IAA Client Intake Form

Income Architecture Audit™ · Cornell Capital Holdings · Confidential

Cornell Capital Holdings · Investment Strategy

Income Architecture Audit™

Intake & Document Request · Capital Diagnostic Preparation Package

Freedom Index™

Passive Income ÷ Target Income

Capital Velocity Score™

(Yield % + Appreciation %) ÷ 2

Annual Income Gap

Target Income − Current Passive

Most portfolios carry $10,000–$50,000 or more in annual capital inefficiency — not because of bad investments, but because the entire strategy is solving the wrong problem. This audit makes that visible, quantified, and undeniable.

Complete the Intake Form

Answer every section that applies. Estimates are fine — a rough number is more useful than a blank.

Gather Your Documents

Use the checklist at the end. Required items are needed to run the full diagnostic.

Submit to Your Advisor

Return this form and all documents together. Your IAA will be delivered within 5 business days.

1. Client Information & Income Goals

Client Full Name*

Date of Birth*

Spouse / Partner Full Name

Spouse Date of Birth

Filing Status

State of Residence*

Email Address

Current Investment Advisor / Firm

Current Advisory Fee (%)

Income Goals

Target Annual Lifestyle Income*

Current Annual Passive Income*

Current Annual W-2 or Business Income

Target Year for Financial Independence

Annual Withdrawal Amount (if currently drawing)

Years Until Portfolio Must Replace Active Income

Current Income Sources (annual)

Dividends & Interest — Taxable

Dividends & Interest — Retirement Accounts

Private Investment Distributions

Annual Rental Income (net)

Social Security Income

Pension or Annuity Income

2. Portfolio Overview

Assets by Account Type

Account Type	Custodian / Institution	Approximate Value
Taxable Brokerage
IRA / 401(k) / Tax-Deferred
Roth IRA / Roth 401(k)
Cash / Money Market / CDs
Real Estate Equity (investment, not primary)
Business Equity / Private Holdings
Other Alternative Assets
Total Investable Assets

Allocation & Performance

Equity %

Fixed Income %

Cash %

Alternatives %

Est. Current Portfolio Yield (income ÷ assets)

Est. Annual Income Generated by Portfolio

Est. Avg Annual Total Return (last 3–5 yrs)

Advisor Structure

Who Manages the Portfolio?

Is Fee Paid From Taxable or Tax-Deferred?

Satisfied with Current Approach?

Yes No Unsure

Ever Had an Income-Focused Portfolio Review?

Yes No Unknown

Currently Drawing from Portfolio?

Yes No

3. Holdings Detail & Tax Position

Holdings Types (check all that apply)

Tax Position

Unrealized Gains — Taxable Account (est.)

Unrealized Losses — Taxable Account (est.)

Capital Loss Carryforward

Gains Realized This Tax Year

Concentrated Positions (>10% in one stock)?

Yes No

Low-Basis Inherited or Long-Held Positions?

Yes No

Est. Annual Dividends & Interest (Taxable)

Est. Annual Capital Gain Distributions

Est. Annual Portfolio Turnover

4. Risk Profile & Income Resilience

Primary Investment Concern

Biggest Financial Fear

Within 5 Years of Retiring?

Yes No Already retired

Experienced Significant Drawdown While Drawing Income?

Yes No

Willingness to Hold Illiquid Alternatives

High Moderate Low

Minimum Annual Liquidity Needed from Portfolio

Time Horizon

Monthly Fixed Expenses Portfolio Must Cover

Income Resilience Stress-Test

If Portfolio Dropped 25% — Impact on Lifestyle?

If Interest Rates Dropped 2% — Impact on Income?

Income Floor in Place?

Social Security Pension Annuity None

5. Retirement Accounts & Tax Context

Retirement Plan Summary

Plan Type	Total Pre-Tax Balance (Owner)	Total Pre-Tax Balance (Spouse)	Total Roth Balance (Owner)	Total Roth Balance (Spouse)	Annual Contributions

Rollover IRAs (unconverted pre-tax)?

Yes No

Prior Roth Conversions Done?

