAVE MORE THAN ONE CLASS OF SHARES OR UNITS?
YES NO EXPLAIN
LENGTH OF OWNERSHIPPERCENTAGE OF OWNERSHIP CLIENT % CO-CLIENT %
NAMES AND RELATIONSHIPS OF OTHER OWNERS
ANNUAL REVENUES
PROFITABILITY?
YES NO
NUMBER OF EMPLOYEES COMPANY DEBT INDICATE AMOUNT PERSONALLY GUARANTEED
DO YOU BORROW PERSONALLY TO SUPPORT THE BUSINESS? YES NO HAVE YOU PLEDGED ANY BUSINESS ASSETS TO BACK BUSINESS PURPOSE LOANS? YES NO
VALUE OF COMPANY OWNED REAL ESTATE COST BASIS OF COMPANY OWNED REAL ESTATE
ESTIMATED VALUE OF BUSINESS HAVE YOU HAD A VALUATION DONE? YES NO IF SO, WHEN?
DO YOU HAVE A BUY-SELL AGREEMENT? YES NO IF SO, IS IT TRIGGERED BY DEATH DISABILITY BOTH
IS THE AGREEMENT FUNDED? YES NO EXPLAIN:
IS THERE A BUSINESS SUCCESSION PLAN? YES NO
DO YOU HAVE KEY EMPLOYEES WHOSE LOSS WOULD BE DETRIMENTAL TO THE CONTINUED PROFITABILITY OF THE BUSINESS? YES NO
IS THE AGREEMENT FUNDED? YES NO IF SO, WITH WHAT TYPE OF INVESTMENT?
ASSE T SUMMARY (CON T INUED)
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PLAN DESCRIPTION
PRESENT VESTED INTEREST
INSURANCEPROCEEDS AT DEATH BENEFICIARY
ANNUAL EMPLOYER CONTRIBUTION
ANNUAL EMPLOYEE CONTRIBUTION HOW INVESTED
PROJECT MONTHLY RETIREMENT INCOME
IRA C $ $ $ $ $
C $ $ $ $ $
C $ $ $ $ $
S $ $ $ $ $
S $ $ $ $ $
S $ $ $ $ $
KEOGH C $ $ $ $ $
S $ $ $ $ $
PENSION C $ $ $ $ $
S $ $ $ $ $
PROFIT SHARING C $ $ $ $ $
S $ $ $ $ $
401(K) C $ $ $ $ $
S $ $ $ $ $
EMPLOYEESTOCK PLANS
C $ $ $ $ $
S $ $ $ $ $
TAX-SHELTEREDANNUITY 403(B)
C $ $ $ $ $
S $ $ $ $ $
NON-QUALIFIED DEFERRED
COMPENSATION
C $ $ $ $ $
S $ $ $ $ $
Is your succession plan to:
Sell business in years?
Pass to family heirs?
Go public?
Do you wish to treat all family members equally?
Leveraged recapitalization?
Other?
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
If so, to whom?
If no, explain:
Explain:
Do you have a company-sponsored retirement plan? YES NO
Please repeat for each business interest. (Attach extra pages, if necessary.)
RETIREMENT PLANS
What level of income (in today’s dollars) do you anticipate needing at retirement? PRE-TAX AFTER-TAX $
After retirement, is your goal to spend down your capital or preserve your wealth for your children and heirs? TOTALLY DEPLETE PARTIALLY DEPLETE PRESERVE
What is your planned retirement age? CLIENT: CO-CLIENT:
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ANNUITIES
FIXED POLICY 1 POLICY 2
OWNER(S)
INSURED(S)
BENEFICIARY(IES)
DATE PURCHASED
ORIGINAL PREMIUM
SURRENDER VALUE
FIXED POLICY 1 POLICY 2
OWNER(S)
INSURED(S)
BENEFICIARY(IES)
DATE PURCHASED
ORIGINAL PREMIUM
SURRENDER VALUE
LIFE INSURANCE
LIFE INSURANCE POLICY 1 POLICY 2 POLICY 3
OWNER(S)
INSURED(S)
BENEFICIARY(IES)
DEATH BENEFIT
CASH VALUE
ANNUAL PREMIUM
TYPE OF INSURANCE
DATE PURCHASED
DATE OF LAST POLICY REVIEW
ISSUING INSURANCE COMPANY
DATE POLICY TRANSFERRED TO TRUST, IF APPLICABLE
ASSE T SUMMARY (CON T INUED)
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INDIVIDUAL LONG TERM DISABILITY
Complete the following if Client #1 or Client #2 is insured under an individual long term disability policy.
