Piedmont Street Management: Registered Investment Adviser
85 Piedmont Street
San Francisco, CA 94117
(415) 731-2944
JimEyres@pstmgt.com
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Background & Credentials Our Approach Topics to Consider Questionnaire
Questionnaire

Personal Financial Questionnaire and Information Checklist


For each person (married couples or domestic partners may answer jointly):

  • Name(s)
  • Social Security Number(s)
  • Date(s) of birth
  • Citizenship
  • Employer(s)
  • Home address
  • Home telephone and fax
  • Business phone(s) and fax(es)
  • Email address(es)

For each child/dependent:

  • Name(s)
  • Date(s) of birth
  • SSN(s)
  • Dependency and health status

We will need to discuss your personal financial goals and concerns: retirement, education, special purchase, pay off large debt, and others.


We will need to discuss any of the following that may apply to you:

  • Home ownership and mortgage
  • Vacation or other real property
  • Cash and savings accounts
  • 401k accounts
  • Keogh or other retirement accounts
  • IRA accounts
  • Deferred compensation accounts
  • Stock options
  • Other investments

Please provide copies of following documents, as applicable:

  • Income tax returns, federal and state, for latest year
  • Estimated income tax for this year
  • Pay stub
  • Will
  • Family trust document
  • Brokerage account statements
  • Latest 401K or SEP statement
  • IRA statements
  • Mutual fund statements
  • Latest pension or retirement statement
  • Savings account statements
  • Limited partnership statements
  • Credit card statements
  • Statements of any other debts
  • Life insurance policy statement(s)
  • Declarations page of all other insurance:
    • Life
    • Health
    • Homeowners
    • Auto
    • Excess Liability
    • Divorce decree
    • Prenuptial agreements

We need to estimate your cash flow. Please estimate how much you spend each month on each of the following:

  • Rent or mortgage payment
  • Transportation
  • Food and beverages
  • Clothing
  • Furnishings
  • Personal care
  • Cash expenditures
  • Medical
  • Insurance premiums
  • Debt and installment payments
  • Entertainment
  • Vacations and holidays
  • Charitable contributions
  • Utilities


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