FNA Word Document by wanghonghx

VIEWS: 9 PAGES: 48

									Financial Needs Analysis



Your name(s):




Your adviser:


Date completed:         /     /




                                                 Financial Wisdom Limited
                                                        ABN 70 006 646 108
                               Australian Financial Services License 231138
                  Head office: Level 16, 52 Martin Place, Sydney NSW 2000
                                                           Tel: 1800 024 864
Page 2 of 48


                         Financial Wisdom Limited and your privacy
       The privacy of your personal information
       1. Why are we asking so many questions?
            We collect your personal information to ensure we are able to provide you with products and services
            appropriate to your needs.
            The financial planning process involves the following steps:
            a) understanding a client’s financial goals
            b) gathering all the details of a client’s financial position
            c) analysing all the issues and options which will form the basis of any recommendations
            d) the adviser providing advice and recommendations, while making all the required disclosures
            e) the client agreeing with the advice and giving the adviser permission to implement all actions
               required to achieve the client’s financial goals
            f) the adviser and the client agreeing to the level of further review and action required to ensure the
               advice and recommendations continue to achieve the client’s identified financial goals.
            Effective financial planning is the result of carefully gathering the right information to enable a
            thorough assessment of your financial goals.
            This can be achieved by completing or updating a Financial Needs Analysis. A Financial Needs
            Analysis will help identify what is relevant and assist in prioritising any actions required. We aim to
            ensure that the personal information we retain about you, is accurate, complete and up to date.
            If you provide us with incomplete or inaccurate information, we may not be able to provide you with
            the products or services you are seeking.
            The law also requires us to collect personal information. For example, The Corporations Act 2001
            requires us to identify a person’s needs, objectives and financial circumstances to be able to provide
            advice, and the Anti Money Laundering and Counter Terrorism Financing Act 2006 (Cth) requires us
            to identify all clients and to conduct identity verification checks.
       2. Access to your personal information
            Subject to permitted exceptions, you can access your personal information at any time by contacting
            your financial adviser.
       3. Communicating your personal information
            At times, we may need to communicate your personal information to other parties, including:
            a) your adviser
            b) external product providers
            c) other members of the Commonwealth Group as required for advice assurance, audit requirements
                 and handling of complaints
            d) organisations (bound by strict confidentiality) to whom we outsource certain functions, such as our
                 auditors. In these circumstances, information will only be used for our purposes
            e) other professionals such as solicitors, accountants and stockbrokers when a referral is required
            f) third parties when required by law (eg under a court order)
            g) government departments or agencies such as ASIC or AUSTRAC.
       4.      Our Privacy Policy
               As a member of the Commonwealth Bank Group of companies, Financial Wisdom Limited has
               adopted the principles set out in the Privacy Act 1988 as part of our continuing commitment to client
               service and maintenance of client confidentiality. For further details, please refer to the Group’s
               Privacy Policy which can be located online at www.commbank.com.au.
                       Gathering all the right facts should lead to the right financial solution for you!

       Adviser use only
                                                                                              Benefit payable to
       Referral source                    Contact name               Phone number
                                                                                                  referrer
                                                                                          $           /            %

       Where did the client hear           Fund manager               Existing client           Advertising
       about the Licensee/Adviser?
                                              Seminar                  Direct mail                 Other
                                                                                                                                               Page 3 of 48

        Have you completed the ‘Client Questionnaire’?        Yes, go to ‘Part B’ on page 9.  No, complete ‘Part A’.
        Part A
        Personal details
        * Mandatory fields                                       Client 1                                               Client 2

        Title                                  Mr  Mrs  Ms  Miss  Dr                                  Mr  Mrs  Ms  Miss  Dr
                                               Other    ______________________________________________    Other
                                                                                                                ______________________________________________




        Last name    *


        Given names          *


        Preferred name

        Gender                                        Male  Female                                             Male  Female
        Date of birth    *                                         /          /                                           /          /

        Age

        Marital status
                                                     Excellent  Good                                          Excellent  Good
        Health
                                                     Average  Poor                                            Average  Poor
        Preferred contact details
        * Mandatory fields                                       Client 1                                               Client 2

        Primary contact                                                                  Client 1  Client 2
        Preferred method of contact                                                 Mail  Phone  Email
        Home address             *




        Postal address ( same as above)




        Home phone ( preferred)

        Work phone ( preferred)

        Mobile ( preferred)

