Tell us about you

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.
What motivated you to get in touch with us ? (Please elaborate)*
For example: retirement planning, investment advice or applying for Age Pension
Full Name*

PrefixFirst NameMiddle NameLast Name
Date of Birth*

MonthDayYear
Address

Street Address

Street Address Line 2

CityState

Postal Code
Mobile Number*
Please enter a valid phone number.Format: (000) 000-0000.
E-mail*
example@example.com
Your occupation*
Your employer
Are you married?*

YesNo
Partner Name

First NameLast Name
Partner DOB

MonthDayYear
Date
Partner's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Your partners occupation and employer
What is your gross annual income ?*
What is your partners gross annual income ?
What is your estimated expenses per month?*
Do you smoke?*

YesNo
Does your partner smoke?

YesNo

Dependants

What are your financial goals?*
For example: I want to retire in 2 years and live comfortably, I want to access my super for general expenses, I want to invest $100,000, I want to ensure me and my family retire comfortably,

Assets and liabilities*

Is there any information you want to provide to elaborate on your assets listed above?
Superannuation

If you know what your employee benefit amounts are, please fill them in below. Alternatively, please bring a copy of your recent superannuation Fund statement which reflects the current fund value.
How many super funds do you have?*
How many super funds does your partner have?
What is your superannuation fund name and approximate balance?*
This helps us with retirement advice
What is your partners superannuation fund name and approximate balance?
Do you have any investment objectives? (Please elaborate)*
Do you have a will?*

YesNo
If yes, when was it last reviewed ?
If you have life cover, please mention how much cover you have eg. 1,000,000 or 0*
If you have Lump Sum Disability/TPD cover, please mention how much you have eg. 1,000,000 or 0*

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

Rows	Monthly Benefit	Waiting period	Benefit expiry age
Income Protection Benefit

Do you have any Personal insurance objectives? (Please elaborate)*
Approximate days of Sick leave and annual leave ?
Any additional details you feel relevant to let us know.
Lastly, how did you hear about us?*
eg. our website, word of mouth, referral (who from?), Facebook, Google, other
Should be Empty: