Do you have partner?
NoYes


Sex*

MaleFemale


Marital Status
MarriedSeparatedDivorcedWidowedNever married


Smoker
YesNo


Occupation*


Job Type*
EmployedSelf Employed


Employer Name*


Salary per annum including superannuation*($)


Centrelink Benefits (If applicable)*


Other Income*($)


State of health (Good or Health Concerns)*


Living expenses per annum*($)



Contents*($)


Cars*($)


Bad Loans



Mortgage*($)


Investment Assets



Super ($) - Retail (Name of Fund) or SMSF?


Super ($) - Retail (Name of Fund) or SMSF?


Bank a/c($)


Term Deposit($)


Shares($)


Managed Funds($)


Investment Properties (How Many and $ Value)


Good Loans



Wealth Protection - How much insurance do you have?


Life - How Much in total($)


Total and Permanent Disability - How Much in total($)


Critical Illness - How Much in total($)


Income Protection - How Much in total($)


Estate Planning - Do you have:



Will? (Yes/No)
YesNo


Includes a trust? (Yes/No)
YesNo


Enduring Power of Attorney? (Yes/No)
YesNo


Enduring Power of Guardianship? (Yes/No)
YesNo

Goals & Objectives (How can we help you?):


Sex

MaleFemale


Marital Status
MarriedSeparatedDivorcedWidowedNever married


Smoker
YesNo


Job Type
EmployedSelf Employed



Contents($)


Cars($)


Partner Bad Loans



Mortgage($)


Partner Investment Assets



Super ($) - Retail (Name of Fund) or SMSF?


Super ($) - Retail (Name of Fund) or SMSF?


Bank a/c($)


Term Deposit($)


Shares($)


Managed Funds($)


Investment Properties (How Many and $ Value)


Partner Good Loans



Wealth Protection - How much insurance do you have?


Life - How Much in total($)


Total and Permanent Disability - How Much in total($)


Critical Illness - How Much in total($)


Income Protection - How Much in total($)


Partner Estate Planning - Do you have:



Will? (Yes/No)
YesNo


Includes a trust? (Yes/No)
YesNo


Enduring Power of Attorney? (Yes/No)
YesNo


Enduring Power of Guardianship? (Yes/No)
YesNo

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