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Ruggiero Investments– Applications
(800) 777-4726
Ruggiero Investments– Applications
IRA
(Individual Retirement Account or Rollover a 401k into a Qualified Plan)
Step
1
of
9
11%
IRA
Client Name
(Required)
Home Address:
(Required)
your Home Address
Mailing Address:
(Required)
your Mailing Address
Social Security
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Age
(Required)
Mother’s Maiden Name:
(Required)
U.S Citizen:
(Required)
Yes
No
Dual Citizen:
(Required)
Yes
No
Marital Status
(Required)
Single
Married
Divorced
Widowed
Children
Yes
No
If so, How Many
Please enter a number greater than or equal to
1
.
Cell #
(Required)
Home #
(Required)
Email Address:
(Required)
Government ID / Driver’s License #:
State
(Required)
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Issue:
(Required)
MM slash DD slash YYYY
Expiration:
(Required)
MM slash DD slash YYYY
Employer:
Are you Owner:
(Required)
Yes
No
Type of Business:
(Required)
Title:
(Required)
Employer Address:
(Required)
Your Employer Address
Do you have Health Insurance Coverage:
(Required)
Yes
No
Do you have an employer sponsored ERISA plan:
(Required)
Yes
No
Business Owner
Value of the Business:
$100k-$500k
$500k–$1 Mill
$1 Mill-$5 Mill
$5 Mill - $25 Mill
N/A
How Many employees do you currently have working for you:
01 – 10
11 – 50
51 – 100
100+
N/A
Do you offer Health Insurance Coverage to your employees:
Yes
No
N/A
Do you offer a 401k plan or similar employer sponsored ERISA plan
Yes
No
N/A
Assets
Annual Income:
1-$100k
$100k-$250k
$250k–500k
$500k-$1 Mill
$1 Mill- $5 Mill
$5 Mill+
Net Worth:
1-$100k
$100k-$500k
$500k-$1 Mill
$1 Mill- $5 Mill
$5 Mill- $25 Mill
$25 Mill+
Liquid Net Worth:
1-$100k
$100k-$500k
$500k-$1 Mill
$1 Mill- $5 Mill
$5 Mill- $25 Mill
$25 Mill+
Federal Tax Bracket:
10%
12%
22%
24%
32%
35%
37%
Bank Assets Checking: $
401 (k)
Profit Sharing: $
Pensions: $
Non-Qualified Investments: $
Alternatives: $
Other: $
Types of Investments
Please mark (Y/N) if you are invested in the current positions
Bonds
Yes
No
Stocks:
Yes
No
Mutual Funds
Yes
No
Index Funds / ETF’s:
Yes
No
UIT’s:
Yes
No
REITS’s:
Yes
No
Limited Partnerships
Yes
No
Structured Product:
Yes
No
Annuities
Yes
No
Variable:
Yes
No
Index:
Yes
No
Whole Life
Yes
No
Life Insurance
Type of Insurance
Term
Universal Index
Universal variable
Whole Life
Type of Insurance
Coverage Amount/ Death Benefit
(Required)
Payment
(Required)
Cash Value
(Required)
Real Estate
Primary Residence Market Value
(Required)
(PR) Mortgage Balance
(Required)
(PR) Mortgage Rate
(Required)
(PR) Equity in Home:
(Required)
Investment Property Market Value:
(Required)
(IP) Mortgage Balance
(Required)
(IP) Mortgage Rate
(Required)
(IP) Equity in Home:
(Required)
Investment Time Horizon:
0-5 Years
6-10 Years
10-20 Years
20 Years +
Years of Experience Investing
Mutual Funds
0-5 Years
6-10 Years
10-20 Years
20 Years +
Stocks
0-5 Years
6-10 Years
10-20 Years
20 Years +
Bonds
0-5 Years
6-10 Years
10-20 Years
20 Years +
ETF’s:
0-5 Years
6-10 Years
10-20 Years
20 Years +
Fixed / Index Annuities
0-5 Years
6-10 Years
10-20 Years
20 Years +
Variable Annuities
0-5 Years
6-10 Years
10-20 Years
20 Years +
REITS’s:
0-5 Years
6-10 Years
10-20 Years
20 Years +
Limited Partnerships
0-5 Years
6-10 Years
10-20 Years
20 Years +
Crypto
0-5 Years
6-10 Years
10-20 Years
20 Years +
Beneficiary
Beneficiary Information
Beneficiary Information / (TOD)
DOB
Percentage
Relationship to Owner
Primary (P)/ Contingent (C)
Actions
Edit
Delete
There are no
Beneficiaries.
