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					tell us about you




LIFESTYLE
Questionnaire
    your financial position and your goals
WELcomE
Lifestyle                     Completing this Lifestyle
                              Questionnaire will be time

Questionnaire
                              well spent.
                              Your involvement in the financial planning process assists


Confidential                  us to deliver strategies to help you achieve your goals and
                              aspirations. the information you provide in this document
                              allows us to understand more than just your financial situation.
                              this is an important part of our approach to help you bridge
                              the gap between where you are and where you want to be.

                              as you work through the document, you will be asked to
                              complete only a portion of each page. Your adviser
                              will discuss your responses with you during the interview
                              and record other details in the “Fss Financial Planning
                              use only” sections.

                              if you require assistance completing this document,
                              please contact us. our contact numbers are shown below.




                                 If your interview is to be held in Sydney or conducted
                                 by telephone, please return your completed
                                 questionnaire 2 weeks in advance.

                                 If you are meeting your adviser outside of Sydney,
                                 you should return your completed questionnaire
                                 3 weeks in advance.




Q invest Limited trading as
                                Po Box r352 royal exchange nsW 1225
“Fss Financial Planning”
                                T 1800 665 756 (toll free)
aBn 35 063 511 580
                                F 1800 459 182 (toll free)
aFs Licence 238274
                                enquiries@fssfp.com.au
                                www.fssfp.com.au

                                                                                                 1
Your lifestyle objectives
Your personal details
Client

Title                Mr       Mrs           Ms         Miss            Dr         sir       other

Surname

First Names

Preferred Name

Date of Birth

Home Address

Phone Numbers    H                      W                          M

Marital Status

Employer

Occupation

Partner

Title                Mr       Mrs           Ms         Miss            Dr         sir       other

Surname

First Names

Preferred Name

Date of Birth

Home Address

Phone Numbers    H                      W                          M

Marital Status       single   Married       De facto   separated       Divorced   Widowed

Employer

Occupation


Interview date                          Adviser

                                                                                                    2
FSS Financial Planning use only              Client                                Partner                         Notes

 If currently working:                                                                                             Proposed retirement Date:

 Employment status?

 If not currently working:
 Worked previously?                              yes     no

 If yes, date of cessation

 Reason for cessation

 Intending to resume work?                       yes     no

 If yes, approx hrs per week

 For how long?

 Expected gross income?


Context
Q1 So we can provide you with the best service possible, please indicate
   your main reason(s) for seeking advice at this time.

        retirement             resignation             Wealth Creation/investing    Borrowing to invest

        ill Health             redundancy              salary Packaging              Wealth Protection/insurance




Your Lifestyle Objectives
Q2 In your own words, describe to us your personal objectives
   and what you consider important for your future lifestyle.




                                                                                                                                               3
Your lifestyle objectives

The following questions assist us to turn your personal lifestyle objectives into financial goals.

Q3 What significant expenditures are you planning now and into the future (e.g. weddings)

 Priority              Item                          When                     Amount $               Frequency Thereafter
 (Low/Medium/High)                                   (year)                   (today’s dollars)


    L       M    H     replace Car                                                                   one-off or every    years


    L       M     H    travel                                                                        one-off or every    years


    L       M     H    renovations                                                                   one-off or every    years


    L       M     H                                                                                  one-off or every    years


    L       M     H                                                                                  one-off or every    years


    L       M     H                                                                                  one-off or every    years



Q4 What is your current cost of living?                                                              Amount $ (per annum)
    We suggest that you complete the budget section (page 20) of this
    document to assist you in answering this question.


Q5 In which year do you plan to retire?                                                              Client             Partner



Q6 What regular income (in today’s dollars and after tax) do you                                     Amount $ (per annum)
   desire in retirement?

Q7 How much money do you prefer to keep readily available                                            Amount $
   for unforeseen expenses?




