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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