Answering the following questions can help you establish an asset allocation mixture consistent with your financial objectives, comfort level with various types of financial instruments and general risk temperament. As you answer each of the following 12 questions, remember your specific financial objective, and be sure to fill out a separate questionnaire for each. There are no right or wrong answers, rather your responses should reflect your investment perspective. Once you submit your answers, a potential asset allocation model, based on your responses, will pop up online. Then, for a more comprehensive financial analysis, contact your Modern Woodmen representative.

Financial Objectives

Funding an Insurance Contract Enhancing Retirement Accumulation Funding Education Accumulating Wealth Special Goal

Select the answer that best suits the financial objective you selected:

1.	My age group is

65 and Up  55 - 64  45 - 54  31 - 44  30 or Under

2.	I have _____ dependents, including grown children and elderly parents, who depend on me financially.

4 or More  3  2  1  0

3.	I intend to maintain the investment for _____ years in order to satisfy this financial objective.

Less than 5 years  5-10 years  11-15 years  More than 15 years

4.	Which best describes the time period during which you anticipate withdrawing funds from the investment?

One lump sum  1-5 years  6-10 years  11-15 years  More than 15 years

5.	What amount of cash reserves do you have to set aside for emergencies (a period of unemployment, major health problem, large home repairs, etc.)?

Less than 3 months' income  3-6 months' income  More than 6 months' income

6.	A. Which of the following financial instruments have you had experience with? (Check all those that apply.)

Savings Accounts, CDs, Money Market Accounts  U.S. Government Bonds or High Quality Corporate Bonds  High Yield Corporate Bonds (lower credit quality bonds)  U.S. Large Company Stocks  U.S. Small Company Stocks  International Stocks and Bonds

6.	B. Which of the following financial instruments would you be willing to invest in? (Check all those that apply.)

Savings Accounts, CDs, Money Market Accounts  U.S. Government Bonds or High Quality Corporate Bonds  High Yield Corporate Bonds (lower credit quality bonds)  U.S. Large Company Stocks  U.S. Small Company Stocks  International Stocks and Bonds

7.	The graphs below show the range of return on four hypothetical portfolios over the last 10 years. Which would you be the most comfortable with?

Portfolio A  Portfolio B  Portfolio C  Portfolio D

8.	From the chart below, which portfolio would you likely choose for your financial objective?

Portfolio A - average annual rate of return of 4%; annual return with      minimal fluctuations  Portfolio B - average annual rate of return of 6%; annual returns two-thirds of      the time fluctuate between -3% and 15%  Portfolio C - average annual rate of return of 10%; annual returns two-thirds      of the time fluctuate between -9% and 31%  Portfolio D - average annual rate of return of 12%; annual returns two-thirds      of the time fluctuate between -21% and 47%

9.	What are you most concerned with?

Preserving capital  Providing additional income  Providing a combination of income and capital growth  Providing strong capital growth

10.	At what level do you want your investment to keep pace with inflation over the long term?

I prefer to keep pace with the rate of inflation.  I prefer to moderately outpace the rate of inflation.  I prefer to significantly outperform the rate of inflation.

11.	If you invested $10,000, and the investment grew to $14,000 in the second year, but declined to $9,000 following the end of the current year, which mostly matches your expected reaction?

I would sell this investment from my portfolio.  I would sell some of this investment and look for other options in which to invest.  I would not do anything and maintain my current position.  I would buy more of this investment.

12.	What do you expect for an average annual rate of return?

Less than 6%  6-8%  9-12%  More than 12%

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