        Fax

        Home e-mail ( preferred)

        Work e-mail ( preferred)




v2.02                                                                                                                            Part A – Personal details
Page 4 of 48


          Business / tax structures
          Do you have control or a stake in a business or tax structure?
           Yes – complete table below.  No – go to ‘Children / dependants’.
                                                              Client 1                       Client 2                                  Structure name

          Partnership                                     Yes  No                       Yes  No
          Sole trader                                     Yes  No                       Yes  No
          Private company                                 Yes  No                       Yes  No
          Self managed super fund (SMSF)                  Yes  No                       Yes  No
          Trust                                           Yes  No                       Yes  No

          Children / dependants
          Do you have any dependants?
           Yes – complete table below.  No,  Not disclosed by client – go to ‘Employment’.
                                                                                        Financially
          Name                          Date of birth        Gender                                                       Their income                   Relationship
                                                                                        dependent?
                                                           Male                   No
                                             /    /
                                                           Female                 Yes until age          ___________
                                                                                                                          $                  pa

                                                           Male                   No
                                             /    /
                                                           Female                 Yes until age          ___________
                                                                                                                          $                  pa

                                                           Male                   No
                                             /    /
                                                           Female                 Yes until age          ___________
                                                                                                                          $                  pa

                                                           Male                   No
                                             /    /
                                                           Female                 Yes until age          ___________
                                                                                                                          $                  pa


          Do any of your dependants require financial advice?                                                                               Yes  No
          Are you planning to expand your family?                                                                                           Yes  No
          What health or other issues (if any) need to be considered for dependants?




          Employment
                                                                              Client 1                                                        Client 2

          Employment status                                  Employee                          Full time                   Employee                          Full time
                                                             Self-employed                     Part time                   Self-employed                     Part time
                                                             Unemployed                        Casual                      Unemployed                        Casual
                                                             Homemaker                         Contract                    Homemaker                         Contract
                                                             Retired                           On leave                    Retired                           On leave
                                                             Student                                                        Student
                                                             Other _____________________________________________            Other _____________________________________________

          Have you recently been retrenched?                              Yes  No                                                       Yes  No
          Do you expect your employment situation                         Yes  No                                                       Yes  No
          to change in the next 5 years?

          Have you worked outside of Australia?                           Yes  No                                                       Yes  No
          If yes, state where and duration                                                                               Country ________________________________________________
                                                         Country ________________________________________________
                                                         From ______ /_______ /_______ to ______ /_______ /_______       From ______ /_______ /_______ to ______ /_______ /_______



Part A – Personal details                                                                                                                                                            v2.02
                                                                                                                                                                                  Page 5 of 48

        Occupation details
        Are you gainfully employed?
         Yes – complete the table below.  No,  Not disclosed by client,  Not applicable – go to ‘Social security’.
                                                                                Client 1                                                                 Client 2

        Primary occupation

        Employer’s name / trading name

        Date started with current employer                                        /           /                                                           /           /

        Number of hours worked per week

        Salary / wages (net of tax)                    $                                               pw / pf / pm             $                                              pw / pf / pm

        Superannuation guarantee (SG)                  $                                                                pa      $                                                                pa

        Do you have the ability to salary sacrifice?                 Yes  No  N/A                                                         Yes  No  N/A
        Can / does your income vary significantly?                          Yes  No                                                                Yes  No
        Unused sick leave entitlements                                                                              days                                                                     days

        Unused annual leave entitlements                                                                            days                                                                     days

        Unused long service leave entitlements                                                                      days                                                                     days

        Are you planning to change occupation?                              Yes  No                                                                Yes  No

        Social security
        Are you in receipt of Centrelink / DVA / overseas pension benefits?
         Yes – complete the table below.  No,  Not disclosed by client,  Not applicable – go to ‘Income summary’.
        Benefit details                                                         Client 1                                                                 Client 2

        Source                                                 Centrelink  DVA  O/S                                                 Centrelink  DVA  O/S
        Name / type of payment

        Payment amount                                 $                                                                  pf    $                                                              pf

        Other payments / entitlements




        Reference number

        Have you gifted assets in the last five                             Yes  No                                                               Yes  No
        years?

