Client Data Questionnaire

We’re glad you chose Pension Financial Group to establish your investment account. Please answer the following questions. We’ll use your responses to complete your account documents.

It’ll only take about 15 minutes.

Please be prepared to provide us with:

Your employers’ name and address (if applicable).
The person/people you would like to name as your beneficiary.

Let’s begin! Please click “Next” below to begin the confidential questionnaire.

"*" indicates required fields

Step 1 of 34

Client Data Questionnaire

Time to Complete: Approximately 15 Minutes

Name*

First Middle Last

Do you have a preferred name?

Date of Birth*

MM slash DD slash YYYY

Cell phone Number

Home phone number

Which is your preferred phone?

Cell Phone

Home Phone

Work Phone

Other

Personal email

Work email

Which is your preferred email?

Personal Email

Work Email

Other

Home address*

Street Address City State / Province / Region ZIP / Postal Code

What is your preferred method of contact?

Phone

Either Phone or Email

Other

What is your preferred method for a meeting?

In Person

Phone Call

Virtual Meeting (Zoom, Skype, etc.)

Other

Employment Status

Next, we'll ask you a few questions about your employment status.

Are you..

Employed

Retired

Self Employed

Homemaker

Not currently employed but looking

Please provide additional information below:

What industry did you formerly work in?

Name of your former employer

What was your occupation?

Work phone number

Place of employment

Employer's address

Street Address City State / Province / Region ZIP / Postal Code

Occupation

What industry are you in?

Occupation

Name of business

Your business address

Street Address City State / Province / Region ZIP / Postal Code

Family Information

Are you...

Married

Single

Divorced

Widowed

Spouse's Name

First Middle Last

Do they have a preferred name?

Spouse's date of birth

MM slash DD slash YYYY

How many children do you have?

How many dependents do you have?

Financial Information

We'll need to know a little more about your financial situation.

Approximate anual gross income

Include all sources: Wages, Social Security, Pensions, Investment Income, etc. Do not include souse's income

What is your approximate net worth?

How much is left over after all your debts are paid?

$1 - $24,999

$25,000 - $49,999

$50,000 - $99,999

$100,000 - $249,999

$250,000 - $499,999

$500,000 - $749,999

$1,000,000 and over

I need to speak to you about this

What is your approximate LIQUID net worth?

The value of ALL your INVESTMENT accounts, stocks, bonds, mutual funds, etc.

$1 - $24,999

$25,000 - $49,999

$50,000 - $99,999

$100,000 - $249,999

$250,000 - $499,999

$500,000 - $749,999

$1,000,000 and over

I need to speak to you about this

What is you tax bracket?

10%

12%

22%

24%

32%

35%

36% and higher

How many years of investment experience do you have?

How many YEARS of investment experience do you have? All 7 categories must have an answer. if none, enter "0"

Stocks*

Bonds*

Mutual Funds*

Annuities*

Margin*

Options*

Partnerships*

Approximately how much do you have invested in each of these asset classes? All 7 classes must have an answer. If zero, enter "0"

Mutual Funds*

Bonds*

Individual Stocks*

Annuities*

Margin*

Options*

Partnerships*

Beneficiary Information

Please tell us who would you like to inherit your account

Who would you like to name as your PRIMARY beneficiary?

This is the person/people that would be first in line to inherit this account

My Spouse

Someone Else

How many PRIMARY beneficiaries will there be?

If there are more than 5, please let us know at the end of this survey.

Primary Beneficiary #1

PERCENT for this individual

Primary Beneficiary #2

PERCENT for this individual

Primary Beneficiary #3

PERCENT for this individual

Primary Beneficiary #4

PERCENT for this individual

Primary Beneficiary #5

PERCENT for this individual

Let's talk about your SECONDARY beneficiaries

This would be the person/people that would be NEXT in line if your primary beneficiary is deceased

How many SECONDARY beneficiaries will there be?

If you're not sure and want to address this later, select 0

Primary beneficiary #1