INVESTOR PROFILE QUESTIONNAIRE - kovackadvisors.com

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INVESTOR PROFILE QUESTIONNAIRE

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Kovack Advisors Investor Profile Questionnaire

Overview

This questionnaire is designed to gather pertinent information needed to understand your financial goals and

objectives, analyze your current financial position, and recommend a financial strategy which will satisfy your

needs and serve as a guide in attaining your goals. Our belief is that long-term success is dependent not only on

the development and implementation of the plan, but also on continually monitoring and revising the plan as

changes in your circumstances occur. This can be accomplished through an ongoing review which will allow you

to maintain control of your financial life.

The extent to which the process is successful depends largely on your commitment. Although this process will

require time and effort on your part, we have attempted to streamline it as much as possible.

This questionnaire is used to gather data concerning personal and family information, income, expenses, economic

assumptions, goals and objectives, investment preferences, and financial and business consultants. It contains the

following sections:

Part I Data Sheet

Part II Investor Profile Questionnaire

Part III Determination of Investor Profile Category

Part IV Client Acknowledgment

The information which you furnish in this questionnaire will be held in strict confidence.

About Kovack Advisors Kovack Advisors (www.kovackadvisors.com) is an SEC registered Investment Advisor in Fort Lauderdale, Florida. We provide a

comprehensive selection of professionally managed fee-based accounts for institutional and private investors. Kovack Advisors is a sister company to Kovack

Securities (www.kovsec.com), an independently owned and operated, full services securities brokerage firm registered with the Financial Industry Regulatory

Authority (FINRA) and the Securities Investor Protection Corporation (SIPC). Kovack Advisors may use Kovack Securities to act as an introducing broker dealer

on a fully disclosed basis when opening customer accounts.

Kovack Advisors, Inc. 6451 North Federal Highway, Suite 1201 Fort Lauderdale, Florida 33308 Phone: (954) 782-4771 Toll-Free: (800) 711-4078 Fax: (954) 333-3726

Visit our website to learn more. www.kovackadvisors.com

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Part I: Data Sheet

Processing InstructionsThis Questionnaire should be completed by the Client and, when necessary, with the help of his/her/their investment advisor representative. All fieldsrespective to account type MUST be completed. Please forward one copy of the completed questionnaire, including the Client Acknowledgement Page with original signature(s) and all other required documents to: Kovack Advisors, Inc., 6451 N. Federal Highway, Suite 1201, Fort Lauderdale, FL 33308.

Individual Account Information

Account Type� Individual � Joint � Tenants with Rights of Survivorship � Tenants in Common � Retirement Account� Custodian for Minor � Other

Client Name

Social Security Number Date of Birth / / mm/dd/yyyy

Marital Status

Dependents: Age and Relation

Joint Client Name

Social Security Number Date of Birth / / mm/dd/yyyy

Marital Status

Dependents: Age and Relation

Primary Address � Personal � Business

Address City State Zip

Home Phone Work Phone Ext Fax

Cellular Phone E-Mail Address

Additional Address � Personal � Business

Address City State Zip

Client Employment Information� Self-Employed � Employee � Retired

Occupation Title Length of Time in Position

Employer Tax Bracket %

Income: Salaries $ Investments $ Other $ Total $

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Joint Client Employment Information� Self-Employed � Employee � Retired

Occupation Title Length of Time in Position

Employer Tax Bracket %

Income: Salaries $ Investments $ Other $ Total $

Account Funding / Maintenance Instructions

Initial Investment Amount: Cash Portion $ Securities Portion $ Total $ (If account is to be funded with securities, please include a copy of the statement.)

