Periodic Review Survey

Contact Information

* Required fields

This field is required

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Status Changes

Family Status Change: (check all that apply)

Employment Status (check all that apply)

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Interests and Concerns

I would like information on or wish to discuss the following: (check all that apply)

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Protection and Insurance Coverage
Do you have a policy service request?
Do you need to review or change your current beneficiaries?
Would you like to convert a term policy to permanent insurance?
Would you like help calculating the proper amount of coverage?
Would you like a new quote for additional or different coverage?

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Asset Allocation
Have you changed your feelings about investing in the market?
Have your liquidity needs changed?
Has your time horizon for investing changed?
Do you feel that your assets are correctly allocated for your needs?
Would you like to explore other investment options?

* If the answer to any of these questions is yes, we should schedule an asset allocation analysis.This analysis is complimentary and a service to you as a valued client

Would you be interested in any of the following: (check all that apply)

Preparing or updating a financial strategy?
Tracking and evaluation of investments held elsewhere?
Submitting a Risk Tolerance Questionnaire to supplement this Periodic Review?
Submitting a Client Profile to supplement this Periodic Review?

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Has our firm delivered a level of service that would lead you to recommend us to a friend or family member?
May our firm use your name as a reference?

Other Issues and Concerns:

Please use the space provided to ask questions or raise issues not addressed in this checklist.
If you would like to recommend us to a business associate, friend or family member - please do so below:
May I use your name as a reference?
May I use your name as a reference?

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Follow Up
How often would you like to review and discuss your financial goals, objectives and progress?
Once a Quarter
Once a Year

Thank You!

I would like to take this opportunity to thank you for your continued trust and business, and for completing this Periodic Review Survey.

This survey is an affirmation of my commitment to help you meet your ongoing financial needs and providing a high level of personalized service.

This Periodic Review is designed to help determine the areas in which you have interests and concerns.It will allow me to update your files and service your needs more completely.Information provided will be kept in the strictest confidence.

GE-61007 (02/11)