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FinancialPLANNINGCONFIDENTIALFact FinderYour Name: DOB:Spouse: DOB:Address:City: State ZipHome Phone: Cell Phone:Your Email: Work Phone:Spouse Email: Work Phone:Referred By: Initial Appointment:SS# - -Spouse SS# - -Do either of you smoke or have health concerns?Client Y NSpouse Y NPhone: 317-841-0370Fax: 317-841-1471All securities through:Money Concepts Capital Corp., Member r.com

FAMILY INFORMATION SHEETChildren:NameSSN - - DOB / /NameSSN - - DOB / /NameSSN - - DOB / /NameSSN - - DOB / /Occupation:Client Job TitleYears EmployedEmployerPhoneEmployer's AddressCityStateZipIncome Spouse's Job TitleYears EmployedEmployerPhoneEmployer's AddressCityStateZipIncome Please bring the following items when you meet with your financial advisor. Completed "Your Financial Profile" worksheets. Latest paycheck stubs and bank statements. Latest Social Security statements (usually arrives 3 months prior to your birthday). All pertinent information regarding present investments such as stocks, bonds, mutual funds, certificates, annuities,etc. (i.e., maturity dates, yields, copies of investment statements). Latest employee benefit statements and booklets. Insurance policies or summary of coverage statements for: life, disability, automobile, home, major medical,nursing home, rental property, umbrella, etc. All pertinent information regarding mortgages or loans (i.e., original balance, current balance, interest rate, term,etc.), including credit card balances. Most recent income tax returns (up to three years if income has changed substantially). Copies of legal documents (i.e. wills, living wills, powers of attorney, trusts, prenuptial agreements, divorce decrees,etc.). Information on unique financial events or situations (i.e., major purchase, debt refinancing, expected inheritance,etc.). If applicable, business financial statements and tax returns for last two years, articles of incorporation, buy/sellagreement, and group benefit employee package. All pertinent information regarding assets owned by dependent children or parents, that will be used to meet goals.Pg. 2Circle Financial Planning, Inc. 317-841-0370

OBJECTIVES & PRIORITIESThe basic purpose of a Financial Plan is to help an individual or family to achieve their personal financial goals andobjectives, within the reasonable constraints of their earning capacity and current financial position. One of the mostimportant steps in this process is the initial identification of specific financial priorities. The financial priorities of mostpeople can generally be classified into two broad categories: short-term and long-term objectives.Please take a moment to rank your personal and family priorities by completing the exercise below. Rank your objectives bynumbering each item starting with 1 as the most important. This list is by no means all-inclusive, so please feel free to add anyobjectives that are important to you.Short-Term ObjectivesMFLong-Term ObjectivesMFFamily income protectionA comfortable retirementReduce current monthly debt loadEducation fundingDevelop short-term liquid emergency fundReduction of tax liabilitiesIncrease overall yield on savings & investmentsEstate PlanningOtherOtherOtherOtherHow much can you set-aside on a regular basis to meet your objectives? How many paychecks do you receive each year?How many paychecks does your spouse receive each year?1224122624522652If you were going to change anything in your current financial situation, what would you change?What is the most important thing we can help you with?If we were meeting here three years from today-and you were to look back over those three years to today, whathas to have happened during that period, both personally and professionally, for you to feel happy about yourprogress?To complete a financial plan, the following items must be available to us in our first interview:1.2.3.4.5.6.7.8.Company Pension Plan (Amounts & Documentation)Company Savings Plan (SEP, 401(k), etc.)Personal & Group Insurance (Client, Spouse, Children)Investments (Stocks, Bonds, Mutual Funds, Limited Partnerships)Other Investments (Real Estate, Hard Assets, etc.)Most recent tax returns (up to three years if income has changed substantially)Do you have a will? (Circle one)YES NODoes your spouse have a will? (Circle one) YES NOCircle Financial Planning, Inc. 317-841-0370Pg. 3

PERSONAL BALANCE SHEETWhat You Own: (Assets)Cash*:Checking AccountSavings AccountCertificate of Deposits (CD's)Money Market FundsLife Insurance Cash ValueSecurities*:StocksBondsMutual Funds AnnuitiesOther InvestmentsOther Property:Automobile #1Automobile #2Household FurnishingsArt & CollectiblesClothing & FursJewelryOther PossessionsReal Estate:HomeOther PropertiesRetirement Plans*:401kIRAPensionKeogh, SEP, SARSEPTSA Other Assets:Equity in BusinessDirect Participation Programs TOTAL ASSETS: * Please bring most recent statements for each account.Pg. 4Circle Financial Planning, Inc. 317-841-0370

PERSONAL BALANCE SHEETWhat You Owe: (Liabilities)Mortgages/LoansHomeHome EquityOther PropertiesAutomobile #1Automobile #2EducationOther DebtsLife Insurance LoanCredit Cards:VisaMasterCardAmerican ExpressDiscoverDepartment StoreTaxes (if in arrears):FederalStateLocalTaxes on InvestmentsOtherOther Liabilities:AlimonyChild SupportOtherTOTAL LIABILITIES:Balance InterestRateR e m a ining T e rm /T e rm ina t io n D a t eMonthlyPayment%%%%%%%%%%%%% Circle Financial Planning, Inc. 317-841-0370Pg. 5

