PERSONAL WEALTH QUESTIONNAIRE

Morgan Stanley Smith Barney LLC.

The Personal Wealth Analysis represents a com-prehensive picture of your current wealth planning circumstances and suggestions for improvement. It begins with the Personal Wealth Questionnaire.

Please complete the Questionnaire as fully as possible. Information is the lifeblood of the planning process. The quality and range of the suggestions will only be as good as the comprehensiveness of the picture: The more we know about you and your family, your objectives and resources, and your charitable com-mitments, the better we can offer recommendations for fulfilling those objectives in as appropriate and tax efficient a manner as possible.

There are no “shortcuts” to completing the Questionnaire. But you may choose to give summary or total amounts where indicated (e.g., the shaded lines for “Total Income” and “Total Expenses” in the Cash Flow Information section). And you may elect only to number a few priorities in the various sections asking about objectives (e.g., the section on Estate and Charitable Planning Information).

To help us construct the most accurate representa-tion, please submit copies of the following with this Questionnaire:

• Your previous year’s tax return

• Your will and living trust, if any

• Financial statements from brokerage firms and banks

• Benefit statements concerning your retirement plans

If you have not already done so, please provide a biographical outline for you and your family, high-lighting:

• Information about your family origins(parents and grandparents)

• Influential factors in growing up

• Education

• Activities

• Positions held (vocational and avocational)

• Current board memberships (for profit and nonprofit)

• Sources of wealth

Once your Personal Wealth Questionnaire has been completed, your Financial Advisor will arrange a meeting to review current circumstances and any proposals.

Personal Wealth QuestionnairePERSONAL INFORMATIONClient Name Date of Birth U.S. Citizen?

� Yes � No

Social Security Number (mandatory) Lead Account Number (to be completed by Financial Advisor)

Address

Phone Fax

E-Mail Address

Occupation and Title

Business Address

Life Status� Single � Married � Divorced/Widowed � Significant Other

Co-Client Name Date of Birth

Social Security Number U.S. Citizen?� Yes � No

Address (if different from above)

Phone Fax

E-Mail Address

Occupation and Title

Business Address

FAMILY INFORMATIONNames of Children Date of Birth Dependent? State of Residence Emotional Maturity* Financial Maturity*

� Yes � No

� Yes � No

� Yes � No

� Yes � No

Names of Grandchildren Date of Birth Dependent? State of Residence Emotional Maturity* Financial Maturity*

� Yes � No

� Yes � No

� Yes � No

� Yes � No

* Please assess the emotional and financial maturity of family members (1 - 5; 1 = lowest, 5 = highest). 5837 (10/2009) p. 1 of 13

FAMILY INFORMATION (CONTINUED)Are all family members in good health?

� Yes � NoIf No, please explain:

Does any family member have a special need?� Yes � No

If Yes, please explain:

Are any family members or relatives (other than co-client and children) dependent on you for support now, or likely to need support in the future? � Yes � No

If Yes, please explain:

Do you have alimony or child support obligations?� Yes � No

If Yes, please explain:

Do you have any special concerns due to current or prior marriage of a family member? � Yes � No

If Yes, please explain:

While married, have you ever lived in a community property state?� Yes � No

If Yes, what state?

Do your children know the history of your family in significant detail? _______________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Do you regularly engage in discussions about what’s important to your family and about your family’s values? __________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________

Do you have a family mission statement? _________________________________________________________________________________________

Have you held or do you hold regular family meetings or retreats? ________________________________________________________________________

Are you or is any member of your family in an occupation or profession which is frequently the target of lawsuits? _______________________________________

Do you have adolescent or older children who drive and are listed on your automobile policy? ______________________________________________________

Do you have a swimming pool at your home (or any of your residences)?_____________________________________________________________________

5837 (10/2009) p. 2 of 13

Do you have a home on the ocean (or in a recognized flood plain)?___________________________________________________________________________

Do you own real estate (e.g. a second or vacation home) in another part of your state or in another state? ______________________________________________

Do you have an office in your home? _______________________________________________________________________________________________

Do you employ domestic workers in any capacity? ______________________________________________________________________________________

Are you planning any major renovation or expansion of your residence? _______________________________________________________________________

Do you engage in any hobbies or activities that may cause harm to yourself or to someone else?______________________________________________________