                                                                                                                                  4
Your current position
The following questions help us to get a clearer picture of your current financial position.

Q8 What do you earn? Please provide before-tax (Gross) income only                     FSS Financial Planning use only

 Type of Income                Client             Partner            Frequency                                   $ (per annum)
                               $                  $                  (w/fn/m/yr)                                 Client                 Partner
 salary/Wages/Business                                                                 totaL (Gross)
 income
                                                                                       less salary sacrifice
                                                                                       standard %
 investment income                                                                     Voluntary




 share Dividends
                                                                                       equals taxable income
 rental income                                                                         take home pay
                                                                                       Centrelink/DVA
                                                                                       Client                    Partner
 social security/DVa                                                                      PCC                        PCC
 (specify type below)
 1.                                                                                       CsHC                       CsHC
 2.                                                                                       Health Care Card           Health Care Card
 3.

 allocated Pension income

                                                                                       Gifting
                                                                                       amount                    $
 superannuation Pension                                                                Date of gift
 other (Family Payment,                                                                Waiting Periods           Weeks
 Child support)
                                                                                       Client LaWP / iMP
                                                                                       Partner LaWP / iMP



                                                                                                                                                  5
Your current position

The following questions help us to get a clearer picture of your current financial position.


Q9 Are you currently salary sacrificing into superannuation?                                      Client          Partner

                                                                                                      yes    no     yes     no



Q10 How much do you estimate you can save                                                         Amount $
    on a yearly basis?


Q11 If you have accrued any long service leave, annual leave or sick leave, please provide details below.
                                                                        FSS Financial Planning use only
       Description                Owner         Weeks/Hours             (Complete only if taken   Client          Weeks          Partner   Weeks
                                                                        as a lump sum)
       Long Service Leave         Client                                Pre 1978                  $                              $
                                  Partner                               1978 – 1993               $                              $
       Annual Leave               Client                                Post 1993                 $                              $
                                  Partner                               annual Leave              $                              $
       Sick Leave                 Client                                Leave Loading             $                              $
                                  Partner                               Total                     $                              $



Q12 Have you previously received a redundancy payout or made withdrawals                          Client          Partner
    from superannuation?

                                                                                                      yes    no     yes     no



Q13 Do you expect to receive a redundancy payout in the near future?                              Client          Partner

                                                                                                      yes    no     yes     no




                                                                                                                                                   6
Personal Assets
Q14 What do you own outside of superannuation?
Please attach additional information if more space is required.


(a) Lifestyle Assets—assets that provide you with enjoyment or necessities in life
                                                                                                     FSS Financial Planning use only
 but are generally not considered available for use in a financial strategy.
Asset                                   Owner                        Market Value                    Centrelink           Note
                                        (Client/Partner/Joint)       $                               Value $
Home …………........ acres                     C         P          J

Home Contents                               C         P          J
Motor Vehicle                               C         P          J

                                            C         P          J

                                            C         P          J

(b) Non-superannuation financial assets                                                              FSS Financial Planning use only

Asset                                   Owner                        Amount         Available for    Rates                Notes
                                        (Client/Partner/Joint)       $              Investment?
Bank accounts

                                            C         P          J                     yes      no

                                            C         P          J                     yes      no

                                            C         P          J                     yes      no

                                            C         P          J                     yes      no
term Deposits                                                                                                             term         Maturity Date

                                            C         P          J                     yes      no

                                            C         P          J                     yes      no

                                            C         P          J                     yes      no
rental Properties                                                                                    Date acquired        Cost price   Loan amount     Income

                                            C         P          J                     yes      no

                                            C         P          J                     yes      no

                                            C         P          J                     yes      no

                                            C         P          J                     yes      no

                                                                                                                                                                7
Your current position
Personal Assets continued
Please attach additional information if more space is required.
 (b) Non-superannuation financial assets                                                    FSS Financial Planning use only

Asset                                Owner                        Amount   Available for    No of shares         DPR?          Purchase   Purchase
                                     (Client/Partner/Joint)       $        Investment?                                         Date       Cost
shares (total)

                                         C         P          J               yes      no

                                         C         P          J               yes      no

                                         C         P          J               yes      no

                                         C         P          J               yes      no
Managed Funds                                                                               Exit Cost            Income        Purchase   Purchase
                                                                                                                 Reinvest?     Date       Cost

                                         C         P          J               yes      no

                                         C         P          J               yes      no

                                         C         P          J               yes      no

                                         C         P          J               yes      no
insurance Bonds                                                                             Start Date           Maturity Date/Age        Exit Cost

                                         C         P          J               yes      no

                                         C         P          J               yes      no
other

                                         C         P          J               yes      no

                                         C         P          J               yes      no

                                         C         P          J               yes      no

                                         C         P          J               yes      no
                                     TOTAL                        $

                                                                                            Type of Lump Sum                   Amount $   When (year)
Q15 Do you expect any future lump sums?
(e.g. inheritance or the sale of a business)
                                                                                                                                                        8
Personal Liabilities
Q16 What do you owe?