MONTHLY CASH FLOWExpensesMonthlyHousing ExpenseMortgage #1 (Principal/Interest or Escrow)Mortgage #2 (Principal/Interest or Escrow)Utilities (Gas, Electric, Phone, etc)InsuranceProperty TaxesHousing Subtotal tenanceTransportation Subtotal Medical ExpensesMedicalDentalDrugsInsuranceOtherMedical Subtotal Child CareFood & BeverageClothingFurnishingsPersonal Care & CashEducation/Self-ImprovementPersonal Debt PaymentEntertainmentVacations & HolidaysCharitable ContributionsOther TOTAL EXPENSES Additional Monthly Savings Gross Income *Income (client)Income (spouse)Pensions & AlimonySocial Security (client)Social Security (spouse)Rental PropertyOther (bonus, trust, settlement, etc.) TOTAL INCOME: * Tax returns & three most recent paystubs preferredPg. 6Circle Financial Planning, Inc. 317-841-0370

INSURANCE QUESTIONNAIRE1.2.3.4.5.Do you have life insurance through work?MaleFemale Yes NoAmount Yes NoAmountCan you purchase additional life insurance through work?MaleFemale Yes NoMaximum Yes NoMaximumDo you have disability insurance through work?MaleFemale Yes NoAmount Yes NoAmountCan you purchase disability insurance through work? (If so, please provide plan with details.)MaleFemale Yes No Yes NoIf you own personal life or disability insurance policies, please provide the following ficiaryDeathBenefitAnnualCostCurrentCash ValueIssueDateWhat company provides your homeowner and auto insurance?Do you have Long Term Care Insurance? (If so, please provide company and policy information.)MaleFemale Yes NoCompanyCoverageCost/month Yes NoCompanyCoverageCost/monthDo you have an umbrella liability policy?MaleFemale Yes NoCompanyCoverageCost/month Yes NoCompanyCoverageCost/monthIf you own a business, do you have any type of business continuation or buy/sell plan?MaleFemale Yes No Yes NoCircle Financial Planning, Inc. 317-841-0370Pg. 7

RISK PROFILE1.When do you expect to begin withdrawing money from your investment account?M F 2.M F Less than 1 year 1 to 2 years 3 to 4 years 5 to 7 years 8 to10 years 11 years or moreOnce you begin withdrawing money from your investment account, how long to you expect thewithdrawals to last?M F 3.M F I plan to take a lump sum distribution 1 to 4 years 5 to 7 years 8 to 10 years 11 years or moreInflation, the rise in prices over time can erode your investment return. Long-term investors should beaware that, if portfolio returns are less than the inflation rate, their ability to purchase goods andservices in the future might actually decline. However, portfolios with long-term returns that significantlyexceed inflation are associated with a higher degree of risk. Which of the following portfolios is mostconsistent with your investment philosophy?M F4. Portfolio 1 will most likely exceed long-term inflation by a significant margin and has a highdegree of risk.Portfolio 2 will most likely exceed long-term inflation by a moderate margin and has a highto moderate degree of risk.Portfolio 3 will most likely exceed long-term inflation by a small margin and has a moderatedegree of risk.Portfolio 4 will most likely match long-term inflation and has a low degree of risk.Portfolios with the highest average returns also tend to have the highest chance of short-term losses.The table below provides the average dollar return of four hypothetical investments of 100,000 andthe possibility of losing money (ending value of less than 100,000) over a one-year holding period.Please select the portfolio with which you are most comfortable.Probabilities After 1 CDPossible Avera ge Value at theEnd of One Year 106,000 107,000 108,000 109,000Chance of Losing Money at theEnd of One Year16%21%25%28%M F Pg. 8 Option AOption BOption COption DCircle Financial Planning, Inc. 317-841-0370

RISK PROFILE5.Investing involves a trade-off between risk and return. Historically, investors who have received highlong-term average returns have experienced greater fluctuations in the value of their portfolio andmore frequent short-term losses than investors in more conservative investments have. Consideringthe above, which statement best describes your investment goals?MF Protect the value of my account. In order to minimize the chance for loss, I am willing toaccept the lower long-term returns provided by conservative investments. Keep risk to a minimum while trying to achieve slightly higher returns than the returnsprovided by investments that are more conservative. Balance moderate levels of risk with moderate levels of returns. Maximize long-term investment returns. I am willing to accept large and sometimesdramatic fluctuations in the value of my investments. 6.7.8.Historically, markets have experienced downturns, both short-term and prolonged, followed by marketrecoveries. Suppose you owned a well-diversified portfolio that fell by 20% (i.e. 1,000 initialinvestment would now be worth 800) over a short period, consistent with the overall market.Assuming you still have 10 years until you begin withdrawals, how would you react?MF I would not change my portfolio.I would wait at least one year before changing to options that are more conservative.I would wait at least three months before changing to options that are more conservative.I would immediately change to options that are more conservative.The following graph shows the hypothetical results of four sample portfolios over a one-year holdingperiod. The best potential and worst potential gains and losses are presented. Note that the portfoliowith the best potential gain also has the largest potential loss. Which of these portfolios would youprefer to hold?MF Portfolio APortfolio BPortfolio CPortfolio DI am comfortable with investments that may frequently experience large declines in value if there isa potential for higher returns.M F Agree Disagree Strongly DisagreeCircle Financial Planning, Inc. 317-841-0370Pg. 9

RISK PROFILE9.10.11.12.Pg. 10To what extent do you actively follow the markets?MF Not at allSomewhatFairly closelyVery closelyHow many years do you have until retirement?MF Already Retired5 years or less5 to 10 yearsOver 10 yearsOver the next several years, do you expect your household annual income to:MF Stay about the sameDecrease moderatelyGrow moderatelyDecrease substantiallyGrow substantiallyBy what percentage do you expect your portfolio to grow annually over the long-term: 10 years?MF 4% to 6%6% to 8%8% to 10%10% to 12%12% to 14%14% to 16%Signature:Date:Signature:Date:Circle Financial Planning, Inc. 317-841-0370

NOTESCircle Financial Planning, Inc. 317-841-0370Pg. 11