Investment Policy Statement

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Personal Information

First Name

Last Name

Birthdate

Occupation

Income & Net Worth

Current annual household income

<$50,000

$50,000-$100,000

$100,000-$250,000

>$250,000

Liquid net worth (Excluding primary residence)

<$50,000

$50,000-$100,000

$100,000-$250,000

$250,000-$1,000,000

>$1,000,000

Any other significant illiquid assets to note? (Optional)

Annual liquidity needs/expected withdrawals

Any other significant financial info (large liabilities, concentrated investment positions, pending M&A, etc)? (Optional)

Investment Goals

Primary goals (retirement, college savings, etc)

Target annual return (aspirational)

Investment time horizon

Any expected major contributions or withdrawals to your account?

Risk Profile

Which of the following statements best describes your investment objectives?

My highest priority is to preserve my investments and I am willing to accept minimal return in order to do so

I seek to generate income from my investments and am interested in investments that have historically demonstrated a low degree of risk of loss of principal value

I seek to grow the principal value of my investments over time and, in pursuit of these gains, am willing to invest in securities that have historically demonstrated a moderate degree of risk to loss of principal value

I seek to accelerate somewhat the growth of the principal value of my investments over time and, in pursuit of these gains, am willing to invest in securities that have historically demonstrated a moderate to above average degree of risk of loss of principal value

I seek a significant appreciation of the principal value of my investments and, in pursuit of these gains, am willing to accept a greater degree of risk by investing in securities that have historically demonstrated a high degree of risk of loss of principal

How would you respond in the event of a decline in the value of your investments?

I would sell my investments immediately if they were to suffer substantial declines

Although declines in investment value make me uncomfortable, I would wait one to two quarters before adjusting my portfolio

I can endure significant declines in the value of my investments and would wait at least one year before adjusting my portfolio

Even if my investments were to suffer a significant decline over several years, I would continue to follow my long-term investment strategy and not adjust my portfolio

I would increase the amount invested in my portfolio in anticipation of an increase in value

Which of the following scenarios would make you more uncomfortable?

Making an investment and watching it decline in value

Selling an investment and watching it increase in value

How would you describe your level of knowledge with regard to finance and investing?

Minimal. I have very little interest in understanding finance and investing, or I have not had the opportunity to learn.

Low. I have basic knowledge of finance, such as understanding what stocks, bonds, and mutual funds are.

Medium. I have knowledge beyond basic products and I understand diversification and other financial and investing terminology and strategy.

High. In addition to understanding most financial products and terminology, I understand factors that affect the price of stocks and bonds.

Advanced. I have an in-depth knowledge of most financial products, including stocks, bonds, and options. I understand overall market risk as well as company specific risk.

Acceptable percentage of principal loss in a short term period? (less than 1 year)

Up to 5%

Up to 10%

Up to 15%

Up to 20%

More than 20%

Additional Information

Restrictions on the Account(s) (Optional)

Other Notes Regarding Client Background (Optional)

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TADPOLE INVESTMENTS LLC

Stamford, CT

gabriel@tadpoleinvest.com

DISCLAIMER: The information provided on this website does not constitute investment advice, financial advice, trading advice, or any other sort of advice. Nothing contained on this site should be construed as a recommendation to buy, sell, or hold any investment or security, or to engage in any investment strategy or transaction.