                                                                                               FSS Financial Planning use only
 Loan Type        Owner                    Amount   Interest           Payment     Frequency   Creditor       Security        F/V        P&I/ IO    Tax
                  (Client/Partner/Joint)   $        %                  $           (fn/m/yr)                                                        Deduct?
 Home Loan           C        P        J                                                                                                                  yes
 Line of Credit      C        P        J                                                                                                                  yes
 Personal Loan       C        P        J                                                                                                                  yes
 Investment          C        P        J                                                                                                                  yes
 Loan
 Credit Card         C        P        J                                                                                                                  yes

                     C        P        J                                                                                                                  yes

                     C        P        J                                                                                                                  yes

                     C        P        J                                                                                                                  yes
                  TOTAL                    $



Superannuation
Q17 What are your superannuation assets?

 Fund Name                                          Owner                 Amount                            Available for       Client No/Super Fund ID
                                                    (Client/Partner)      $                                 investment?

                                                       C         P                                             yes       no

                                                       C         P                                             yes       no

                                                       C         P                                             yes       no

                                                       C         P                                             yes       no

                                                       C         P                                             yes       no
                                                    TOTAL                 $




                                                                                                                                                                9
Your current position

Estate Planning
The next three questions permit us to consider the impact on your loved-ones and beneficiaries of your estate,
if you should pass away. In many cases, the circumstances of you and/or your beneficiaries may have changed
since you first decided upon your estate planning needs.



Q18 Do you have a will?                                                               Client                           Partner

                                                                                         yes       no                     yes       no

      If yes, when was it last reviewed?                                                       /      /                         /    /


      FSS Financial Planning use only
                                        Client               Partner                  Notes

      Will held by

      testamentary trust?                  yes   no             yes      no

      enduring Poa?                        yes   no             yes      no

      Date last updated

      advance Health Directive?            yes   no             yes      no


Q19 Would you like to leave a gift to your beneficiaries when you                     Description or Amount $
    pass away?

Q20 Please provide details of your children and other dependants.
      Name                                                   Male/Female              Date of Birth         Financially Dependant?       When Independent?

                                                                yes      no                                      yes      no               yes     no

                                                                yes      no                                      yes      no               yes     no

                                                                yes      no                                      yes      no               yes     no

                                                                yes      no                                      yes      no               yes     no



                                                                                                                                                             10
Q21 What general insurances do you have in place?                                                     FSS Financial Planning use only

     Type                                     Replacement Cover?      Sum Insured                     Reviewed within past 12 months?
                                                                      $
     Home                                                                                                 yes
     Contents                                                                                             yes
                                              Market Value?
     Motor Vehicle                               yes     no                                               yes
     Caravan/Boat                                yes     no                                               yes
     Other                                       yes     no                                               yes


Q22 Do you have health insurance?                                     Client                          Partner

                                                                         yes       no                    yes       no
     If so, which of the following applies?                              Hospital only                   Hospital only

                                                                         ancillary only                  ancillary only

                                                                         Both                            Both




Q23 Please advise us of any health issues which may affect your financial position or future goals.

     Client




     Partner




                                                                                                                                        11
Your current position

Wealth Protection
In developing strategies to create and build wealth, a sound financial plan will also include strategies to protect wealth should an
unforeseen personal event (such as illness, injury or death) occur. Such an event could undermine your (and your family’s) plans for a
comfortable lifestyle—both before and after retirement. A wealth protection strategy can be tailored to your individual circumstances
and often involves the use of personal risk insurance policies. This section supplies us with the information needed to provide you
with meaningful, tailored wealth protection recommendations.

Q24 Please provide us with details of your current personal insurance cover
(please bring insurance documentation if available).