Are you on the board of a public company? __________________________________________________________________________________________

Are you on the board of a public charity? ___________________________________________________________________________________________

Have you hosted any charitable event in your home in the last months, or do you intend to host any such event? __________________________________________

Do you have a family office? _____________________________________________________________________________________________________

Do you have an investment partnership; or do you invest directly in your own private equity? ________________________________________________________

5837 (10/2009) p. 3 of 13

ADVISORSMorgan Stanley Smith Barney Financial Advisor Branch #

Accountant Phone

Address

Attorney (Trusts & Estates) Phone

Address

Private Banker Phone

Address

Life Insurance Agent Phone

Address

Other Financial Advisor Phone

Firm

PLANNING CONCERNS AND OBJECTIVESAll planning should begin and end with your personal considerations and aims. To help us better understand yours, please number the following in order of their importance to you, with 1 signifying of greatest importance. If several are of equal concern, you may indicate that by giving the same number to those objectives. Likewise, if any are of little or no value to you, simply leave them numberless.

_________ Maintaining a comfortable lifestyle through my/our retirement years

_________ Minimizing Income Tax & Capital Gains Tax

_________ Generating adequate capital to run and grow my own business

_________ Positioning as many of my assets for my family as I can while mini-mizing Estate & Gift Tax

_________ Supporting my interests in and commitments to charitable causes

_________ Planning for business succession

_________ Protecting my family’s assets from creditors and litigation

_________ Optimizing the use of loans to maximize net worth _________ Diversifying large single stock and stock option positions, or other

liquid assets

_________ Ensuring that family members with special needs are well cared for

_________ Involving my children and grandchildren in philanthropic pursuits

_________ Beginning or adding to my art collection or dealing with other collectibles

_________ Creating a legacy that will help to keep my children and grandchil-dren productive

_________ Protecting the value of my assets using hedging techniques

5837 (10/2009) p. 4 of 13

ASSET SUMMARY

SUMMARY BALANCE SHEETTOTAL ASSETS: ____________ TOTAL LIABILITIES: ____________

Note: You may provide complete statements for all accounts in each of the following areas, in lieu of completing the section, but you must provide the information on ownership (C, S, J, CP).

CASH & CASH EQUIVALENTS (Use the worksheet on page 8 to enter holdings in a retirement account.)

Including checking, savings, money market, CDs Client (C) Co-Client Joint (J) Community Property (CP) Morgan Stanley Smith Barney Assets*

STOCKS, BONDS, MUTUAL FUNDS (Use the worksheet on page 9 to enter holdings in a retirement account.)STOCKS

Name # Shares Cost BasisDate of

AcquisitionCurrentValue Client (C) Co-Client Joint (J)

Community Property (CP)

Morgan Stanley Smith Barney

Assets*

BONDS

Name Face Amount % Cost BasisDate of

AcquisitionCurrentValue Client (C) Co-Client Joint (J)

Community Property (CP)

Morgan Stanley Smith Barney

Assets*

MUTUAL FUNDS

Name # Units NAV Cost BasisDate of

AcquisitionCurrentValue Client (C) Co-Client Joint (J)

Community Property (CP)

Morgan Stanley Smith Barney

Assets*

* Please indicate with a “� � ” those assets held at Morgan Stanley Smith Barney and any of its affiliates. 5837 (10/2009) p. 5 of 13

ASSET SUMMARY (CONTINUED)

STOCKS, BONDS, MUTUAL FUNDSOTHER PUBLICLY TRADED SECURITIES Client (C) Co-Client Joint (J) Community

Property (CP)Morgan Stanley Smith Barney

Assets*

* Please indicate with a “� � ” those assets held at Morgan Stanley Smith Barney and any of its affiliates.

Note: Is any stock subject to Section 83(b) election? � Yes � No

STOCK OPTION HOLDINGS (SUBMIT STATEMENTS)Description or Name Date of Grant Type of Grant No. of Shares Expiration Date Exercise Price Vesting Details

� Incentive� Nonqualified

� Incentive� Nonqualified

� Incentive� Nonqualified

� Incentive� Nonqualified

� Incentive� Nonqualified

� Incentive� Nonqualified

Please detail any legal restrictions (e.g., Rule 144) that apply to your ability to market securities freely.

