Investor Risk Profile Questionnaire

Registration Type

Registered Retirement Savings Plan (RRSP) Retirement Income Fund (RIF) Prescribed Retirement Income Fund (PRIF) Tax-Free Savings Account (TFSA) Life Income Fund (LIF) Restricted Life Income Fund (RLIF) Registered Education Savings Plan (RESP) Locked-In Retirement Savings Plan (Locked-In RSP) Restricted Locked-In Retirement Savings Plan First Home Savings Account (FHSA) Locked-In Retirement Account (LIRA) Non-registered Account

Your Personal Information

Name * Email *

Profession

Employer

Employer Since

Last Financial Planning Date

Last Will & Estate Planning Date

Financial Objectives *

Risk Assessment

Please select the option that best describes your situation for each question.

2.When do you plan to start withdrawing at least 25% of your savings? *

Less than 1 year 1 to 3 years 4 to 5 years 6 to 9 years More than 10 years

3.Over the next five years, you plan to: *

Withdraw principal on a regular basis (e.g. Home Buyers' Plan, retirement withdrawals) Withdraw all investment income plus some principal Withdraw all investment income, without touching principal Withdraw only part of the investment income Reinvest income to keep growing savings (no withdrawals)

4.What is your total annual income before taxes? *

$25,000 or less $25,001 to $35,000 $35,001 to $50,000 $50,001 to $100,000 $100,001 or more

5.What is your net worth? (Total assets minus total liabilities) *

$25,000 or less $25,001 to $50,000 $50,001 to $100,000 $100,001 to $200,000 $200,001 or more

6.Please describe your tolerance for investment risk.

Very low — I am not willing to risk losing money. My sole objective is to safely preserve capital and shelter it from market fluctuations.* Low — A drop in investment value would worry me, but I can tolerate an occasional decline of up to 5%, knowing it can lead to greater returns over the long term. Moderate — I am willing to accept a short-term decline of 5% to 10% in the value of my investments in exchange for higher long-term returns. Above average — I can accept a short-term decline of 10% to 20% in the value of my investments, knowing that over the long term the gains will offset this loss and produce higher returns. Very high — I am pursuing long-term growth. A 20% decline in the value of my investments within a year would not concern me.

* If you are not able to tolerate any loss of principal, please select an investment with no downside risk.

7.If you invested $10,000 for one year, what range of final values after one year would you find acceptable?

Gains only, between $10,000 and $10,300 Between $9,500 and $11,000 Between $9,000 and $11,500 Between $8,500 and $12,000 Between $8,000 and $12,500

* If you are not able to tolerate any loss of principal, please select an investment with no downside risk.

8.How would you describe your investment knowledge? *

Very low — I am just getting started with investing. Low — I know some investments are riskier than others. Moderate — I understand different types of investments and their risks (e.g. equities are riskier than bonds). Above average — I understand the return potential, risks, and how the value of these investments fluctuates over time. Very high — I follow the markets closely (equities, bonds, funds, real estate, etc.) and have in-depth knowledge of these investments.

Your Choice of Investments

Choice of Investments * Does your choice match the assessed risk profile? *

Yes No

Notes

Client Note Advisor Note

Confirmation

I confirm that the information provided above is true and complete, and I agree and understand that my answers will be used for an investment suitability assessment. *

I have reviewed this Investor Risk Profile result, confirm it is accurate, and confirm I have received a copy of this result. *

Client Signature (please type full legal name) *

Date *

City & Province of Signing *

Agent's Signature

BM Initials