Wealth Management Questionnaire - Merrill

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Wealth ManagementQuestionnaireYour Name(s)DateINCLUDED IN THIS QUESTIONNAIRE:Personal Information page 3Goals & Projected Expenses page 6Financial Advisor/Team NameIncome page 9Financial Advisor/Team Phone NumberLiabilities page 21Financial Advisor EmailMerrill Lynch makes available products and services offered by Merrill Lynch, Pierce, Fenner & Smith Incorporated (MLPF&S), a registeredbroker-dealer and member SIPC, and other subsidiaries of Bank of America Corporation (“BofA Corp.”). Merrill Lynch Life Agency Inc. is alicensed insurance agency and a wholly owned subsidiary of BofA Corp.Investment products offered through MLPF&S and insurance and annuity products offered through Merrill Lynch Life Agency Inc.:Are Not FDIC InsuredAre Not Bank GuaranteedMay Lose ValueAre Not DepositsAre Not Insured by Any FederalGovernment AgencyAre Not a Condition to Any BankingService or ActivityMLPF&S is a registered broker-dealer, Member SIPC and a wholly owned subsidiary of BofA Corp.Assets page 11Insurance page 23Estate page 26

Your GoalsMatter To UsWhether you’re interested in getting a better understanding of your assets and liabilities,trying to figure out what you can expect when you retire, or looking to help your children payfor college, meeting your financial goals could depend, in large part, on the success of theinvestment approach you adopt today. At Merrill Lynch, we are guided by a structured, five-stepGoals-Based Wealth Management process designed to help you pursue your goals.The first step of the Goals-Based Wealth Management process involves defining your attitudestoward investing and assessing your financial situation. This questionnaire will assist yourFinancial Advisor in gathering information about your goals and expenses, income, assets andliabilities. As you will see, it’s helpful to provide copies of financial statements so that yourFinancial Advisor can pull current, detailed information directly from there. He or she may alsoask you to complete an Investment Personality Questionnaire to better understand who you areas an investor and what is important to you.Building on this foundation, your Financial Advisor will work with you to identify, defineand prioritize your goals. This questionnaire will not only help your Financial Advisor collectinformation about your goals, but it’s also the first step in opening a dialogue about yourneeds, concerns and priorities.Once you and your Financial Advisor have developed and implemented goals-based portfoliostailored to your goals, be sure to review the approach regularly to track progress to your goals.It is important to keep your Financial Advisor informed as life events take place or there arechanges in your financial situation, needs, and goals, so that you can discuss changes to theinvestment approach as needed.

Personal InformationClient 1BIOGRAPHICAL INFORMATIONFull NameGenderFirst, Middle, Last, SuffixMFPreferred NameDate of BirthSSNmm/dd/yyyyMarital StatusSingleMarriedDomestic PartnershipSeparatedDivorcedWidowedCONTACT INFORMATIONCurrent Street AddressCityEmailDo you own or rent?Politically exposed person:A person who has beenentrusted with a prominentpublic function, or an individualwho is closely related tosuch a person.CountryPreferred Phone NumberRestricted/control person:A person, such as a directoror large shareholder,in a relationship of control(the power to direct themanagement and policiesor the company in question)with the issuer of restricted/control securities.State ZIP CodeWorkHomeOwnMobileOtherBest Time to CallRentEMPLOYMENT INFORMATIONEmployment StatusOccupation/TitleEmployerStart Date (mm/dd/yyyy)Employer Street AddressCityCountryAre you a restricted/control person?NoState ZIP CodeIndustryYesIF YES Company NameIF YES Company Ticker SymbolAre you a senior political person or politically exposed person?NoYesCITIZENSHIPAre you a U.S. citizen?NoYesIF NO Country of CitizenshipCountry of Dual Citizenship, if applicableSECTION 1 Personal InformationPage 3 of 28