HOMESPrimary Home Market Value Date Cost Basis Remaining Mortgage

Owner � C � J

� S � CP

� Revocable Trust

� Other

Original Term Date Fixed % / Adj Rate % Monthly P & I

Secondary or Vacation Home Market Value Date Cost Basis Remaining Mortgage

Owner � C � J

� S � CP

� Revocable Trust

� Other

Original Term Date Fixed % / Adj Rate % Monthly P & I

Do you plan to buy or sell any homes in the next 12 months? � Yes � No

5837 (10/2009) p. 6 of 13

ASSET SUMMARY (CONTINUED)INVESTMENT REAL ESTATE

Description Owner* Market ValueRemaining Mortgage Interest Rate

Cost Basis Annual Income

Cash Expenses

What are your plans for this property?

� C � J� S � O

� C � J� S � O

� C � J� S � O

� C � J� S � O

� C � J� S � O

OTHER INVESTMENTS AND ASSETS (Submit Statements)Including Partnerships, LLCs, Precious Metals, Futures, Venture Capital, Notes Receivables, Hedge Funds, Privately Held Securities, Exchange Funds, Collectibles and Personal Property

Description Owner*Year

Purchased Cost BasisAny RemainingInstallments

Current ValueIf Known

CurrentCash Flow

Annual Taxable Income (Loss) Projection

� C � J� S � O

� C � J� S � O

� C � J� S � O

� C � J� S � O

� C � J� S � O

* O=Other, e.g., Family Limited Partnership or LLC

CLOSELY HELD BUSINESS INTEREST OR PROFESSIONAL PRACTICEName of Business

Industry/Profession Year Established

Structure (C Corp., S Corp., LLC, Partnership)

Do you have more than one class of shares or units? Explain:� Yes � No

Length of Ownership Percentage of OwnershipClient % Co-Client %

Names and Relationshipsof Other Owners

Annual Revenues Profitability?� Yes � No

Number of Employees Company Debt Indicate Amount Personally Guaranteed

Do you borrow personally to support the business? � Yes � No

Have you pledged any professional assetsto back business purpose loan? � Yes � No

Value of Company Owned Real Estate Cost Basis of Company Owned Real Estate

Estimated Value of Business Have you had a valuation done? � Yes � NoIf so, when?

Do you have a buy-sell agreement? � Yes � No If so, is it triggered by � Death � Disability � Both

5837 (10/2009) p. 7 of 13

ASSET SUMMARY (CONTINUED)

CLOSELY HELD BUSINESS INTEREST OR PROFESSIONAL PRACTICE (continued)Is the Agreement funded? Explain:

� Yes � No

Is there a business succession plan? � Yes � No

Do you have key employees whose loss would be detrimental to the continued profitability of the business? � Yes � No

Is the Agreement funded? � Yes � NoIf so, with what type of investment?

Is your succession plan to:Sell business in __________ years? � Yes � NoPass to family heirs? � Yes � NoGo public? � Yes � NoIf so, to whom? ____________________________________________Do you wish to treat all family members equally? � Yes � No If No, Explain: _____________________________________________Leveraged recapitalization? � Yes � NoOther? � Yes � No Explain: _________________________________________________

Do you have a company-sponsored retirement plan?� Yes � No

If so, what kind?

Please repeat for each business interest. (Attach extra pages if necessary.)

RETIREMENT PLANSWhat level of income (in today’s dollars) do you anticipate needing at retirement?

� Pre-Tax � After-Tax $

After retirement, is your goal to spend down your capital or preserve your wealth for your children & heirs?� Totally deplete � Partially deplete � Preserve

What is your planned retirement age? Client: Co-Client:

Plan Description Present Vested Interest

InsuranceProceeds at Death Beneficiary

Annual Employer Contribution

Annual Employee Contribution How Invested

Project Monthly Retirement Income

IRA C $ $ $ $ $

C $ $ $ $ $

C $ $ $ $ $

S $ $ $ $ $

S $ $ $ $ $

S $ $ $ $ $

Keogh C $ $ $ $ $

S $ $ $ $ $

Pension C $ $ $ $ $

S $ $ $ $ $

Profit Sharing C $ $ $ $ $

S $ $ $ $ $

401(k) C $ $ $ $ $

S $ $ $ $ $

EmployeeStock Plans

C $ $ $ $ $

S $ $ $ $ $

Tax-ShelteredAnnuity 403(b)