 A. Income Insurance (Income Protection, Accident and Sickness Insurance)

 Type of Cover   Life Insured      Policy Owner        Sum Insured      Waiting Period   Benefit Period              Annual Premium   Insurer   Cover held
                                                       ($per month)     (wks)            (2yrs, 5yrs or to age 65)   Cost                       within Super

                                                                                                                                                   yes     no

                                                                                                                                                   yes     no

 B. Term Life (Death, Total and Permanent (TPD) or Trauma/Critical Illness cover)

 Type of Cover   Life Insured      Policy Owner        Policy Beneficiary                Sum Insured                 Annual Premium   Insurer   Cover held
                                                                                                                     Cost                       within Super
                                                                                                                                                   yes     no

                                                                                                                                                   yes     no

                                                                                                                                                   yes     no

                                                                                                                                                   yes     no

 C. Whole of Life/Endowment Insurance

 Maturity Date   Life Insured      Policy Owner        Investment Cash Value             Sum Insured                 Annual Premium   Insurer   Cover held
                                                                                                                     Cost                       within Super

                                                                                                                                                   yes     no

                                                                                                                                                   yes     no

                                                                                                                                                   yes     no

                                                                                                                                                   yes     no

                                                                                                                                                                12
Checklist – is a risk insurance assessment warranted?
This checklist provides a quick and easy way to identify whether a risk assessment is warranted in your situation. If so, further
information will be requested for us to prepare recommendations for you (please refer to the notes below the checklist). We appreciate
you may have provided details regarding some of these questions in other sections of this questionnaire, however we only require a
yes/no answer here to identify whether you may have a need for insurance. If a risk assessment is warranted, then your answers to the
questions on the following page provide us with the information needed to determine the appropriate types and amounts of cover for you.


                                                                                                                                  Yes   Unsure   No

 Do you or your partner have a mortgage or any other significant debts, or have you provided personal guarantees for loans?

 Do you have any geared assets (ie have you borrowed to purchase property, shares, or other assets)?

 Do you have any financial dependants (eg children or other people who depend upon your financial support)?

 think about the investments you currently have and the income they generate. if you stopped working today would you need
 additional income to maintain your lifestyle?

 if you were to die suddenly, would your partner require more income than they currently earn (include income generated by your
 combined investments)?

 Would you require additional funds to meet medical costs associated with a serious illness (as a guide—allow up to $50,000)?



If you answered “yes” or “unsure”
to any of the above questions it is important that we review your personal insurance needs as part of your financial plan.
some more information will be required in order for this to be carried out properly—please complete the following section.




If you answered “no”
to all the above questions you are unlikely to require personal risk insurance coverage and you should proceed
directly to page 16.

Your current position




                                                                                                                                                      13
Your Employment Details
                                                                                                                   Client                 Partner
What are your main duties at work?


What proportion of your work involves manual duties (eg lifting, driving, using tools)?
are you employed on a full-time basis (minimum 30 hours per week)?
What is your employment status (permanent employee, casual, fixed term contract)?
if fixed term contract please state duration and expiry of contract
How long have you been with your current employer?
How long have you been in your current role?
are you contemplating changing jobs in the next 6 months?
What (if any) tertiary or trade qualifications do you have?
taking sick leave, other income entitlements and cash reserves into account, how long could you cope financially
if you could not work due to an accident or illness?




Your Capital / Lump Sum Needs
1    after debts have been discharged what level of income does your family need in the event of your untimely
     death? (Leave blank if unsure)                                                                                Amount $ (per annum)
2    after debts have been discharged what level of income does your family need in the event of your partner’s
     untimely death? (Leave blank if unsure)                                                                       Amount $ (per annum)

3    Would you want to continue working if your spouse/partner died or became permanently incapacitated?           Client Y   /n          Partner Y   /n
4    Would you want to discharge your existing debts if you suffered a life-threatening illness—eg cancer, heart
     attack etc?                                                                                                   Client Y   /n          Partner Y   /n

5    Do you smoke?                                                                                                 Client Y   /n          Partner Y   /n




                                                                                                                                                           14
Checklist—am I eligible for insurance?
The process of implementing cover involves the completion of a more detailed application form, which contains a series
of questions about your occupation, lifestyle and your medical history. This checklist will help us determine whether
cover is likely to be available for you and to negotiate favourable terms on your behalf. Note—if you feel more comfortable,
this section can be completed at or after your appointment.