Regular Withdrawal $ � Monthly � Quarterly � One-Time Starting Withdrawal Date / / mm/dd/yyyy

Regular Contribution $ � Monthly � Quarterly � One-Time Starting Contribution Date / / mm/dd/yyyy

Is there currently a formal written investment policy under which plan assets are monitored? � No � Yes (please attach)

Organization Account Information

Account Type� Foundation/Endowment � Defined Contribution Plan [Profit Sharing / 401(k) / Money Purchase / 403(b)(7)] � Defined Benefit Plan � Nonprofit Organization � Government Entity � Taft-Hartley � Professional Association � Corporation � Sole Proprietorship � Partnership � Trust � Other

Account Plan Name (if applicable)

Sponsor Name Tax Identification Number -

Address of Organization

City State Zip Country

Contact Name Title / Function

Work Phone Ext Fax E-Mail

Plan Trustee(s)

If this is a retirement or pension plan, please indicate the number of participants

Account Funding / Maintenance Instructions

Initial Investment Amount: Cash Portion $ Securities Portion $ Total $ (If account is to be funded with securities, please include a copy of the statement.)

Regular Withdrawal $ � Monthly � Quarterly � One-Time Starting Withdrawal Date / / mm/dd/yyyy

Regular Contribution $ � Monthly � Quarterly � One-Time Starting Contribution Date / / mm/dd/yyyy

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Financial Data

1. Please list other investments outside this managed account, including partnerships, CDs, stocks, bonds, mutual funds, money market funds, and investment partnerships:

Asset Type Asset Value

Bank Accounts $ CDs $ Money Market Funds $ Stocks $ Bonds $ Mutual Funds $ Tax-Deferred Annuities $ Life Insurance (cash value) $ Investment Real Estate $ Other (please specify) $

TOTAL $

2. List any existing financial liabilities that should be taken into consideration in the management of your account(s):

3. How are the assets you plan to contribute to your account(s) currently invested:

4. Based on the assets listed above, indicate the allocation of discretionary vs. non-discretionary funds:

Discretionary accounts %Non-Discretionary accounts %

TOTAL %

5. Based on the assets listed above, indicate the allocation among the following types of retirement accounts:

IRA %Simple Employee Pension (SEP) %Profit Sharing / 401(k) / Money Purchase / 403(b)(7) %Defined Benefit %Other (please specify) %

TOTAL %

6. Do you anticipate any changes in your overall financial circumstances in the foreseeable future? If yes, when?

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7. What is the ultimate purpose or need your investment funds are to meet?

8. Approximately when will the funds be needed for that purpose?

9. Any additional considerations which will help us design your investment plan?

Part II: Investor Profile Questionnaire

The purpose of this questionnaire is to assist you in defining your investment goals by assessing your attitude toward risk and return. There is no right or wrong answer—only answers that reflect your fiscal needs and your psychological attitude toward risk. Each answer has a point value shown in parentheses. Write down your points for each answer, and then add up the points for each page. Write that total in the blank at the bottom of the page.

1. These funds represent % of your investment funds and the purpose of the funds you are placing under professional money management is: (Choose all that apply)a. � A source of current incomeb. � Source of future retirement incomec. � Specific future need such as funding college education, buying a vacation homed. � Unspecified future use such as funding a trust for children or funding a charitable foundation

2. How long will these funds be dedicated for the purpose stated in question one? This is the time frame for the investment portfolio. Point Value _____ (Choose one)a. � Eight or more years (5 points)b. � Six to seven years (4 points)c. � Four to five years (3 points)d. � Two to three years (2 points)e. � Under two years (1 point)

3. How would you describe your outlook for the U.S. economy? (Choose one) Point Value _____ a. � Very positive (5)b. � Neutral (3)c. � I am undecided (1)d. � Very negative (-2)

4. What is your outlook for inflation? (Choose one) Point Value _____ a. � Remain at about current levels over the next twelve months (2)b. � Increase moderately over the next twelve months (0)c. � Increase substantially over the next twelve months (-2)

TOTAL POINTS FOR PAGE _____

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5. How would you generally categorize your investment objectives? (Choose one) Point Value _____ a. � Maximum capital appreciation, even though the level of risk might be higher and the level of current

income might be lower (6)b. � Capital appreciation with lower current yield but a view to capital preservation (4)c. � A balance between capital appreciation, preservation of capital and current income (3)d. � Preservation of capital and relatively high current income (1)