POLICY 1 POLICY 2
ANNUAL EARNED INCOME
ANNUAL PREMIUM AMOUNT
MONTHLY BENEFIT AMOUNT
POLICY ELIMINATION PERIOD
POLICY BENEFIT PERIOD
COST OF LIVING ADJUSTMENT RIDER
ISSUING INSURANCE COMPANY
LONG TERM CARE
Complete the following if Client #1 or Client #2 is insured under a long term care insurance policy.
POLICY 1 POLICY 2
NAME OF POLICY OWNER
ANNUAL PREMIUM AMOUNT
DAILY BENEFIT AMOUNT
POLICY ELIMINATION PERIOD
POLICY BENEFIT PERIOD
INFLATION ADJUSTMENT RIDER
ISSUING INSURANCE COMPANY
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GROUP LIFE INSURANCE
Complete the following for each life insurance policy of which Client #1 or Client #2 is the insured. Please specify if the beneficiary is a trustee of an irrevocable life insurance trust.
POLICY 1 POLICY 2
INSURED
BENEFICIARY(IES)
DEATH BENEFIT
CASH VALUE
ANNUAL PREMIUM
TYPE OF INSURANCE
ISSUING INSURANCE COMPANY
GROUP DISABILITY INSURANCE
Complete the following if Client #1 or Client #2 is covered by group long term disability insurance.
POLICY 1 POLICY 2
MONTHLY PREMIUM AMOUNT
MONTHLY BENEFIT AMOUNT
POLICY ELIMINATION PERIOD
POLICY BENEFIT PERIOD
ISSUING INSURANCE COMPANY
WHO PAYS THE PREMIUMS? (YOU OR YOUR COMPANY)
OTHER INSURANCE
HEALTH COVERAGE YES NO PROPERTY / CASUALTY YES NO
PERSONAL EXCESS LIABILITY YES NO IF YES, HOW MUCH?
ASSE T SUMMARY (CON T INUED)
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L IAB IL IT IES
MORTGAGE DEBT
PROPERTY TITLE NAME TOTAL DEBT MATURITY LENDER
NOTES PAYABLE AND OTHER NON-MORTGAGE DEBT
(include loans, margin debt, taxes currently due, taxes on assets sold beyond 1 year)
TYPE* CURRENT OUTSTANDING AMOUNT TOTAL CREDIT MATURITY COLLATERAL LENDER
*D= Demand; R=Revolving Credit; T=Term Loan; M=Margin Credit; C=Credit Card; A=Auto; X=Taxes Due; O=Other; P=Promissory
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CONTINGENT LIABILITIES
Do you have any outstanding letters of credit or surety bond? YES NO Amount:
Are you a guarantor or endorser of any debt of a third party? YES NO Amount:
Are you contingently liable on any lease or contract? YES NO Amount:
Are there any lawsuits, claims or judgments pending against you (including divorce)? YES NO Amount:
Have any of your debts, debts guaranteed by you or debts of a company or partnership 20% or more owned by you been discharged through bankruptcy or settled for less than the amount owed? YES NO Amount:
Do you have any other contingent liabilities such as “cash calls”? YES NO Amount:
Are any of your tax obligations past due? YES NO Amount:
Is the IRS auditing or contesting any prior tax returns? YES NO Amount:
PLEASE DETAIL YOUR ATTITUDES TOWARDS DEBT AND LIQUIDITY
I dislike debt and want to be debt-free. YES NO
I use loans to take advantage of opportunities. YES NO
I use loans aggressively to maximize my net worth. YES NO
I have sufficient cash reserves for unexpected needs. YES NO
I would sell liquid assets rather than borrow to meet my needs. YES NO
Do you have any upcoming capital needs or large expenses (in the next 12 months)? YES NO How much?:
L IAB I L I T I ES (CON T INUED)
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CASH FLOW INFORMAT ION (Please submit most recent tax return)
FEDERAL INCOME TAX BRACKET % STATE INCOME TAX BRACKET % OTHER INCOME TAX BRACKET (E.G., CITY TAXES) %
FILING STATUS SINGLE MARRIED MARRIED, FILING SEPARATELY HEAD OF HOUSEHOLD
Note: If you wish, you may elect to provide totals only for income and expenses. It is preferable, however, to provide as much information as possible for purposes of cash flow analysis.