 No.    Question                                                                                                 Client                     Partner
 1      Have you ever received medical treatment for any heart condition, stroke or cancer?                         yes      no                    yes       no

 2      Have you ever sought treatment for any back related condition?                                              yes      no                    yes       no

 3      Have you ever sought treatment from a medical practitioner for stress, anxiety or depression?               yes      no                    yes       no
 4      Have you ever had an insurance application declined or accepted on revised terms
                                                                                                                    yes      no                    yes       no
        (eg with a premium loading or for an exclusion for a particular condition)?
 5      are you aware of any other medical condition which might affect your ability to obtain insurance?           yes      no                    yes       no


 if you or your partner have answered “yes” to any of the above questions please provide details below:

 Name of Condition             Treatment Received (including medication)                                    Date Commenced        Date Finalised         Degree of Recovery %




 FSS Financial Planning use only




                                                                                                                                                                                15
Your Personal Risk Profiler
This is a series of questions that will guide us in selecting a mix of investments to
meet your personal goals. Your answers will reflect your preferences when investing.
Your adviser will discuss these and other aspects of investing with you
to ensure that we understand your personal level of risk tolerance.


Please read the following before completing the profiler.


  Consider:
  ■   Your present circumstances and future personal goals.
  ■   the amount of money you are investing and for how long it will be invested.
  ■   investment timeframes are as follows:
      sHort terM                at call up to 3 years
      MeDiuM terM               3 years to 7 years
      LonG terM                 7 years and beyond

  ■   Growth investments, such as shares and property, can change in value as well as pay an income return.
      they provide the opportunity for higher returns over the medium to long term. However, returns can be
      low or negative over the short to medium term.

  ■   Defensive investments, such as cash and fixed interest, offer lower risk and greater capital security. they generally
      deliver lower returns over the medium to long term and provide all or most of their return in the form of income.
  ■   Whenever you invest there are a number of risks to consider. these can include the risk that:
      – the value of your capital will fall
      – your capital will not keep pace with inflation
      – you will outlive your capital.


  Remember
  How well you achieve your financial and lifestyle goals depends upon how you respond to risk.




                                                                                                                              16
In relation to each of the questions below, please choose the answer you prefer and tick
the corresponding box. Your partner should also do this (you may have different answers).


Q1 How much knowledge do you have of investment markets?                                                                     Score   Client   Partner

 (a)    i don’t follow what goes on in investment markets.                                                                    1

 (b)    i sometimes read about investment markets and know that returns can vary year to year.                                2
 (c)    i read about investment markets whenever i get the chance and understand that different investments have different
        risk and return characteristics.                                                                                      3


Q2 With the amount of money you have to invest, which option do you prefer?                                                  Score   Client   Partner
 (a)    the safety of my money is my primary objective. i would rather have a low rate of return and know my
        capital will not fall in value.                                                                                       1
 (b)    the safety of my money is important. i would rather have a moderate rate of return and know my capital is
        relatively stable.                                                                                                    2
 (c)    i am prepared to accept some volatility in my capital over time in exchange for potentially higher returns
        over the longer term.                                                                                                 3

 (d)    i am prepared to accept a higher degree of volatility to receive a potentially higher return on my investment.        4



Q3 If you knew that a change in legislation could leave you worse off financially, would you
                                                                                                                             Score   Client   Partner
   take a risk in arranging your investments in order to qualify for tax advantages?
 (a)    i would not take a risk if there was any chance i could end up worse off financially.                                 1

 (b)    i would take a risk if there was only a small chance i could end up worse off financially.                            2

 (c)    i would take a risk as long as there was more than a 50% chance i would finish up better off.                         3



Q4 Keeping in mind your primary financial goals, how long are you planning to invest the
                                                                                                                             Score   Client   Partner
   majority of your money?
 (a)    Less than 3 years.                                                                                                    1

 (b)    3 to 4 years.                                                                                                         2

 (c)    5 to 6 years.                                                                                                         3

 (d)    7 years or more.                                                                                                      4



                                                                                                                                                        17
Your Personal Risk Profiler




Q5 What is the likelihood that you will require access to the invested money?                                     Score   Client   Partner

 (a)   almost certainly required within the next 3 years.                                                          1
 (b)   Little chance of requiring the majority of funds for at least 3–5 years. May need to withdraw a small
                                                                                                                   2
       portion in 3–5 years.

