Your Personal and Financial Goals

Now accepting new clients with investable assets of $250,000 and above.

Please answer the following questions providing detail where needed. We also ask that you please mail a recent copy of all statements, including brokerage and mutual fund accounts as well as both current and former employer retirement plans to:
Fragasso Financial Advisors
610 Smithfield St, Suite 400
Pittsburgh, PA 15222

If you have any questions while preparing this form, please feel free to contact a member of our Financial Planning Department for help (412) 227-3200 or 1 (800) 900-4492

* = Required Field

	LeastMost
Retirement security	1 2 3 4 5
Improved investment management	1 2 3 4 5
Tax reduction strategies (e.g. charitable gifting, tax-free vs. taxable bonds, etc.)	1 2 3 4 5
Estate planning	1 2 3 4 5
Business succession planning	1 2 3 4 5
College education funding	1 2 3 4 5
Providing for your family in the event of death and/or disability	1 2 3 4 5

What is most important to you within the next 5 years?

Do your long-term financial goals differ? Yes No

What are your three top long-range goals?

What steps are you taking toward reaching these goals?

How confident are you that you will achieve these goals?

What do you see as your biggest challenge in achieving your goals?

How confident are you that your current asset allocation and security selection will enable you to reach your financial goals?

What have you done to structure your portfolio to ensure it will withstand another downturn or benefit from a market upswing?

PERSONAL DATA:	FIRST NAME*	M.I.	LAST NAME*	SEX	BIRTH DATE
CLIENT A:
CLIENT B:

HOME ADDRESS
Street:*		City:*
State:*		Zip:*
Home Phone:*
Email:*		Alternate Email
Client A Business Phone:		Client B Business Phone:

EMPLOYEE DATA: CLIENT A			EMPLOYEE DATA: CLIENT B
Self Employed?			Self Employed?
Occupation:			Occupation:
Employer's Name:		Years	Employer's Name:		Years
Gross Salary:	$		Gross Salary:	$

Assets
Do you have? (check all that apply)	Client A	Annual Additions	Client B	Annual Additions	Joint	Annual Additions
Personal investment/brokerage account		$		$		$
Traditional IRAs		$		$		$
Roth IRAs		$		$		$

Real Estate
	Market Value	Mortgage Balance	Monthly Payment principal & interest	Interest Rate	Term	Property Taxes
Residence	$	$	$	$	$	$
Business Property	$	$	$	$	$	$
Recreational Property	$	$	$	$	$	$

Retirement Planning
Does your employer offer a retirement plan?	Yes	No	Do you participate	Yes	No
Client A
Client B
If yes, what are you contributing? Client A % or $ Client B % or $
Employer Contributions: Client A % or $ Client B % or $
Desired retirement age: Client A Client B
Defined benefit pension income expected? Client A Yes No How much? $ At what age? Client B Yes No How much? $ At what age?
Are you currently able to increase your retirement plan contributions to help reach your retirement goals?

COLLEGE FUNDING

Do you wish to pre-fund your child(ren)'s educational expenses, if possible?

	NAME	BIRTH DATE	WILL ATTEND COLLEGE	YEAR TO BEGIN	# YEARS	CURRENT $ SET ASIDE*	MONTHLY ADDITIONS (IF ANY)
Oldest Child						$	$
Child 2						$	$
Child 3						$	$
Child 4						$	$
Child 5						$	$
Child 6						$	$
*Includes statements for children's accounts or money earmarked for children's education.

When do you expect to tap into your retirement account? Less than 5 years.
Between 5 and 10 years.
Between 10 and 15 years.
More than 15 years to retirement.

What do you expect to happen to your pay (salary) in the next 5 years?
I expect my pay to increase much faster than inflation (due to promotions, new job, etc).
I expect my pay to increase slightly faster than inflation.
I expect my pay to just keep up with inflation.
I expect my pay to decrease (due to retirement, part-time work, depressed industry, etc).

How do you feel about investing for retirement?
I am seeking maximum stability even if returns are low.
I can tolerate a small amount of fluctuation in my investment account value and am seeking consistent returns.
I am middle-of-the-road and prefer both growth potential and consistency of returns. I can tolerate a fair amount of market movement in exchange for more attractive long-term returns.
I am willing to assume a relatively high level of volatility for potentially greater returns.
I am seeking maximum long-term growth, even if it means wide swings in my account value.

How willing are you to increase your investment return?
I am willing to take a lot more risk with all of my retirement account.
I am willing to take a lot more risk with some of my retirement account.
I am willing to take a little more risk with all of my retirement account.
I am willing to take a little more risk with some of my retirement account.
I am unwilling to take on more risk.

If the stock market went down 15%, what would you do?
Sell all of my stock funds immediately and put the money in something guaranteed.
Transfer some of my stock funds into less aggressive investments.
Do nothing and wait for it to come back.
Buy more: increase my stock investments while prices are low.

If you received several statements in a row with negative returns and realized that your account had lost 20%, what would you do?
Sell all of my stock funds immediately and put the money in something guaranteed.
Transfer some of my stock funds into less aggressive investments.
Do nothing and wait for it to come back.
Buy more: increase my stock investments while prices are low.

What has been your experience working with a financial advisor?

Do you feel you can better reach your goals with the help of a financial advisor?

Please include any additional comments that you feel would help with this analysis.

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