Financial Planning Client Fact Find Form

Tell Us About You

All information is kept in strict confidence and is used to determine your personal needs and requirements so that we can provide you with a personalised financial plan.

Full Name*

PrefixFirst NameMiddle NameLast Name

Date of Birth*

MonthDayYear

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Mobile Number

Please enter a valid phone number.

E-mail

example@example.com

Occupation

Are you married?

YesNo

What is your gross annual income ?

Please send us a copy of a recent payslip

What is your combined approximate savings per month?

Do you smoke?

YesNo

Dependants

	Name	Surname	Date of birth	Gender
Child 1
Child 2
Child 3
Child 4

What motivated you to get in touch with us ? (Please elaborate)

Assets and liabilities

	Current Value	Loan amount	Repayment	Purchase price
Property
Vehicle
Bank Savings
Shares
Other

Do you have a will?

YesNo

If yes, when was it last reviewed ?

What are your financial goals that you would like us to talk about ?

Superannuation and personal insurance

If you know what your employee benefit amounts are, please fill them in below. Alternatively, please send us a copy of your recent superannuation Fund statement which reflects the current fund value. Also, if applicable please send us a statement reflecting an explanation of what personal insurance benefits you have (income protection benefits, life cover, lump sum disability/TPD )

Superannuation Fund name and approximate balance.

(We use this value to incorporate into your Retirement Planning figures)

Superannuation Fund name and approximate balance.

(We use this value to incorporate into your Retirement Planning figures)

If you have life cover, please mention how much cover you have eg. 1,000,000 or 0

If you have Income protection, please indicate Benefit amount, waiting period and Benefit expiry age.

	Monthly Benefit	Waiting period	Benefit expiry age
Income Disability Benefit

Do you have any Personal insurance objectives? (Please elaborate)

What is your height and weight ?

Would you like to plan for your children's education? If so, please indicate your preferences and approximate cost.

	Public School	Private School	Cost per year
Primary School
Secondary School
University

Approximate days of Sick leave and annual leave ?

Do you have any investment objectives? (Please elaborate)

If you have Lump Sum Disability/TPD cover, please mention how much you have eg. 1,000,000 or 0