INCOME PRE-RETIREMENT IN RETIREMENT
CURRENT INCOME
WAGES
INVESTMENT INCOME
BUSINESS INCOME
RENTAL INCOME
OTHER
SOURCES & AMOUNTS OF RETIREMENT INCOME
QUALIFIED PLAN / PENSION INCOME
INVESTMENT INCOME
BUSINESS INCOME
RENTAL INCOME
OTHER
TOTAL INCOME
EXPENSES PRE-RETIREMENT IN RETIREMENT
CURRENT EXPENSES
MORTGAGE(S)
AFTER-TAX LIVING EXPENSES
ANNUAL GIFTING
CHARITABLE GIFTING
RETIREMENT EXPENSES
MORTGAGE(S)
AFTER-TAX LIVING EXPENSES
ANNUAL GIFTING
CHARITABLE GIFTING
TRAVEL
TOTAL EXPENSES
Note: Will there be any extraordinary expense or income item over coming years (e.g., purchase of a luxury boat, redesign of home)? Yes NoIf so, please give approximate amount __________________ and year __________________ .
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Do you have a will? YES NO If Yes, when was it last updated?
Who is named as executor / executrix?
Does your will provide for the creation of a trust at your death? YES NO
If so, what type of trust is it? (e.g., credit shelter, marital)
Who is named as trustee? Successor trustee?
If your will includes any specific bequests to an individual or institution other than a co-client, please list the name(s) and amount(s) (and asset(s)).
Do you have a living trust? YES NO If Yes, who is trustee? Successor trustee?
What is type? What is market value?
Are you the income or principal beneficiary of a trust established by someone else? YES NO Explain:
Are you currently gifting to children, grandchildren or other individuals? YES NO If Yes, please list.
ESTATE & CHARITABLE PLANNING INFORMAT ION
DONOR RECIPIENT AMOUNT DATE OF GIFT
Is the gift Outright? in Trust? Have you filed gift tax returns? YES NO If Yes, please include copy.
Do you currently make contributions to charity? YES NO If Yes, amount of annual cash contributions Amount of long term capital gain property
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What are your primary objectives in gifting to charity? (please number with 1 being the highest priority)
Provide Current Gift to Charity(ies)
Provide Future Gift to Charity(ies)
Provide Gift to Charity(ies) at Death
Reduce or Postpone Capital Gains Taxes on Assets
Increase Income from Current Assets
Reduce Income Taxes
Provide Income for Children or Others
Reduce Estate Taxes
If income is an objective for you or another family member, as part of your charitable gifting, please prioritize among the following.
Start Income Immediately
Start Income in _________ Years
Start Income at Retirement ( _________ )
Start Income for Parents or Grandparents in ________ Years
Start Income for Co-Client at Donor’s Death
Start Income for Children ____________
Do you have an asset which you would like to gift to family members in the future (at a discount in value), while donating some of the growth and income to charity now? YES NO
If so, do you believe the asset will appreciate significantly in the future? YES NO
Are you interested in involving family members in your charitable giving commitments? YES NO
If Yes, would these commitments amount to a substantial sum? (e.g., over $1,000,000.00) YES NO
Do you have a charitable trust? YES NO
If Yes, what kind of trust is it? If Yes, please include copy.
What is the Fair Market Value? What is the Annuity or Unitrust payout?
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NOTES
PWM7025347 2012-PS-358-03/2012 © 2012 Morgan Stanley Private Wealth Management, a division of Morgan Stanley Smith Barney LLC. Member SIPC. 7252204 10/12