Personal Information (continued)Client 2BIOGRAPHICAL INFORMATIONFull NameGenderFirst, Middle, Last, SuffixMFPreferred NameDate of BirthSSNmm/dd/yyyyMarital StatusSingleMarriedDomestic PartnershipSeparatedDivorcedWidowedCONTACT INFORMATIONCurrent Street AddressCityEmailDo you own or rent?Politically exposed person:A person who has beenentrusted with a prominentpublic function, or an individualwho is closely related tosuch a person.CountryPreferred Phone NumberRestricted/control person:A person, such as a directoror large shareholder,in a relationship of control(the power to direct themanagement and policiesor the company in question)with the issuer of restricted/control securities.State ZIP CodeWorkHomeOwnMobileOtherBest Time to CallRentEMPLOYMENT INFORMATIONEmployment StatusOccupation/TitleEmployerStart Date (mm/dd/yyyy)Employer Street AddressCityCountryAre you a restricted/control person?NoState ZIP CodeIndustryYesIF YES Company NameIF YES Company Ticker SymbolAre you a senior political person or politically exposed person?NoYesCITIZENSHIPAre you a U.S. citizen?NoYesIF NO Country of CitizenshipCountry of Dual Citizenship, if applicableSECTION 1 Personal InformationPage 4 of 28

Personal Information (continued)All ClientsDEPENDENT INFORMATIONName (First and Last)Date of Birth (mm/dd/yyyy)GenderRelationshipMFMFMFMFOTHER ADVISORSFirst and Last NameFirm NameType (Attorney, CPA, Insurance Agent, etc.)CityStateZIP CodePhone EmailFirst and Last NameFirm NameType (Attorney, CPA, Insurance Agent, etc.)CityStateZIP CodePhone EmailFirst and Last NameFirm NameType (Attorney, CPA, Insurance Agent, etc.)CityStateZIP CodePhone EmailEnter your current andexpected effective tax rates,or check here if you wouldlike us to project thembased on income.TAX INFORMATIONProject my tax rates based on incomeIncome Tax%%Capital Gains Tax%%Current RateCurrent RateSECTION 1 Personal InformationExpected Retirement RateExpected Retirement RatePage 5 of 28

Goals &Projected ExpensesHow do you feel about your financial picture?Do you feel like you have:Not enough moneyJust enough moneyMore than enough moneyWhat’s important to you?Your financial advisor can help you make investment-related decisions tailored to your financial circumstances, needs,goals, liquidity requirements, risk tolerance, time horizon, and investment objectives. To create a starting point fora conversation about your goals, think about what’s important to you. As you list your needs and concerns by thecategories below, talk to your advisor about how you feel about and prioritize these areas of your life.SECTION 2 Goals & Projected ExpensesPage 6 of 28

Goals & Projected Expenses (continued)Attach additionalsheets if necessary.GOAL INFORMATIONGoal NamePriority How important is this goal? Plot on the continuum below:EssentialImportantToday’s DollarsEnter the amount ofmoney in today’s dollars(not adjusted for inflation)you think you’ll needfor each goal.Inflation AssumptionUnless you specify an inflationassumption, your FinancialAdvisor will use a standardannual inflation rate to adjustboth the amount neededto fund your goals and thevalue of income sources overtime. If you are unsure, yourFinancial Advisor can helpyou determine an appropriatespecific inflation assumptionfor each of your goals andincome sources.Goal OwnerAspirational Start Date and Duration Target Amount or Range(Number of Years or Lifetime) (in Today’s Dollars)To pursue this goal, I’d be willing to. (Examples: Retire later, Reduce spending, Save more)Goal NamePriority How important is this goal? Plot on the continuum below:EssentialImportantGoal OwnerAspirational Start Date and Duration Target Amount or Range(Number of Years or Lifetime) (in Today’s Dollars)To pursue this goal, I’d be willing to. (Examples: Retire later, Reduce spending, Save more)Goal NamePriority How important is this goal? Plot on the continuum below:EssentialImportantGoal OwnerAspirational Start Date and Duration Target Amount or Range(Number of Years or Lifetime) (in Today’s Dollars)To pursue this goal, I’d be willing to. (Examples: Retire later, Reduce spending, Save more)Goal NamePriority How important is this goal? Plot on the continuum below:EssentialGoal OwnerImportantAspirational Start Date and Duration Target Amount or Range(Number of Years or Lifetime) (in Today’s Dollars)To pursue this goal, I’d be willing to. (Examples: Retire later, Reduce spending, Save more)SECTION 2 Goals & Projected ExpensesPage 7 of 28

