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The purpose of this document is to assist you in providing input to I P E X, so that I P E X can recommend an asset allocation that is suitable for your needs. There are no right or wrong answers to any of the questions. In many instances, you may not have an opinion on a particular issue. That is fine. Feel free to leave a question blank if you do not have an opinion. This document is designed simply to make I P E X aware of areas in which you do have an opinion that I P E X should consider in recommending an asset allocation.Regardless of how many questions you leave blank please return this form. Thank you.

Should you have any questions concerning this form, please do not hesitate to contact us at: 888 IPEX-USA

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Person Completing Form:
   
 
 
1. What is the purpose of your Investment Program?
   
 
 
2.  What is the time horizon for your investment program?
 
Short-Term
 
Medium-Term
 
Long-Term
 
 
3. How much cash to do you feel that you need to maintain in your account for liquidity purposes, in order to cover potential distributions over a 12 month period? Please answer with a percentage
   
 
 
Distributions
   
 
 
 
+Expenses
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
+Inflation
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
How often do you conduct surveys?
 
Weekly
 
Monthly
 
Quarterly
 
Annually
 
 
 
Return Objectives
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