Personal Profile - Discovery Meeting
Requested Financial Adviser
Please Select
Angela Matthews
Victor Kolkur
Nikita Trainin
Dylan Mann
Shao Ma
Chantelle Schofield
Oliver Nelson
Andrew Hamilton
Keely Wickins
Leave blank if unknown
Source of Client/s - Please help us to understand where you came from?
How did you find out about our financial advice service?
Collecting the right infomation.
I need a plan for ONLY myself.
I/we need a plan as a financial couple.
I/we currently have children or dependants (protect & provide for).
I/we currently own property.
I/we have some loans or debt/s.
Personal Information
Client
Partner
Title
Prefered Name
First Names
Last Name
DOB
Mobile
Email
Home Address
Identity Requirements - (please provide one if possible)
Client
Partner
NZ Drivers Licence
Version Number
NZ Passport Number
Passport Exp:
IRD Number
Country Born
NZ Residancy Status
Notes
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Scope of Advice Required
Select the advice required for a financial plan
I/we want a 'Plan A' - Savings & Investment Advice or KiwiSaver advice.
I/we want a 'Plan B' - Family Insurance Plan Advice.
I/we want 'Stop Working - Retirement Plan' with Projections.
I/we want Mortgage or Loan advice.
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Dependant - Children
Children & Dependants - (could be adult dependants or other family)
Name
DOB (age)
Extra Needs
Notes
1st Child
2nd
Child
3rd
Child
4th
Child
5th
Child
6th
Child
7th
Child
8th Child
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Your Goals and Objectives
Goals and Objectives to Plan
S. M. A. R.T. GOALS - A specific goal has a much greater chance ofbeing accomplished than a general goal. *Who: Whois involved?*When: Establish a time frame.*What: Whatdo I want to accomplish? *Where: Identify alocations. *Why: Specificreasons, purpose or benefits of accomplishing the goal. EXAMPLE: A goal may be, "Buy a first home." S. M. A. R. T. GOAL would say, "John to save a minimum 10%deposit on a 3br home + garage in south Auckland currently valued at $780,000within the next 3-5 years to provide a home for the family and financialsecurity."
Immediate goals & objectives
What you want
When you want it
Why you want it
1st Goal
2nd Goal
3rd Goal
4th Goal
Short term goals (next 2 years)
What you want
When you want it
Why you want it
1st Goal
2nd Goal
Medium term goals (2 to 5 years)
What you want
What
When you want it
Why you want it
1st Goal
2nd Goal
Long term goals (5 to 10 years)
What you want
What
When you want it
Why you want it
1st Goal
2nd Goal
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Your Earned Incomes (Not Investment Incomes like rent or interest)
Occupation and Employment
Client
Partner
1st Occupation
1st Employer Name
1st Yearly Income / Salary (Before Tax)
2nd
Employer Name
2nd Job -
Occupation
2nd Yearly Income / Salary (Before Tax)
Clients Employment Status
Home care-Executive
Full time
Part Time
Casual
Self Employed
Contractor
Retired
Partner Employment Status
Home care-Executive
Full time
Part Time
Casual
Self Employed
Contractor
Retired
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Your Property - Real Estate Assets
Your Property Assets
Address
Owner
Weekly Rent
Market Value
Loan Amount
1st Property
2nd Property
3rd Property
4th Property
5th Property
6th Property
Valuations are from
iVal
Purchase Price
CV or GV
Licenced agent appraisal
Owner Estimate
Other
Property Manager - Name and Contact
If self-managed put self
Are your rentals 'Healthy Homes Certified' currently.
Yes
No
Other
Property Asset Notes
If there is anything extra or planning notes for discussion please let us know.
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Your Assets Information
Investment Assets
Name of Asset
Value
Owner
Notes
Cash
Cash
Crypto Assets
Crypto Assets
Term Deposits
Term Deposits
Managed Funds
Managed Funds
Shares NZ
Shares Overseas
Business Interests
Business Interests
Other 1
Other 2
Other 3
Other 4
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Loans & Debts
Loans & Debt
Loan 1
Loan 2
Loan 3
Loan 4
Lender
Value
Owner
Rate %
Monthly Repayment
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Retirement Savings Assets
KiwiSaver / Retirement Savings
Client
Partner
Child 1
Child 2
KiwiSaver Name
Est Balance
Investment Option
Notes
KiwiSaver Current Contribution Savings Rate
Client
Partner
Employee / Rate
3% - Default
4%
6%
8%
10%
$1042.86 for gov $521.43
Unknown
Nil -Zero
3% - Default
4%
6%
8%
10%
$1042.86 for gov $521.43
Unknown
Nil -Zero
Self Employed or Employer Rate
3% - Default
4%
6%
8%
10%
$1042.86 for gov $521.43
Unknown
Nil -Zero
3% - Default
4%
6%
8%
10%
$1042.86 for gov $521.43
Unknown
Nil -Zero
Other Retirement Savings Assets
Client
Partner
Pensions or Superannuations
Est Balance
Investment Option
Notes
First Home Buyer Info
Client
Partner
I have never owned any property
Yes
No
Yes
No
I have owned property before, but never taken out KiwiSaver
Yes
No
Yes
No
I currently own a property
Yes
No
Yes
No
I have been contributing 3% to KiwiSaver for more than 5 years
Yes
No
Yes
No
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Insurance Advice
Creating the 'Plan B' for your situation;
I/we have no 'Plan B' and would like full Insurance Advice.