Goals & Projected Expenses (continued)Attach additionalsheets if necessary.GOAL INFORMATIONGoal NamePriority How important is this goal? Plot on the continuum below:EssentialImportantToday’s DollarsEnter the amount ofmoney in today’s dollars(not adjusted for inflation)you think you’ll needfor each goal.Inflation AssumptionUnless you specify an inflationassumption, your FinancialAdvisor will use a standardannual inflation rate to adjustboth the amount neededto fund your goals and thevalue of income sources overtime. If you are unsure, yourFinancial Advisor can helpyou determine an appropriatespecific inflation assumptionfor each of your goals andincome sources.Goal OwnerAspirational Start Date and Duration Target Amount or Range(Number of Years or Lifetime) (in Today’s Dollars)To pursue this goal, I’d be willing to. (Examples: Retire later, Reduce spending, Save more)Goal NamePriority How important is this goal? Plot on the continuum below:EssentialImportantGoal OwnerAspirational Start Date and Duration Target Amount or Range(Number of Years or Lifetime) (in Today’s Dollars)To pursue this goal, I’d be willing to. (Examples: Retire later, Reduce spending, Save more)Goal NamePriority How important is this goal? Plot on the continuum below:EssentialImportantGoal OwnerAspirational Start Date and Duration Target Amount or Range(Number of Years or Lifetime) (in Today’s Dollars)To pursue this goal, I’d be willing to. (Examples: Retire later, Reduce spending, Save more)Goal NamePriority How important is this goal? Plot on the continuum below:EssentialGoal OwnerImportantAspirational Start Date and Duration Target Amount or Range(Number of Years or Lifetime) (in Today’s Dollars)To pursue this goal, I’d be willing to. (Examples: Retire later, Reduce spending, Save more)SECTION 2 Goals & Projected ExpensesPage 8 of 28

IncomeAll ClientsEnter information aboutyour salary and otherearned income sources(such as alimony, rentalincome, etc.). Do notinclude income frominvestments, pensions,Social Security, etc.,which are covered inlater sections.Inflation AssumptionUnless you specify aninflation assumption, yourFinancial Advisor will use astandard annual inflation rateto adjust both the amountneeded to fund your goalsand the value of incomesources over time. If youare unsure, your FinancialAdvisor can help youdetermine an appropriatespecific inflation assumptionfor each of your goals andincome sources.EARNED INCOMEDescriptionSalary, Self-Employment, etc.OwnerCurrent or Anticipated Start Year %Annual Amount in Today’s DollarsInflationAssumptionDescriptionSalary, Self-Employment, etc.OwnerCurrent or Anticipated Start Year %Annual Amount in Today’s DollarsInflationAssumptionDuration (Number of Years or Lifetime)DescriptionSalary, Self-Employment, etc.OwnerCurrent or Anticipated Start Year %Annual Amount in Today’s DollarsAll ClientsDuration (Number of Years or Lifetime)InflationAssumptionDuration (Number of Years or Lifetime)SOCIAL SECURITY OwnerAge You Started or Plan toStart Taking Social SecurityAnnual Amount OwnerAge You Started or Plan toStart Taking Social SecurityAnnual AmountCheck here if you would like us to estimate your annual amount based on earnings.SECTION 3 Income InformationPage 9 of 28

