Strategem Investment Services New Client Questionnaire

Strategem Client Questionnaire

Please complete as much of this Client Questionnaire as possible and submit it prior to your appointment. This will allow us to prepare for our meeting so we can use our time together effectively.

Name

	Client 1	Client 2
Full name (please include middle name)
Preferred name

Strategem Advisor

It's time to get to know you a bit better

The following questions will help us get to know your individual situation and tailor a personalised experience.

	Client 1	Client 2
Title
Gender
DOB
Marital Status
Dependants (If so, please provide name and ages)
Health (Excellent, Good or Poor)
Employment (ie Full-time, part time)
Occupation
Employer
Do you currently have an up to date Will and Power of Attorney in place?

Information gathering

The following information will help us set you up in our system.

Your Contact Details

	Client 1	Client 2
Home Address
Postal Address
Home Phone Number
Mobile Phone Number
Email Address
Preferred Method of Contact

How can we help you

Now that we have some information about who you are, we'd love to dig a little deeper into how we can help you. This information will ensure we can make the most of our time together.
Main reason for seeking advice
Your Major Objectives - Short term 0-12 months
Your Major Objectives - Medium term 1 - 5 years
Your Major Objectives - Long term 5 years +

Information gathering

Please provide the following information relating to your income

Income

	Client 1	Client 2
Salary/Business Income
Rental Income
Share/Investment Income
Interest
Pension income
Government Benefits
Trust Distributions
Worker's Compensation
Other
Total Income

Information gathering

Please provide the following information relating to your annual expenses

Annual Expenses

	Client 1	Client 2
Total Household Expenses
Loan Repayments
School Fees
Other
Other
Other
Total Expenses (p.a)

Information gathering

Please provide the following information relating to your lifestyle assets

Your Lifestyle Assets

	Owner	Value2
Home
Contents
Vehicles
Other
Other

Information gathering

Please provide the following information relating to your investment assets

Your Investment Assets

	Owner	Value
Investment Property
Shares
Managed Funds
Term Deposits
Cash
Other

Information gathering

Please provide the following information relating to your super funds

Your Super Funds

	Fund 1	Fund 2	Fund 3	Fund 4
Fund name
Owner (ie Client 1, Client 2)
Account Balance
Employer Contributions (p.a)
Salary Sacrifice (p.a)
After-tax contributions (p.a)

Information gathering

Please provide the following information relating to your liabilities

Your Liabilities

	Owner	Value
Home loan
Investment loan
Credit card
Other
Other
Other

Information gathering

Please provide the following information relating to your life insurance

Your Life Insurance

	Policy 1	Policy 2	Policy 3	Policy 4
Insurer
Owner (ie Client 1, Client 2)
In Super? (yes or no)
Life Insured?
Death cover ($)
TPD Cover ($)
Trauma Cover ($)
Income Protection Cover ($ per month)
Waiting Period
Benefit Period
Premium ($)
Premium Frequency

Information gathering

Please provide the following information relating to your future
Future Changes
What changes are likely to these details over the next five years?
Your Concerns
What key issues would you like to discuss?
Any other information
Is there anything else we should know about?

This form has been completed by blanks . By entering your name you are acknowledging that you have submitted this information for use by your Strategem Advisor. Date: blank .