Provide your details

Full Name

Person 1

DOB

Person 1

Full Name

Person 2 If applicable

DOB

Person 2 If applicable

Do you have any children?

If yes, please provide the age of each child

Why are you seeking financial advice?

Please provide as much detail as you can about your goals and your reasons for seeking advice.

Phone Number*

Email Address*

Address

Occupation & Name of Employer

Person 1

Occupation & Name of Employer

Person 2 If applicable

Annual income before tax

Person 1

Annual income before tax

Person 2 If applicable

Source of income

Person 1

If other please specify

Source of income

Person 2 if applicable

If other please specify

Do you have the ability to save or invest any income?

If yes, how much per week?

House value

Value of any Motor Vehicles, Boats, Caravan etc

Value of Investment Properties

Value of Shares or Managed Funds

Value of Current Bank Accounts/Savings

Superannuation Fund Name and Account Balance (approx.)

Person 1

Superannuation Fund Name and Account Balance (approx.)

Person 2 if applicable

Home Loan amounts outstanding and repayment amount

Are you happy with your current lender and interest rate?

Yes
No

Investment Loan amounts outstanding and repayment amount

Credit Cards total balance owing

Do you have any Life and Income Insurance Policies?

If yes, please provide a summary of insured amounts and payments

Are you comfortable with your current level of insurance?

Yes
No

Do you have a Will / Power of Attorney

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