Income (continued)All ClientsEnter informationabout additionalretirement income(pension, annuity, etc.)that you are receivingor anticipate receiving.RETIREMENT INCOMEDescription OwnerAnnual Amount in Today’s DollarsInflation Indexed:NoStart Date and Duration (Number of Years or Lifetime)Survivor Benefit: NoYesIF YES Rate%Tax Exempt:NoYesIF YES Rate%YesDescription Inflation Indexed:OwnerAnnual Amount in Today’s DollarsNoStart Date and Duration (Number of Years or Lifetime)Survivor Benefit: NoYesIF YES Rate%Tax Exempt:NoYesIF YES Rate%YesDescription Inflation Indexed:OwnerAnnual Amount in Today’s DollarsNoStart Date and Duration (Number of Years or Lifetime)Survivor Benefit: NoYesIF YES Rate%Tax Exempt:NoYesIF YES Rate%YesDescription Inflation Indexed:OwnerAnnual Amount in Today’s DollarsNoStart Date and Duration (Number of Years or Lifetime)Survivor Benefit: NoYesSECTION 3 Income InformationIF YES Rate%Tax Exempt:NoYesIF YES Rate%YesPage 10 of 28

AssetsAll ClientsAttach statements orcomplete this section forall non–Merrill Lynch orBank of Americataxable accounts.TAXABLE INVESTMENT ACCOUNTSDescriptionAccount Name and DescriptionFinancial Institution %Account OwnerCost BasisAnnual contribution indollar amount orpercentage of salaryAnnual Contribution in Today’s DollarsOwnership Type (Single, Joint, Trust, etc.)Market ValueInflation AssumptionStart Date and DurationWho are your designated beneficiaries?DescriptionAccount Name and DescriptionFinancial Institution %Account OwnerCost BasisAnnual Contribution in Today’s DollarsOwnership Type (Single, Joint, Trust, etc.)Market ValueInflation AssumptionStart Date and DurationWho are your designated beneficiaries?DescriptionAccount Name and DescriptionFinancial Institution %Account OwnerCost BasisAnnual Contribution in Today’s DollarsOwnership Type (Single, Joint, Trust, etc.)Market ValueInflation AssumptionStart Date and DurationWho are your designated beneficiaries?SECTION 4 AssetsPage 11 of 28

Assets (continued)TAXABLE INVESTMENT ACCOUNTS (CONTINUED)DescriptionAccount Name and DescriptionFinancial Institution %Account OwnerCost BasisAnnual Contribution in Today’s DollarsOwnership Type (Single, Joint, Trust, etc.)Market ValueInflation AssumptionStart Date and DurationWho are your designated beneficiaries?Attach statements orcomplete this section forall non–Merrill Lynch orBank of Americataxable accounts.TAXABLE INVESTMENT ACCOUNTS: ASSET ALLOCATIONClient 2Client 1%%%%%%%%%%%%%%%%%%CASHEQUITYFIXED INCOMETaxableTax-FreeALTERNATIVE INVESTMENTSReal AssetsHedge Fund StrategiesPrivate Equity Annual Taxable Savings TargetSECTION 4 AssetsCASHEQUITYFIXED INCOMETaxableTax-FreeALTERNATIVE INVESTMENTSReal AssetsHedge Fund StrategiesPrivate Equity Annual Taxable Savings TargetPage 12 of 28

Assets (continued)All ClientsAttach statements orcomplete this section forall retirement accounts(e.g., IRA, Roth IRA,KEOGH, 401(k), ProfitSharing, SEP, SIMPLE).Where appropriate, pleaseindicate pre-tax, post-taxor Roth contribution.Annual contribution indollar amount orpercentage of salaryRETIREMENT ACCOUNTSDescriptionAccount Name and DescriptionFinancial InstitutionAccount Owner Cost Basis Ownership Type (Single, Joint, Trust, etc.) Market ValueMandatory Withdrawals (If applicable) Annual Contribution in Today’s DollarsInflationAssumption%Start Date and DurationEmployer will match%of first /%contributed by employee.Employer will match%of next /%contributed by employee.Employer maximum matching contribution limit Do you have company profit sharing?NoYesIf Yes /%Who are your designated beneficiaries?DescriptionAccount Name and DescriptionFinancial InstitutionAccount Owner Cost Basis Ownership Type (Single, Joint, Trust, etc.) Market ValueMandatory Withdrawals (If applicable) Annual Contribution in Today’s DollarsInflationAssumption%Start Date and DurationEmployer will match%of first /%contributed by employee.Employer will match%of next /%contributed by employee.Employer maximum matching contribution limit Do you have company profit sharing?NoYesIf Yes /%Who are your designated beneficiaries?SECTION 4 AssetsPage 13 of 28