Add Beneficiary
Maximum number of beneficiaries reached.
Bank Account Information:
Account Title
(Required)
Bank Name
(Required)
Routing #
(Required)
Account #
(Required)
Succession Planning
Yes
No Will
Power of Attorney
Yes
No
Health Care Proxy
Yes
No
Trust (Irrevocable / Revocable / Living):
Yes
No
Business Owner’s - Succession Plan:
Yes
No
Business Owner - Buy/ Sell Agreement:
Yes
No
Name of your Lawyer
Phone
Name of your CPA
Phone
Risk Questionnaire
Estimated Amount to be invested with Ruggiero Investments:
1-$100k
$100k-$250k
$250k–500k
$500k-$1 Mill
$1 Mill- $5 Mill
$5 Mill+
TBD
Desired Retirement Age:
Before 65
65 – 70
71 – 75
75 +
Already Retired
Never
N/A
Desired Monthly/Annual Income: $
$1-$50k
$50k-$100k
$1000k–250k
$250k-$500k
$500k – 1 Mill
$1 Mill+
N/A
Select the following type of accounts that are being opened:
Individual
Joint
Custodial
Guardianship
Trust
Corporate
LLC
Non-Profit
Qualified (IRA, Rollover, SEP, Pension, 401k, etc.)
Charitable Foundation
Other
I expect to start drawing income:
Immediately
Within 5 years
In 5-10 years
In 10-20 years
Not in the foreseeable future
When do you first expect to access the principal amount?
Within 3 years
Between 3-5 years
Between 5-15 years
Not in the foreseeable future
What is your most important objective?
Safety is a concern
Some risk and preservation of principal
Some growth but will accept fair risk for market returns
Growth and will accept greater risk for higher returns
Which approach below best describes how you would like to invest to achieve your goal?
Conservative: Seek lower levels of risk. Current income or in the future with long-term growth
Moderately Conservative: Seek current income with long-term growth as secondary with some risk
Moderate: Seek both growth and income and accept moderate risk
Moderately Aggressive: Seeking long-term growth with income as a secondary goal & will accept above-average level of risk
Aggressive: Long-term growth with higher levels of risk and income not a priority
Are you currently working with a Financial Advisor:
Yes
No
Other
What brings you to Ruggiero Investments:
Leaving an employer
Retirement
Life Changing Situation
Passing of a loved one
Looking to Start Investing
Review Current Portfolio
Change Financial Advisor
Other
Investment Risk Assessment Scorecard
Rate each question from 1-5 based on the client's responses to determine their overall risk tolerance. Use the following scale:
Question 1
When do you plan to retire?
Answer (Plan to Retire)
1-5 Years
6-10 Years
11-15 Years
10-20 Years
21 Years+
Score (Plan to Retire)
1
2
3
4
5
Question 2
Looking ahead to the next five years, which of the following statements best describes your outlook?
Answer (Looking ahead 5 years)
I may be laid off or plan to retire
My annual income will likely to reduced
My annual income tends to greatly fluctuate
My annual income will not likely change
My annual income will most likely increase a steady rate
Score (Looking ahead 5 years)
1
2
3
4
5
Question 3
Do you have enough non-retirement assets to cover expenses for
Answer (Non retirement asset)
One month or less
2-3 months
4-6 months
6 months to 1 year
More than 1 year
Score (Non retirement asset)
1
2
3
4
5
Question 4
Please rate you tolerance for investment risk
Answer (tolerance for investment)
Very Low
Moderately Low
Average
Moderately High
Very High
Score (tolerance for investment)
1
2
3
4
5
Question 5
If you were to invest $100,000 over a 5- year period, which of the following best/ worst case scenarios would you be willing to accept?
Answer (invest $100k over 5 year)
$110
000 best / $100
000 worst
$120
000 best / $98
000 worst
$150
000 best / $90
000 worst
$180
000 best / $70
000 worst
$200
000 best / $50
000 worst
Score (invest $100k over 5 year)
1
2
3
4
5
Question 6
When you learn the value of your investments dropped 30% you:
Answer (Value dropped 30%)
Sell immediately
Sell if it drops further
Wait until the value returns and then sell
Continue to hold for a long time
Buy more
Score (Value dropped 30%)
1
2
3
4
5
Notes
Choose advisor
(Required)
Thomas A Ruggiero
Thomas W Ruggiero
Christopher T Ruggiero
Matthew Cianci
Donald B Johns
No Advisor Currently
Other
Please specify:
Δ
Ruggiero Investments, LLC
IRA
Questions about your application?
(800) 777-4726
