Confidential Investor Profile

Weber Asset Management, Inc

Confidential Investor Profile

This questionnaire is designed to help us develop a portfolio strategy which meets your specific investment goals.

All information supplied here will be held in strict confidence.

U.S. Securities and Exchange Commission guidelines require that we have a thorough understanding of your financial situation and investment experience. Therefore, please provide an answer for all the information requested.



Salutation:Dr.Mr.Mrs.Ms.






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Approximate initial amount to be managed:
$
1. Age:Spouse's Age:


2. Family status:SingleMarriedDivorcedWidowed




3. How many dependents rely on you for financial support?


4. Employment status:

You
Full-time employedNot employedPart-time employedRetired
Spouse
Full-time employedNot employedPart-time employedRetired
5. If still working, number of years to retirement:

You
Less than 22 - 55 - 1010 - 1515 plus
Spouse
Less than 22 - 55 - 1010 - 1515 plus


6. Over the past five years, what has been your general investment philosophy? (Choose a level from 1 to 5.)
Mostly conservative investments, which may limit growth of principal in order to reduce the risk of loss.Average level of risk.Mostly aggressive investments; higher-than- average risk of loss in the pursuit of higher-than- average profits.12345

7. To what degree does your investment portfolio provide current income to cover living and other expenses?

Extremely highHighModerately highLowNot at all



8. Your estimate of what your income will be this year:

$

Spouse's Income:$


9. Over the next five years, do you expect your annual income to:

Increase substantiallyIncrease somewhatRemain about the sameDecrease somewhatDecrease substantially


10. Over the next 5 years, do you expect your annual spending to:

Increase substantiallyIncrease somewhatRemain about the sameDecrease somewhatDecrease substantially


11. What is your approximate net worth (assets minus any debt owed)?

Exclude the value of your primary residence, and its mortgage, if any.

Debt exceeds assets$0—$100,000$100,000—$250,000$250,000—$500,000$500,000—$1,000,000$1,000,000—$1,500,000$1,500,000—$2,000,000$2,000,000—$3,000,000$3,000,000—$5,000,000$5,000,000—$8,000,000$8,000,000—$10,000,000over $10,000,000


12. Other than the money we will be managing, the approximate amount you currently have in:












13. What portion of your annual income are you able to save for investment purposes?

None1%-3%4%-7%8%-10%Over 10%
14. To help us evaluate your experience in investing and your comfort level with investments of various types, please complete the chart below.

The amount of experience and knowledge you have in each type of investment is (write the appropriate number for each type of investment):


(1) Little of None
(2) Some
(3) A Great Deal










15. Please describe any important facts which would change this picture of your financial situation (maximum of 1,000 characters):





1000 Characters remaining



It is often helpful for your accountant to know about the work we do for you. Please provide the following information so that we may communicate with him or her.

Accountant:
Address:

Phone ()

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