        If yes, how much and when?
                                                       $__________________________ on             /         /
                                                                                        __________ _________ ________________   $__________________________ on             /         /
                                                                                                                                                                 __________ _________ ________________




                                                       $__________________________ on             /         /
                                                                                        __________ _________ ________________   $__________________________ on             /         /
                                                                                                                                                                 __________ _________ ________________




                                                       $__________________________ on             /         /
                                                                                        __________ _________ ________________   $__________________________ on             /         /
                                                                                                                                                                 __________ _________ ________________




v2.02                                                                                                                                                            Part A – Personal details
Page 6 of 48


          Income summary
           Not disclosed by client,  Not applicable – go to ‘Expenditure details’.
          Gross income (pa)                                                             Client 1                     Client 2

          Salary / wages                                                    $                       pa    $                       pa

          Reportable fringe benefits (grossed up)                           $                       pa    $                       pa

          Work allowances                                                   $                       pa    $                       pa

          Commissions / bonus                                               $                       pa    $                       pa

          Centrelink / DVA payments                                         $                       pa    $                       pa

          Overseas pension                                                  $                       pa    $                       pa

          Maintenance payments                                              $                       pa    $                       pa

          Superannuation pension                                            $                       pa    $                       pa


          Interest / fixed interest payments                                $                       pa    $                       pa

          Dividends / managed fund distributions                            $                       pa    $                       pa


          Rental income                                                     $                       pa    $                       pa

          Other taxable income                                              $                       pa    $                       pa

          Non-taxable income                                                $                       pa    $                       pa

          Total                                                             $                       pa    $                       pa

          Is your income likely to change in the next 12 months?                        Yes  No                   Yes  No
          If yes, to what?                                                  $                        pa   $                       pa


          Taxation details                                                              Client 1                     Client 2

          Are you an Australian resident for tax purposes?                              Yes  No                   Yes  No
          Do you have a HECS debt?                                                      Yes  No                   Yes  No
          Are you claiming the Family Tax Benefit?                               Part A  Part B  No         Part A  Part B  No
          Do you have private hospital cover in place?                                  Yes  No                   Yes  No
          Are you claiming the private hospital cover rebate?                           Yes  No                   Yes  No
          Do you have an application to vary a PAYG?                                    Yes  No                   Yes  No
          Tax payments outstanding                                          $                             $

          Tax losses carried forward                                        $                             $


          Notes




Part A – Personal details                                                                                                              v2.02
                                                                                                                                Page 7 of 48

        Expenditure details
         Not disclosed by client – go to ‘Professional advisers’.
        What is your annual cost of living?
                                                                                                       $                              pa
        Use the budget planner below if you need to calculate your annual cost of living.

        How much do you or your household save each year?                                              $                              pa


        Do you expect any changes to your current savings pattern?                                               Yes  No
        If yes, provide details




        Budget planner
        Item                                        Amount                  Item                                  Amount
        Personal                                                            Transport
        Food                            $                             pa    Registration / licensing   $                              pa

        Clothing                        $                             pa    Insurance                  $                              pa

        Medical / pharmaceutical        $                             pa    Car Loan / lease           $                              pa

        Gas / water / electricity       $                             pa    Petrol and maintenance     $                              pa

        Phone / post / internet         $                             pa    Fares / taxi               $                              pa

        Furnishings                     $                             pa    Other                      $                              pa

        Alcohol                         $                             pa    Sub total                  $                              pa

        Hair / beauty                   $                             pa                                   Client 1            Client 2
        Other                           $                             pa    General
        Sub total                       $                             pa    Superannuation             $              pa   $              pa

        Housing                                                             Life insurance             $              pa   $              pa

        Rates and taxes                 $                             pa    Trauma / TPD insurance     $              pa   $              pa

        Insurances                      $                             pa    Health insurance           $              pa   $              pa

        Repairs / maintenance           $                             pa    Other                      $              pa   $              pa

        Rent / mortgage                 $                             pa    Sub total                  $              pa   $              pa

        Other                           $                             pa    Tax deductible expenses
        Sub total                       $                             pa    Income protection          $              pa   $              pa

        Entertainment                                                       Memberships                $              pa   $              pa

        Mag's / CD / books / DVD's      $                             pa    Professional texts         $              pa   $              pa

        Gifts                           $                             pa    Other                      $              pa   $              pa

        Restaurants / outings           $                             pa    Sub total                  $              pa   $              pa

        Sports / membership             $                             pa    Dependants
        Holidays                        $                             pa    Education                  $              pa   $              pa

        Credit / Store cards            $                             pa    Child care                 $              pa   $              pa