6. What are your personal investment parameters? (Choose one in a, one in b, and one in c. Minimum Loss of Value cannot be chosen together with Emphasis on Growth) Point Value _____ a. Loss of Value: � Minimum (1) � Moderate (3) � Not my first concern (5)b. Dividend Yield: � Important (1) � Some (3) � None (5)c. Growth: � Some (1) � Moderate (3) � Emphasis (5)

7. If you were faced with the following three alternatives, which would you choose? (Choose one) Point Value _____ a. � High long-term returns even though the returns may vary greatly over the short term (5)b. � Consistent short-term returns even though returns over the long-term may be lower (1)c. � No preference (3)

8. Which option in both (a) and (b) would make you more upset? (Answer both a and b) Point Value _____ a. � Holding cash/money market funds when the market goes up (5)

OR � Holding stocks when the market goes down (0)

b. � Selling a stock and seeing it immediately increase in value (5) OR

� Buying a stock and having it immediately decrease in value (0)

9. An increase in investment return is usually associated with higher level of fluctuation in the value of the portfolio over short periods of time. Would you be willing to accept increased fluctuation in an attempt to achieve a higher return? (Choose one) Point Value _____ a. � Yes (5)b. � No (-3)

10. Total return has two components: appreciation and yield. Stocks with the highest appreciation potential often have lower yields. How should your portfolio be invested? (Choose one) Point Value _____ a. � Emphasize appreciation (5)b. � Balance between appreciation and yield (3)c. � Emphasize yield (1)

11. If you inherited $1,000,000 and you invested $500,000, assuming there was no need to liquidate, at what loss in market value would you liquidate the portfolio? (Choose the answer which best reflects your attitude.) Point Value _____ a. � Loss of $25,000 (5%) (0)b. � Loss of $50,000 (10%) (1)c. � Loss of $75,000 (15%) (4)d. � Loss of $100,000 (20%) (5)e. � Loss of $125,000 (25%) (8)

TOTAL POINTS FOR PAGE _____

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12. Time is a critical element in investment returns. Maximum return is achieved over the full investment cycle. Each investment objective has a different length to its cycle. These cycles vary from 90 days (in the case of 90-day U.S. Treasury Bills) to 10 years (in the case of stocks in some small growth companies). What is your time frame for achieving investment returns? (Choose one) Point Value _____ � 90 days (0) � One year (1) � Three years (2) � Five years (3) � Seven years (4) � Ten years (5)

13. Return expectations are usually based on maintaining the buying power of the funds after inflation. What is your minimum return goal for your entire managed account? (Choose one) Point Value _____ a. � At least equal to inflation, with the possibility of loss of 0% to 5% over a 12-month period (0)b. � Inflation plus 1% to 3% annually over the investment cycle, with the possibility of a loss of 3% to 6% over a 12-month period (1)c. � Inflation plus 1% to 3.5% annually over the investment cycle, with the possibility of a loss of 4% to 8% over a 12-month period (2)d. � Inflation plus 2% to 4% annually over the investment cycle, with the possibility of a loss of 8% to 12% over a 12-month period (3)e. � Inflation plus 3% to 5% annually over the investment cycle, with the possibility of a loss of 10% to 15% over a 12-month period (4)f. � Inflation plus 4% to 5.5% annually over the investment cycle, with the possibility of a loss of 14% to 20% over a 12-month period (5) g. � Inflation plus 5% to 6.5% annually over the investment cycle, with t he possibility of a loss of 20% to 30% over a 12-month period (6)

14. Do you anticipate any major expenditures in the next five years which may require liquidation of all or part of your investments? (Choose one) Point Value _____ a. � Yes (0)b. � No (4)

TOTAL POINTS FOR PAGE 5 _____TOTAL POINTS FOR PAGE 6 _____TOTAL POINTS FOR PAGE 7 _____

TOTAL POINTS FOR QUESTIONNAIRE _____

After you have added your total points on this questionnaire, please turn to page 8 to determine the Investor Profile Category appropriate for you, based on the point total listed above.