C $ $ $ $ $

S $ $ $ $ $

Non-Qualified Deferred Compensation

C $ $ $ $ $

S $ $ $ $ $

5837 (10/2009) p. 8 of 13

ASSET SUMMARY (CONTINUED)

ANNUITIESFixed Policy 1 Policy 2

Owner(s)

Insured(s)

Beneficiary(ies)

Date Purchased

Original Premium

Surrender Value

Fixed Policy 1 Policy 2

Owner(s)

Insured(s)

Beneficiary(ies)

Date Purchased

Original Premium

Surrender Value

LIFE INSURANCELife Insurance Policy 1 Policy 2 Policy 3

Owner(s)

Insured(s)

Beneficiary(ies)

Death Benefit

Cash Value

Annual Premium

Type of Insurance

Date Purchased

Date of Last Policy Review

Issuing Insurance Company

Date Policy Transferred to Trust, if Applicable

INDIVIDUAL LONG TERM DISABILITYComplete the following if Client #1 or Client #2 is insured under an individual long term disability policy.

Policy 1 Policy 2

Annual Earned Income

Annual Premium Amount

Monthly Benefit Amount

Policy Elimination Period

Policy Benefit Period

Cost of Living Adjustment Rider

Issuing Insurance Company

5837 (10/2009) p. 9 of 13

ASSET SUMMARY (CONTINUED)

LONG TERM CAREComplete the following if Client #1 or Client #2 is insured under a long term care insurance policy.

Policy 1 Policy 2

Name of Policy Owner

Annual Premium Amount

Daily Benefit Amount

Policy Elimination Period

Policy Benefit Period

Inflation Adjustment Rider

Issuing Insurance Company

GROUP LIFE INSURANCEComplete the following for each life insurance policy of which Client #1 or Client #2 is the insured. Please specify if the beneficiary is a trustee of an irrevocable life insurance trust.

Policy 1 Policy 2

Insured

Beneficiary(ies)

Death Benefit

Cash Value

Annual Premium

Type of Insurance

Issuing Insurance Company

GROUP DISABILITY INSURANCEComplete the following if Client #1 or Client #2 is covered by group long term disability insurance.

Policy 1 Policy 2

Monthly Premium Amount

Monthly Benefit Amount

Policy Elimination Period

Policy Benefit Period

Issuing Insurance Company

Who pays the premiums?(You or your company)

OTHER INSURANCE

Health Coverage: � Yes � No

Property/Casualty: � Yes � No

Personal Excess Liability: � Yes � No If Yes, how much? __________________________

5837 (10/2009) p. 10 of 13

LIABILITIESMORTGAGE DEBT

Property Title Name Total Debt Maturity Lender

NOTES PAYABLE AND OTHER NON-MORTGAGE DEBT(include loans, margin debt, taxes currently due, taxes on assets sold beyond 1 year)

Type* Current Outstanding Amt. Total Credit Maturity Collateral Lender

*D= Demand; R=Revolving Credit; T=Term Loan; M=Margin Credit; C=Credit Card; A=Auto; X=Taxes Due; O=Other; P=Promissory

CONTINGENT LIABILITIESDo you have any outstanding letters of credit or surety bond? � Yes � No Amount: ________________

Are you a guarantor or endorser of any debt of a third party? � Yes � No Amount: ________________

Are you contingently liable on any lease or contract? � Yes � No Amount: ________________

Are there any lawsuits, claims or judgments pending against you (including divorce)? � Yes � No Amount: ________________

Have any of your debts, debts guaranteed by you or debts of a company or partnership 20% or more owned by you been discharged through bankruptcy or settled for less than the amount owed? � Yes � No Amount: ________________

Do you have any other contingent liabilities such as “cash calls”? � Yes � No Amount: ________________

Are any of your tax obligations past due? � Yes � No Amount: ________________

Is the IRS auditing or contesting any prior tax returns? � Yes � No Amount: ________________