 (c)   Little chance of requiring the majority of funds for at least 5–7 years. a small portion may be required
                                                                                                                   3
       in case of emergency.

 (d)   no access at all required for at least 7 years. other funds have been set aside for emergencies             4




Q6 In targeting your long-term objectives, how would you feel if your capital decreased
                                                                                                                  Score   Client   Partner
   by 10% in one year?

 (a)   i can’t accept any declines in the value of my investments.                                                 1
 (b)   i generally invest for the long term, but would be concerned with this decline.                             2

 (c)   Provided i didn’t require access to my capital, i would not be too concerned about my capital declining
                                                                                                                   3
       in the short term.
 (d)   i invest for the long term and would accept these fluctuations.                                             4




Q7 How concerned are you that the earnings on your savings and investments should
                                                                                                                  Score   Client   Partner
   exceed the rate of inflation?

 (a)   not concerned.                                                                                              1

 (b)   Moderately concerned.                                                                                       2

 (c)   Highly concerned.                                                                                           3




                                                                                                                                             18
Q8 What are you currently looking for in your investment?                                                                                Score    Client        Partner

 (a)       i want a regular income and/or want to protect my capital.                                                                     1

 (b)       i want a mixture of growth and income from my investment.                                                                      2

 (c)       i am looking to generate long-term wealth.                                                                                     3




Q9 Which of the following statements describes your feelings towards choosing
                                                                                                                                         Score    Client        Partner
   an investment?
 (a)       i would select investments that have a zero or low degree of capital volatility associated with them.                          1

 (b)       i prefer to diversify with a mix of investments, which have an emphasis on low capital volatility. i can accept having a
           small proportion of the portfolio invested in assets that have a higher degree of short-term volatility in order to achieve    2
           a slightly higher return. i can accept a negative investment return of 1 in 10 years.

 (c)       i prefer to diversify my investments with an emphasis on more growth investments, which have potentially higher
                                                                                                                                          3
           returns, but still having a small amount of defensive investments. i can accept a negative return of 1 in 6 years.

 (d)       i would select investments that have a higher degree of capital fluctuation so that i can earn potentially higher long-        4
           term returns. i can accept a negative return of 1 in 3 years in order to achieve this goal.




Now add your individual scores and write your totals in the Total Score boxes below.


If you scored:               You may be more comfortable with                                                                                    Total score:

                                                                                                                                                  Client        Partner

 under 15                    a conservative investment mix with lower expected returns.

 16 – 23                     a moderate investment mix with moderate risk and return.

 24 or more                  an aggressive investment mix with higher risk and higher expected returns.
 Your current expenditure



                                                                                                                                                                          19
Your current expenditure


              Expenses                      Amount $             Frequency                                           Yearly Total $
                                                                 Weekly, Fortnightly, Monthly, Quarterly or Yearly
Food          Groceries                                                                                                               this worksheet will
                                                                                                                                      assist you to identify
              alcohol & tobacco
                                                                                                                                      your current cost of
Housing       rent
                                                                                                                                      living for question 4
              telephone                                                                                                               on page 4.
              electricity
              Gas
              Council rates/Body Corp
              Household Maintenance
              Furnishings & appliances
              House & Contents insurance
              Household Cleaning
              Gardening
Transport     Petrol
              Commuting & travel Costs
              Motor Vehicle Maintenance
              Motor Vehicle registration
              Motor Vehicle insurance
              Club Fees
Health        Health insurance
              Chemist & toiletries
              other Medical Costs
Personal      Clothing & Footwear
              Grooming
              Laundry & Dry Cleaning
              newspapers & Magazines
              entertainment
              Charities & Gifts
              sport, recreation & Hobbies
              Holidays & short trips
              Pets & Vet Fees
              Lotteries & Gaming
                                            Sub-total expenses                                                       A=
                                                                                                                                                        20
                      Expenses                               Amount $               Frequency                                           Yearly Total $
                                                                                    Weekly, Fortnightly, Monthly, Quarterly or Yearly

Loans                 Home Mortgage
                      Lease/Hire Purchase
                      other repayments
Education             education expenses
                      Child Maintenance
                      Child Care
Insurance             Life insurance
                      income Protection
                      other insurance
Rental                rental Property Loan repayments
                      rental Property rates/Body Corp
                      rental Property agent Costs
                      rental Property repairs
                      rental Property insurance
Other                 other expenses
                                                             Sub-total expenses                                                         B=


                                                             Total cost of living                                                       A+B=




 Don’t forget to sign!
 thank you for providing us with details of your current
 situation, your goals and objectives. Please turn over to
 the next page and complete this document by signing it.
 We look forward to helping you in your planning.




