IAS Request Form

Welcome to JMMB's Investment Advisory Services. Please complete this brief information request form. It only takes a few minutes, and with your inputs we will be able to craft a custom investment portfolio for you! All information is kept strictly confidential! Please complete as much information as possible. Thank you!

Please enter N/A in those fields which do not apply to your circumstances.
DEMOGRAPHIC INFORMATION	Monday, February 06, 2012
*Are You Currently a JMMB Client?
*Your Gender:	Male Female Joint/Both
*Your Last Name:
*Your First Name:
*Your Middle Name (or initial):
*Which title do you prefer?
*Address:
*City, Parish:	,
*Code:	E.g. "10" if it is in Kingston 10
*Home Phone:
*Work Phone:
*Cellular Phone:
*Best Time to Contact You:
*Date Of Birth:	"01-Dec-1969"
*Email Address: E.g., me@yahoo.com	* Must be correct format.

In the remainder of this questionnaire you will be asked questions relating to your financial status and investment goals. It is very important that the information on this form be consistent. Thus, if you are pursuing your financial goals jointly with someone else, please respond to all the questions on this form based on your joint status.

CLIENT'S CURRENT FINANCIAL STATUS
*Number of JMMB accounts?:
*Please check all that apply:	Cheqmate SaveSmart SureInvestor TaxShelter
*Approx. how much do you have invested at JMMB ?:	(JA$ equiv.)
*Approx. how much do you have invested at other institutions ?:	(JA$ equiv.)
*Do you currently rent or own your primary residence?:	Rent Own
*Primary Residence Property Type:
*Monthly Payment on Primary Res:	(JA$ equiv.)
*What is your initial investment avail:	($Round up)
*Currently, my emergency fund has:	No Money less than 6 Months Salary greater than 6 Months Salary
*No. of Dependents by age range:	< 5, 5-18, 18-60, >60
*Monthly investment amount available:	(JA$ equiv.)

SETTING INVESTMENT GOALS

Please List Your Investment Goals In Rank Order

Rank	Goal	Timeframe (Yrs)	Amount Needed (JA$)	Description
1st Priority
2nd Priority
3rd Priority
4th Priority

CLIENT'S PERSONAL RISK TOLERANCE
Select which of these three portfolio management styles is most comfortable to you?:
*I/We prefer an investment portfolio that has returns that are practically assured, and has little chance of falling below its original value.:	Conservative, (Low risk)
*I/We prefer an investment portfolio that is expected to yield high returns, but may have moderate fluctuations in value.:	Moderate, (Medium risk)
*I/We prefer an investment portfolio that is expected to yield very high returns, but may have significant fluctuations in value.:	Aggressive, (High risk)
*How would you describe your comfort level of financial knowledge?

Please inform me of other JMMB services in the future