PLEASE DETAIL YOUR ATTITUDES TOWARDS DEBT AND LIQUIDITY

I dislike debt and want to be debt-free. � Yes � No

I use loans to take advantage of opportunities. � Yes � No

I use loans aggressively to maximize my net worth. � Yes � No

I have sufficient cash reserves for unexpected needs. � Yes � No

I would sell liquid assets rather than borrow to meet my needs. � Yes � No

Do you have any upcoming capital needs or large expenses (in the next 12 months)? � Yes � No How much?: ___________________

5837 (10/2009) p. 11 of 13

5837 (10/2009) p. 12 of 13

CASH FLOW INFORMATION (PLEASE SUBMIT MOST RECENT TAX RETURN)Federal Income Tax Bracket

%State Income Tax Bracket

%Other Income Tax Bracket (e.g., City Taxes)

%Filing Status

� Single � Married � Married, filing separately � Head of Household

Note: If you wish, you may elect to provide totals only for income and expenses. It is preferable, however, to provide as much information as possible for purposes of cash flow analysis.

INCOME Pre-Retirement In Retirement

Current Income

Wages

Investment Income

Business Income

Rental Income

Other

Sources & Amounts of Retirement Income

Qualified Plan / Pension Income

Investment Income

Business Income

Rental Income

Other

TOTAL INCOME

EXPENSES Pre-Retirement In Retirement

Current Expenses

Mortgage(s)

After-Tax Living Expenses

Annual Gifting

Charitable Gifting

Retirement Expenses

Mortgage(s)

After-Tax Living Expenses

Annual Gifting

Charitable Gifting

Travel

TOTAL EXPENSES

Note: Will there be any extraordinary expense or income item over coming years (e.g., purchase of a luxury boat, redesign of home)? � Yes � No

If so, please give approximate amount __________________ and year __________________ .

ESTATE & CHARITABLE PLANNING INFORMATIONDo you have a will? � Yes � No If yes, when was it last updated?

Who is named as executor/executrix?

Does your will provide for the creation of a trust at your death? � Yes � No If so, what type of trust is it? (e.g., credit shelter, marital)

Who is named as trustee? Successor trustee?

If your will includes any specific bequests to an individual or institution other than a co-client, please list the name(s) and amount(s) (and asset(s)).

Do you have a living trust? � Yes � No If yes, who is trustee? Successor trustee?

What is type? What is market value?

Are you the income or principal beneficiary of a trust established by someone else? � Yes � No Explain:

.

ESTATE & CHARITABLE PLANNING INFORMATION (CONTINUED)

Are you currently gifting to children, grandchildren or other individuals? � Yes � No If yes, please list.

Donor Recipient Amount Date of Gift

Is the gift � Outright? � in Trust? Have you filed gift tax returns? � Yes � No If yes, please include copy.

Do you currently make contributions to charity? � Yes � No If yes, amount of annualcash contributions

Amount of long-termcapital gain property

What are your primary objectives in gifting to charity? (please number with 1 being the highest priority)

______ Provide Current Gift to Charity(ies)

______ Provide Future Gift to Charity(ies)

______ Provide Gift to Charity(ies) at Death

______ Reduce or Postpone Capital Gains Taxes on Assets

______ Increase Income from Current Assets

______ Reduce Income Taxes

______ Provide Income for Children or Others

______ Reduce Estate Taxes

If income is an objective for you or another family member, as part of your charitable gifting, please prioritize among the following.

______ Start Income Immediately

______ Start Income in _________ Years

______ Start Income at Retirement (_________)

______ Start Income for Parents or Grandparents in ________ Years.

______ Start Income for Co-Client at Donor’s Death

______ Start Income for Children ____________

Do you have an asset which you would like to gift to family members in the future (at a discount in value), while donating some of the growth and income to charity now? � Yes � No

If so, do you believe the asset will appreciate significantly in the future? � Yes � No

Are you interested in involving family members in your charitable giving commitments? � Yes � No

If yes, would these commitments amount to a substantial sum? (e.g., over $1,000,000.00) � Yes � No

Do you have a charitable trust? � Yes � No If yes, what kind of trust is it?If yes, please include copy.

What is the Fair Market Value? What is the Annuity or Unitrust payout?

5837 (10/2009) p. 13 of 13

Notes

Notes

Notes

© 2009 Morgan Stanley Smith Barney LLC.

PS2023 6/2009