Know Your Client Information: Client Number Client Name Consultant Number Consultant Name

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Know Your Client Information

Client Number Client Name

Consultant Number Consultant Name

Date Printed: ________________________


Gross Annual Personal Income of Applicant
under $25,000 $25,000 - $49,999 $50,000 - $74,999 $75,000 - $99,999
$100,000 - $124,999 $125,000 - $200,000 over $200,000
Personal Net Worth of Applicant
under $20,000 $20,000 - $34,999 $35,000 - $59,999 $60,000 - $99,999
$100,000 - $199,999 $200,000 - $499,000 $500,000 - $999,999 over $1,000,000
Investment Knowledge
novice fair good excellent
Other Investments Ever Held (To update select ALL that apply)
bonds mortgages stocks mutual funds term deposits real estate

Plan Number Plan Type


Investment Objectives
safety income balanced growth aggressive growth speculation
Investment Time Frame/Liquidity
0 - 1 yrs 1 - 3 yrs 3 - 5 yrs 5 - 10 yrs 10 - 20 yrs 20+ yrs
Risk Profile/Tolerance
low medium medium-high high

Plan Number Plan Type


Investment Objectives
safety income balanced growth aggressive growth speculation
Investment Time Frame/Liquidity
0 - 1 yrs 1 - 3 yrs 3 - 5 yrs 5 - 10 yrs 10 - 20 yrs 20+ yrs
Risk Profile/Tolerance
low medium medium-high high

Plan Number Plan Type


Investment Objectives
safety income balanced growth aggressive growth speculation
Investment Time Frame/Liquidity
0 - 1 yrs 1 - 3 yrs 3 - 5 yrs 5 - 10 yrs 10 - 20 yrs 20+ yrs
Risk Profile/Tolerance
low medium medium-high high

I agree that the above ’Know Your Client’ information, as amended, is complete and accurate.

Client Signature x ______________________________________________________ Date __________________________________

Consultant Signature x __________________________________________________ Date __________________________________

Regional Director Signature x_____________________________________________ Date __________________________________

C3250 (06/2005-PW) TMTrademark owned by IGM Financial Inc. licensed to its subsidiary corporations.

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