                                                                                                                                                         21
Collection Statement Privacy Act 1988 (Cth)


Your privacy is important to us at FSS Financial Planning
By completing this Lifestyle Questionnaire you are supplying personal and health information to us.
You may also supply personal and/or health information to us in other ways, such as during an appointment
or telephone conversation or by letter or completing another form.


 You should be aware that:
 ■   we will use your information to:
     – provide you with, implement and review financial planning advice and services
     – communicate with you in relation to the advice and services we provide you with
     – determine future business strategies and products and to develop our services
     – provide you with information regarding products or services offered by Fss Financial Planning which may be of interest to you;

 ■   in the course of doing business Fss Financial Planning may outsource certain tasks to third party suppliers such as mailing houses, information
     technology support and email suppliers. From time to time we also seek expert help to improve our systems, products and services. in these
     circumstances we may disclose your personal information to third parties who we will require to hold this information confidentially and in
     accordance with the requirements of privacy law. in addition, your personal information will not be shared with third parties, other than of this
     kind, without your consent;

 ■   we collect health information for the purpose of ensuring any advice and/or products recommended are appropriate to your individual needs.
     Your health information will not be provided to any other party;

 ■   if you do not provide full or accurate information, we may not be able to provide you with the products and/or services you are seeking;

 ■   we may be obliged by law to disclose your information and to report on prudential or risk management matters to regulators; and

 ■   you can contact Fss Financial Planning by phone, fax or email and request access to your information. Where there is some legal or
     administrative reason to deny you access, we will inform you of that reason. there may be some charge to give you full access where your
     request requires the retrieval and compilation of information that has been archived or is significant in volume.



You can obtain a copy of our privacy policy on www.fssfp.com.au or by requesting it from us.

 Client Information Certification




                                                                                                                                                         22
Client Information Certification

By signing below, I/we confirm that:

■   the details provided in this form are accurate; and i/we are not aware of any other information relevant to the provision of financial advice and understand
    that this information is the basis on which advice and recommendations will be made; and

■   if i/we have not provided full and/or accurate information, Fss Financial Planning will not be able to fully analyse my/our requirements and/or my/our needs
    and therefore the appropriateness of the recommendations made will be limited; and

■   i/we have received, read and understood the Fss Financial Planning Financial services Guide which was sent to me/us with this Lifestyle Questionnaire;
    and

■   unless we notify Fss Financial Planning to the contrary, Fss Financial Planning may send me/us information from time to time about its products and
    services; and

■   i/we authorise Fss Financial Planning to use my/our personal information:
    – to obtain any further information required to enable Fss Financial Planning to provide me/us with appropriate financial planning advice and services,
    – to obtain any further information required from anyone who has, does or will provide products and/or services to me/us (this may include for example
      my/our superannuation fund/s, regulatory authorities, other financial planning organisations, financial advisers and/or financial product issuers); and

■   i/we have read and understood the Collection statement on the preceding page.




Client Full Name                                     Client Signature                                           Date


Partner Full Name                                    Partner Signature                                          Date




FSS Financial Planning use only
i confirm that the amendments and inclusions of all data documented by me in this Lifestyle Questionnaire have been made with the
knowledge and acceptance of the client and/or their partner.


Adviser Full Name                                    Adviser Signature                                          Date




                                                                                                                                                                   23
Thank You


            23
Po Box r352 royal exchange nsW 1225
T 1800 665 756 (toll free)
F 1800 459 182 (toll free)
enquiries@fssfp.com.au
www.fssfp.com.au
Q invest Limited trading as
“Fss Financial Planning”
aBn 35 063 511 580 aFs Licence 238274




                              a.1.10.1-1v1: 01.09.07

				
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