Assets (continued)All ClientsAttach statements orcomplete this section forall retirement accounts(e.g., IRA, Roth IRA,KEOGH, 401(k), ProfitSharing, SEP, SIMPLE).Where appropriate, pleaseindicate pre-tax, post-taxor Roth contribution.Annual contribution indollar amount orpercentage of salaryRETIREMENT ACCOUNTS (CONTINUED)DescriptionAccount Name and DescriptionFinancial InstitutionAccount Owner Cost Basis Ownership Type (Single, Joint, Trust, etc.) Market ValueMandatory Withdrawals (If applicable) Annual Contribution in Today’s DollarsInflationAssumption%Start Date and DurationEmployer will match%of first /%contributed by employee.Employer will match%of next /%contributed by employee.Employer maximum matching contribution limit Do you have company profit sharing?NoYesIf Yes /%Who are your designated beneficiaries?DescriptionAccount Name and DescriptionFinancial InstitutionAccount Owner Cost Basis Ownership Type (Single, Joint, Trust, etc.) Market ValueMandatory Withdrawals (If applicable) Annual Contribution in Today’s DollarsInflationAssumption%Start Date and DurationEmployer will match%of first /%contributed by employee.Employer will match%of next /%contributed by employee.Employer maximum matching contribution limit Do you have company profit sharing?NoYesIf Yes /%Who are your designated beneficiaries?SECTION 4 AssetsPage 14 of 28

Assets (continued)All ClientsAttach any applicableNQDC plan information.DEFERRED COMPENSATION PAYOUTDescriptionAccount Name and DescriptionFinancial InstitutionOwnerOwnership (Single, Joint, Trust, etc.)Account Value (current)%Payout Start YearPayout Duration (years)Plan Type (fixed or variable) %Earnings Rate(fixed only)Annual Contributions in Today’s DollarsInflationStart Date and DurationAssumptionWho are your designated beneficiaries?DescriptionAccount Name and DescriptionFinancial InstitutionOwnerOwnership (Single, Joint, Trust, etc.)Account Value (current)%Payout Start YearPayout Duration (years)Plan Type (fixed or variable) %Earnings Rate(fixed only)Annual Contributions in Today’s DollarsInflationStart Date and DurationAssumptionWho are your designated beneficiaries?RETIREMENT ACCOUNTS: ASSET ALLOCATIONClient 1%CASH%EQUITY%Taxable%%Client 2%Hedge Fund Strategies%CASHEQUITYSECTION 4 Assets%FIXED INCOME%Tax-Free%Real Assets%Private Equity%%Taxable%ALTERNATIVE INVESTMENTSINVESTMENTSTax-FreeReal Assets%FIXED INCOME%ALTERNATIVE INVESTMENTS%Hedge Fund Strategies%Private EquityPage 15 of 28

Assets (continued)All ClientsComplete this section forall education accounts(529 College SavingsPlan, Coverdell EducationSavings Account, etc.)or other educationoriented savings. Pleaseindicate the investmentobjective for each account(e.g., growth, income).EDUCATION SAVINGSDescriptionAccount Name and DescriptionFinancial InstitutionStudentAnnual Contribution in Today’s DollarsAccount TypeOwner Account Value (current)%Inflation AssumptionStart Date and DurationDescriptionAccount Name and DescriptionStudentAnnual Contribution in Today’s DollarsAccount TypeFinancial InstitutionOwner Account Value (current)%Inflation AssumptionStart Date and DurationAccount Name and DescriptionStudentAnnual Contribution in Today’s DollarsAccount TypeFinancial InstitutionOwner Account Value (current)%Inflation AssumptionStart Date and DurationAccount Name and DescriptionFinancial InstitutionStudentAnnual Contribution in Today’s DollarsSECTION 4 AssetsInvestment ObjectiveDescriptionInvestment ObjectiveDescriptionInvestment ObjectiveAccount TypeOwner Account Value (current)%Inflation AssumptionInvestment ObjectiveStart Date and DurationPage 16 of 28