Yes No

Tax Context

Est. Marginal Federal Tax Rate

Est. Federal Effective Rate

Est. State Tax Rate

Subject to Net Investment Income Tax (NIIT)?

Yes No Unknown

Expected Marginal Rate in Retirement

6. Charitable Giving & Wealth Structures

Annual Charitable Giving Total

How Do You Give?

Cash / Check Credit card Appreciated securities DAF

Own Appreciated Securities to Donate?

Yes No

DAF in Place?

Yes No

Trust Structures?

Yes No

Estate Plan?

Life Insurance?

Yes No

Total Net Worth (approximate)

Describe Trusts / Life Insurance (if any)

7. Prior Planning & Engagement Goals

Formal Investment Review Previously Done?

Yes No

Shift to Income-Focused Strategy Before?

Yes No

Significant Financial Events Expected in Next 1–3 Years

Primary Engagement Goals (check all that apply)

Understand what my portfolio is currently producing in income Close the income gap — increase passive income toward my target Reduce unnecessary tax drag on investment income Reduce sequence-of-returns risk before or during retirement Evaluate private credit / alternative income allocations Optimize charitable giving with appreciated securities Evaluate Roth conversion opportunities Diversify a concentrated stock position Get a second opinion on current portfolio structure

Anything Else We Should Know?

Authorization

By signing below, I confirm that the information provided in this intake form is accurate to the best of my knowledge, and I authorize Cornell Capital Holdings to use this information to prepare my Income Architecture Audit. I understand this audit is a diagnostic engagement and does not constitute investment advice, a securities offering, or a financial plan.

Client Signature

Printed Name

Date

Spouse / Co-Client Signature

Printed Name

Date

Document Checklist

The IAA is only as precise as the data behind it. Required items are essential to run the full diagnostic. Recommended items increase the accuracy of your Freedom Index™ and Capital Velocity Score™ calculations.

Investment Account Statements

Required

Holdings Detail Report — All Taxable Accounts

Must include positions, shares, cost basis, and unrealized gain/loss. Export from custodian portal.

Required

Most Recent Monthly or Quarterly Statement — Taxable Brokerage

Confirms current values and any cash/sweep positions

Required

Most Recent Statement — All Retirement Accounts (IRA, 401k, Roth)

Confirms balances by account type

Recommended

12-Month Performance Report

Shows income generated vs. total return for the last 12 months

Optional

IRA Holdings Detail

Positions and balances inside IRA/rollover accounts if not included in above

Tax Documents

Required

1099-DIV — Prior Year

Shows qualified dividends, ordinary dividends, and capital gain distributions from taxable accounts

Required

1099-B — Prior Year

Shows realized gains and losses — confirms actual tax drag from portfolio activity

Recommended

Schedule D and Form 8949 from most recent 1040

Confirms carryforwards and gain/loss detail

Recommended

Federal Form 1040 — most recent year

Confirms all income sources, effective rate, and tax situation

Optional

K-1s from Private Funds or Partnerships

Required if any private investment income is included in the IAA scope

Advisory & Plan Documents

Recommended

Current Investment Advisory Agreement

Confirms fee structure, billing method, and services included

Recommended

401(k) Plan Summary / Investment Menu

Shows available fund options and current elections

Optional

Prior Financial Plan or Retirement Projection

Provides baseline assumptions for income gap and trajectory analysis

Optional

Investment Policy Statement (IPS)

Documents current stated objectives, constraints, and allocation guidelines

Optional

Private Fund Statements (quarterly or annual)

Other

Optional

Form 5498 — IRA Contribution Summary

Optional

Annuity Contract Summary

If annuity held — confirms surrender value, income rider terms, and payout options

Optional

DAF Account Statement

Optional

Trust Documents

If any assets are held in trust and included in portfolio scope

Ready to submit? Return this completed form and all gathered documents to your Cornell Capital advisor. Your Income Architecture Audit™ will be delivered within 5 business days.

IAA Client Intake Form · Cornell Capital Holdings · Confidential · v1.0 April 2026

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