Protect my immediate family in the event of medical issues
Review of your current Personal Insurance to match your needs and goals
Just purchased a new property and would like some General Cover (Referral)
Review of your current General Insurance Cover (Referral)
Personal Insuance Cover - To get advice please select the cover you needs or want advice on;
INCOME PROTECTION - If I couldn’t work due to medical event or accident, I would like to receive a continuing monhtly payment to cover lost personal income, living costs, mortage payments, food, power, and other things.
MEDICAL COVER - If I had a medical event or acident , I’d like to access the private healthcare system with my medical costs paid for me.
TRAUMA COVER - If I were to suffer a traumatic incident like cancer,heart attack, stroke, head trauma, major burns, coma, loss of sight, heart attack , I would like to receive a large lump sum payout to cover lost family income, specialist medical treatments, debt reduction time off work and other things.
DISABILITY - If I was permanently disabled, I would like to receive a large lump sum payout
LIFE COVER - In the event of death or terminal illness, I would like my family to receive a large lump sum payout to cover debts, living costs, housing, education or other things.
Current Personal Insurance Products
Health Insurance
Income Protection
Trauma Cover
Total Disability Cover
Life Cover
Client
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
Partner
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
Child 1
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
Child 2
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
I would like a quote & advice on this
I do not need cover or advice on this
I have cover now
Current Insurance Cover Amounts
Health Insurance
Income Protection
Trauma Cover
Total Disability Cover
Life Cover
Client
Partner
Child 1
Child 2
Insurance Quoting Data
Client
Partner
Height (cm)
Weight (kg)
Smoker or Vaper
Male / Female (at birth)
Doctors Name
Doctors Address
Medical History
Client
Partner
High or Low blood pressure?
Abnormal or high cholesterol?
Respiratory or breathing disorder (asthma, lung disorder, bronchitis, etc)?
Male / Female (at birth)
History of Mental health conditions including depression, stress or anxiety?
Cancer, tumour or abnormal PAP/cervical smears?
Any ongoing musculoskeletal issues?
Any other perceived medical issues?
Are you involved in any hazardous pastimes, skydiving, rock climbing, BASE jumping, etc?
Have you ever been to hospital for an operation or treatment?
Are you taking any regular medication, receiving advice or
monitoring for a medical event or condition?
Is there a history of particular illness in your family, such as diabetes, heart condition, or genetic disorders?
Do your Children have any pre-existing conditions that would affect them getting insurance?
If 'Yes' to any questions above, please add details to the Notes below including any medication you are taking:
Who matters to you? Insurance isn’t just for you. Start by thinking about who is important to you and select anyone who’s lifestyle or finances will be affected if you die or are unable to work.
You
Spouse/Partner
Children
Other
What makes you worry? Which events will mean you can’t take care of your people? We think most of these will matter to most people, so we’ve selected them all for you
Getting Sick
Passing Away
Having an Accident
Not working Again
Getting a long term Disease
Redundancy
Other
Sell Down of Assets In an event of a death, disability or illness which assets would you be prepared to sell down assets or rely on family to pay for living costs?
Cash Savings
Selling Other Assets
Home downsize
Rely on other family
No
Other
How would you rate your understanding of personal insurance risk
Please Select
Low
Medimum
High
What would happen if both you and your partner were unable to work for 2-3 years?
Please Select
I would sell assets and spend any savings.
I would need to move home with family.
I would have to rely on a sickness benefit.
I plan to have insuance to protect us from this.
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Estate Questions
Type a question
Client
Partner
Do you have a Will?
Does you Will suit the current situation?
Who holds a copy of the will?
Are there likely to be will disputes in your family?
Have you granted someone 'Power of Attorney?
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Your Professional Team
Your Professional Team
Name
Email
Mobile
Accountant
Solicitor
Mortgage Broker
Property Manager
Realtor
Other
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Financial Plan - Advice Report Process
Financial Plan - Advice Report Process
Client Authority to proceed with the construction of a financial plan report. Financial advice reports preparations are charged on a fixed quote basis depending on the level of complexity and the number of people involved. The price is calculated based on the amount of time needed to prepare each report. An invoice for the cost quoted will be issued via email to the clients for approval before any work will be started. The process in preparing your financial plan will include the following. 1-The collection and analysis of all relevant personal and financial data. 2-The identification of financial goals and objectives. 3-The provision of a written report with recommendations. 4-The co-ordination and implementation of recommendations if approved.
Client Declaration
I/We declare that the information provided by me/us in all the documents attached to this Declaration is to the best of my/our knowledge is accurate. I/We acknowledge I/we have read and understood the information relating to the Privacy Act 2020 and how my/our information may be used. I/We understand the services being provided are restricted to the scope of service or subject to specific limitations indicated on the scope of service page. I/We confirm that once the planning process is complete, I/we am/are happy for the Adviser to obtain non-obligatory estimates, quotes and/or pre-approvals on my/our behalf. I/wegive permission for the Adviser to approach Insurance product providers for an indicative approval and quotes. I/We further understand that implementation of any recommendations will be subject to my/our acceptance of the terms offered and completion of the required application forms. I/We wish to proceed with the construction of a financial plan based on the following information disclosed by us.
Client Signature
*
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