Assets (continued)All ClientsBANK ACCOUNTSDescription Annual Contribution in Today’s DollarsFinancial InstitutionAccount OwnerAnnual contribution indollar amount orpercentage of salarySavings, Checking, CDs, etc.Ownership Type (Single, Joint, Trust, etc.)InflationAssumption% BalanceStart Date and DurationWho are your designated beneficiaries?DescriptionSavings, Checking, CDs, etc.Account Owner Annual Contribution in Today’s DollarsFinancial InstitutionOwnership Type (Single, Joint, Trust, etc.)InflationAssumption% BalanceStart Date and DurationWho are your designated beneficiaries?DescriptionSavings, Checking, CDs, etc.Account Owner Annual Contribution in Today’s DollarsFinancial InstitutionOwnership Type (Single, Joint, Trust, etc.)InflationAssumption% BalanceStart Date and DurationWho are your designated beneficiaries?DescriptionSavings, Checking, CDs, etc.Account Owner Annual Contribution in Today’s DollarsFinancial InstitutionOwnership Type (Single, Joint, Trust, etc.)InflationAssumption% BalanceStart Date and DurationWho are your designated beneficiaries?SECTION 4 AssetsPage 17 of 28

Assets (continued)BANK ACCOUNTS (CONTINUED)Description Annual Contribution in Today’s DollarsFinancial Institution Account OwnerAnnual contribution indollar amount orpercentage of salarySavings, Checking, CDs, etc.Ownership Type (Single, Joint, Trust, etc.)InflationAssumption%BalanceStart Date and DurationWho are your designated beneficiaries?All ClientsREAL ESTATE ASSETSAttach additionalpages as needed.DescriptionPrimary Residence, Vacation Home, Investment Property, etc.OwnerOwnership Type (Single, Joint, Trust, etc.)Street AddressCityState Use Proceeds to Fund Goals:Estimated Market ValueZIP CodeNoYesWho are your designated beneficiaries?DescriptionPrimary Residence, Vacation Home, Investment Property, etc.OwnerOwnership Type (Single, Joint, Trust, etc.)Street AddressCityState Use Proceeds to Fund Goals:Estimated Market ValueZIP CodeNoYesWho are your designated beneficiaries?SECTION 4 AssetsPage 18 of 28

Assets (continued)All ClientsEnter informationabout any other assetspotentially availableto fund goals.PERSONAL ASSETSDescriptionBusiness Interest, Expected Inheritance, Boat, etc.OwnerOwnership Type (Single, Joint, Trust, etc.) Use Proceeds to Fund Goals:Estimated Market ValueNoYesWho are your designated beneficiaries?DescriptionBusiness Interest, Expected Inheritance, Boat, etc.OwnerOwnership Type (Single, Joint, Trust, etc.) Use Proceeds to Fund Goals:Estimated Market ValueNoYesWho are your designated beneficiaries?DescriptionBusiness Interest, Expected Inheritance, Boat, etc.OwnerOwnership Type (Single, Joint, Trust, etc.) Use Proceeds to Fund Goals:Estimated Market ValueNoYesWho are your designated beneficiaries?SECTION 4 AssetsPage 19 of 28