The following three questions concern the guidelines and constraints for your portfolio.

1. Do you want your investments to only include highly recognized company names? (Choose one)a. � Yes, only recognized companiesb. � Yes, only recognized companies for some of my portfolioc. � No preference

2. What is your preference in regard to the bond quality in your portfolio? (Choose all that apply)a. � U.S. governmentb. � Highly rated corporate bondsc. � Highest yielding bonds, regardless of riskd. � No preference

3. Are there any companies or industries in which you prefer not to be invested (restrictions)?

Companies Industries

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PART III: INVESTOR PROFILE CATEGORY

To determine your Investor Profile Category, follow these simple steps.

1. What is your INVESTMENT TIME FRAME? Refer to the answer in question 2 on page 5, which was years.

2. What is your Questionnaire POINT TOTAL from page 7? points.

3. Refer to the chart below to locate your corresponding INVESTOR PROFILE CATEGORY.

Under 2 years 2-3 years 4-5 years 6-7 years 8+ years Profile Allocation to Allocation Equities % Targets %

5-35 points 5-25 points 5-20 points 5-15 points 0-10 points 1 Up to 151 15/85

36+ points 26-45 points 21-35 points 16-25 points 11-20 points 2 15-45 30/70

46-65 points 36-45 points 26-35 points 21-30 points 3 30-50 40/60

65+ points 46-55 points 36-45 points 31-40 points 4 40-60 50/50

56-65 points 46-55 points 41-50 points 5 55-75 65/35

65+ points 56-65 points 51-60 points 6 70-90 80/20

65+ points 60+ points 7 90-100 90/10

4. What is the Profile RISK LEVEL?Risk is defined as the maximum loss in market value over any consecutive 4-quarter period. What is the risk percentage range of the Investor Profile Category identified in question 3 above? % - %

Profile Risk Level 1 1%-5% Profile Risk Level 2 3%-6% Profile Risk Level 3 4%-8%Profile Risk Level 4 8%-12% Profile Risk Level 5 10%-15% Profile Risk Level 6 14%-20%Profile Risk Level 7 20%-30%

5. I have answered the Investor Profile Questionnaire and I have reviewed the description of the identified Investor Profile Category. The Profile that best matches my investment criteria is:

� 1 � 2 � 3 � 4 � 5 � 6 � 7

1. Allocation to equities may be up to 30% for the corresponding CHOICE Fund Model. Please speak with your Investment Advisor Representative for additional information.

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PART IV: CLIENT ACKNOWLEDGEMENT

By completing and signing this client acknowledgement, I acknowledge that I have read and understand the Investor Profile Questionnaire and that myanswers are true and correct to the best of my knowledge. I further acknowledge and agree that the Investor Profile Questionnaire does not make or implyany guarantee of the achievement of my investment objectives. I understand that if my selected asset allocation model differs from my profiled asset allocation model, this model carries with it a different risk / reward scenario than that of my profiled model and may conflict with one of more of my responses. I will speak with my Investment Advisor Representative for more information and to discuss possible concerns.

For Corporate, Partnership, Trust, For Individual Clients:Employee Benefit Plan or Other Entity Client:

(Print Name of Entity) (Print Name)

Date / / (Authorized Name) (Signature)

Date / / If Fiduciary, Indicate Title (Signature)

Title (Print Name of Joint Client, if any)

Date / / (Signature of Joint Client, if any)

If Fiduciary, Indicate Title (Authorized Name)

Date / / (Signature)

Title

This section is for Home Office use only.

Investment Advisor Representative Name Kovack Advisors, Inc. Principal Name

Date / / Date / / (Signature) (Authorized Signature)

IMPORTANT: Clicking on the CLEAR FORM button will delete all information.

INVESTOR PROFILE QUESTIONNAIRE - kovackadvisors.com

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