Assets (continued)All ClientsNonqualified (NSO) Noncashemployee compensation. Mustbe reported as ordinary income(excess of fair market value overoption price) when exercised.Incentive (ISO)Considered a statutory stockoption. Generally, a statutorystock option is not includedin your gross income whengranted. If certain requirementsare met when the option isexercised, the entire gain is taxedas long-term capital gains.Restricted Stock A grantof employer stock subject tonon-transferability and vestingrestrictions. Restricted stockusually includes voting anddividend rights. It is not taxableuntil the restrictions lapse, unlessthe employee makes an 83(b)election to be taxed at grant.SAR Stock appreciation right.A right usually granted to anemployee, to receive a bonusequal to the appreciation in thecompany’s stock over a specifiedperiod. The employee is notrequired to pay the exerciseprice, but rather receives theamount of the increasein cash or stock.RSU Restricted Stock Unit. Theright to receive a future deliveryof shares subject to vesting.A Restricted Stock Unit awardoffers no ownership rights untilvesting but may provide fordividend equivalent units.Vested bargain elementAlso known as the gain, it iscalculated by subtracting theexercise price from the marketprice of the company stock onthe date that the optionis exercised.STOCK OPTIONSTypeNonqualifiedIncentiveRestricted StockSARRSUOtherCompany Name or SymbolOwnerGrant Date (mm/dd/yyyy) Strike PriceNumber of Shares UnexercisedNonqualifiedIncentiveNumber of Shares VestedVested Bargain ElementNext Vesting Date (mm/dd/yyyy)TypeExpiration Date (mm/dd/yyyy)Number of Shares VestingRestricted StockSARRSUFrequency (years)OtherCompany Name or SymbolOwnerGrant Date (mm/dd/yyyy) Strike PriceNumber of Shares UnexercisedNonqualifiedIncentiveNumber of Shares VestedVested Bargain ElementNext Vesting Date (mm/dd/yyyy)TypeExpiration Date (mm/dd/yyyy)Number of Shares VestingRestricted StockSARRSUFrequency (years)OtherCompany Name or SymbolOwnerGrant Date (mm/dd/yyyy) Strike PriceNumber of Shares UnexercisedNonqualifiedIncentiveNumber of Shares VestedVested Bargain ElementNext Vesting Date (mm/dd/yyyy)TypeExpiration Date (mm/dd/yyyy)Number of Shares VestingRestricted StockSARRSUFrequency (years)OtherCompany Name or SymbolOwnerGrant Date (mm/dd/yyyy) Strike PriceNumber of Shares UnexercisedNext Vesting Date (mm/dd/yyyy)Expiration Date (mm/dd/yyyy)Number of Shares VestedVested Bargain ElementNumber of Shares VestingFrequency (years)Who are your designated beneficiaries?SECTION 4 AssetsPage 20 of 28

LiabilitiesAll ClientsEnter information aboutany mortgages you hold.MORTGAGESDescriptionPrimary Residence, Vacation Home, Investment Property, etc.Owner BalanceLoan Type:FixedAdjustableCurrent Interest RateFixed-AdjustablePayments Remaining (months)Ownership Type (Single, Joint, Trust, etc.)% Monthly Payment (Principal and Interest)Adjustment Period Begins (mm/dd/yyyy)Holding Period (years)DescriptionPrimary Residence, Vacation Home, Investment Property, etc.Owner BalanceLoan Type:FixedAdjustableCurrent Interest RateFixed-AdjustablePayments Remaining (months)Ownership Type (Single, Joint, Trust, etc.)% Monthly Payment (Principal and Interest)Adjustment Period Begins (mm/dd/yyyy)Holding Period (years)DescriptionPrimary Residence, Vacation Home, Investment Property, etc.Owner BalanceLoan Type:FixedAdjustableCurrent Interest RateFixed-AdjustablePayments Remaining (months)SECTION 5 LiabilitiesOwnership Type (Single, Joint, Trust, etc.)% Monthly Payment (Principal and Interest)Adjustment Period Begins (mm/dd/yyyy)Holding Period (years)Page 21 of 28

Liabilities (continued)Enter information aboutany other liabilities(lines of credit, securitybased loans, credit cards,student loans, auto loans,etc.). that you hold.OTHER LIABILITIESDescriptionOwner BalanceOwnership Type (Single, Joint, Trust, etc.)Current Interest Rate% Monthly Payment (Principal and Interest)DescriptionOwner BalanceOwnership Type (Single, Joint, Trust, etc.)Current Interest Rate% Monthly Payment (Principal and Interest)DescriptionOwner BalanceOwnership Type (Single, Joint, Trust, etc.)Current Interest Rate% Monthly Payment (Principal and Interest)DescriptionOwner BalanceOwnership Type (Single, Joint, Trust, etc.)Current Interest Rate% Monthly Payment (Principal and Interest)DescriptionOwner BalanceOwnership Type (Single, Joint, Trust, etc.)Current Interest Rate% Monthly Payment (Principal and Interest)DescriptionOwner BalanceSECTION 5 LiabilitiesOwnership Type (Single, Joint, Trust, etc.)Current Interest Rate% Monthly Payment (Principal and Interest)Page 22 of 28

InsuranceAll ClientsLIFE INSURANCEDescription of Policy(Term, Whole, Variable, Universal)Owner Type(Single, Joint, Common Property, ILIT, Other)Insured TypePolicy OwnerWhose Life is Insured?Net Death Benefit (Single, First to Die, Second to Die)Insurance CompanyNet cash surrender valueCurrent amount of equity builtup in a permanent life insurancepolicy, less applicable surrendercharges and any outstandingloans and accrued interest.Policy End Year (if Term)Amount Provided by Employer (if Any) Net Cash Surrender Value Planned Premium DurationAnnual Premium Primary Beneficiary(ies)Contingent ription of Policy(Term, Whole, Variable, Universal)Owner Type(Single, Joint, Common Property, ILIT, Other)Insured TypePolicy OwnerWhose Life is Insured?Net Death Benefit (Single, First to Die, Second to Die)Insurance CompanyPolicy End Year (if Term)Net Cash Surrender Value Annual Premium Amount Provided by Employer (if Any) Planned Premium DurationPrimary Beneficiary(ies)Contingent ION 6 InsurancePage 23 of 28

Insurance (continued)All ClientsLIFE INSURANCE (CONTINUED)Description of PolicyPolicy Owner(Term, Whole, Variable, Universal)Owner TypeWhose Life is Insured?(Single, Joint, Common Property, ILIT, Other)Insured TypeNet Death Benefit (Single, First to Die, Second to Die)Insurance CompanyNet cash surrender valueCurrent amount of equity builtup in a permanent life insurancepolicy, less applicable surrendercharges and any outstandingloans and accrued interest.Policy End Year (if Term)Net Cash Surrender Value Amount Provided by Employer (if Any) Annual Premium Planned Premium DurationPrimary Beneficiary(ies)Contingent -TERM CARE INSURANCEDescription of PolicyOwner Type(Traditional LTC or Life Insurance with LTC Rider)Who is the Insured?(Single, Joint, Common Property, ILIT, Other)Premium WaiverNoYesPolicy OwnerYear PurchasedElimination Period (Days)Insurance CompanyTax DeductibleAnnual Premium NoBenefit IncreaseYesSimpleInflation RiderCompoundDescription of PolicyOwner TypeBenefit DurationAmount Provided by Employer (if Any) Planned Premium DurationAnnual Benefit (Traditional LTC or Life Insurance with LTC Rider)(Single, Joint, Common Property, ILIT, Other)Premium WaiverInsurance CompanySECTION 6 InsuranceNoYesYear PurchasedPolicy OwnerWho is the Insured?Elimination Period (Days)Annual Premium Page 24 of 28

Insurance (continued)All ClientsLONG-TERM CARE INSURANCE (CONTINUED)Tax DeductibleNoBenefit IncreaseYesSimpleInflation RiderCompoundBenefit DurationPlanned Premium DurationDescription of PolicyOwner TypeAnnual Benefit Amount Provided by Employer (if Any) (Traditional LTC or Life Insurance with LTC Rider)Who is the Insured?(Single, Joint, Common Property, ILIT, Other)Premium WaiverNoYesP

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