        Other                           $                             pa    Maintenance payment        $              pa   $              pa

        Other                           $                             pa    Other                      $              pa   $              pa

        Sub total                       $                             pa    Sub total                  $              pa   $              pa

        Total                                                                                          $                                  pa




v2.02                                                                                                                 Part A – Personal details
Page 8 of 48


          One-off expenses          None,  Not disclosed by client – go to ‘Professional advisers’.
          Description                                                                   Date                Amount required

                                                                                    /          /        $

                                                                                    /          /        $

                                                                                    /          /        $

                                                                                    /          /        $



          Professional advisers
           None,  Not disclosed by client – go to ‘Part B’ on page 9.
          Type                                     Name                                    Company                   Phone

          Solicitor

          Accountant

          Insurance adviser

          Doctor

          Other


          Notes




Part A – Personal details                                                                                                     v2.02
                                                      Page 9 of 48

        Part B
        Why are you seeking advice?




        Lifestyle / personal goals
        Short term (less than 2 years)




        Medium term (2 to 5 years)




        Long term (more than 5 years)




        Special interests / hobbies




v2.02                                    Part B – Goals and objectives
Page 10 of 48


         Your financial planning objectives
         Select the goal/s that apply to you by ticking the corresponding box. Add any goals not included here to
         the end of the list.
         Please provide specific details about each of your goals in the space provided. Include as much
         information as you can to help me develop a solution tailored to your specific needs.
         Your goals                               Details (mandatory and personalised)            Your instructions

          Build wealth                                                                              Meet goal now

                                                                                                     Ongoing goal
                                                                                                     Meet in ________ years
                                                                                                     Not in scope


          Make a one-off                                                                            Meet goal now
             investment                                                                              Ongoing goal
                                                                                                     Meet in ________ years
                                                                                                     Not in scope


          Commence a                                                                                Meet goal now
             regular
             investment plan
                                                                                                     Ongoing goal
                                                                                                     Meet in ________ years

                                                                                                     Not in scope


          Review                                                                                    Meet goal now
             investment
             portfolio
                                                                                                     Ongoing goal
                                                                                                     Meet in ________ years
                                                                                                     Not in scope


          Save for a future                                                                         Meet goal now
             expense                                                                                 Ongoing goal
                                                                                                     Meet in ________ years
                                                                                                     Not in scope


          Manage cash          flow                                                                 Meet goal now
                                                                                                     Ongoing goal
                                                                                                     Meet in ________ years

                                                                                                     Not in scope


          Reduce debt                                                                               Meet goal now

                                                                                                     Ongoing goal
                                                                                                     Meet in ________ years
                                                                                                     Not in scope


          Reduce tax                                                                                Meet goal now
                                                                                                     Ongoing goal

                                                                                                     Meet in ________ years
                                                                                                     Not in scope




Part B – Goals and objectives                                                                                              v2.02
                                                                                   Page 11 of 48

        Your goals              Details (mandatory and personalised)     Your instructions

         Contribute to super                                              Meet goal now

                                                                           Ongoing goal
                                                                           Meet in ________ years
                                                                           Not in scope


         Consolidate super                                                Meet goal now
            into one fund                                                  Ongoing goal

                                                                           Meet in ________ years
                                                                           Not in scope


         Plan for                                                         Meet goal now
            retirement                                                     Ongoing goal
                                                                           Meet in ________ years

                                                                           Not in scope


         Review insurance                                                 Meet goal now
            needs                                                          Ongoing goal
                                                                           Meet in ________ years
                                                                           Not in scope


                                                                          Meet goal now
                                                                           Ongoing goal

                                                                           Meet in ________ years
                                                                           Not in scope


                                                                          Meet goal now
                                                                           Ongoing goal
                                                                           Meet in ________ years

                                                                           Not in scope


                                                                          Meet goal now

                                                                           Ongoing goal
                                                                           Meet in ________ years
                                                                           Not in scope


                                                                          Meet goal now
                                                                           Ongoing goal

                                                                           Meet in ________ years
                                                                           Not in scope


                                                                          Meet goal now
                                                                           Ongoing goal
                                                                           Meet in ________ years
                                                                           Not in scope




v2.02                                                                  Part B – Goals and objectives
Page 12 of 48


         Additional questions relating to your objectives
         Liquidity       Not applicable,  Not disclosed by client – go to ‘Investments’.
         How much money would you like to set aside in a readily accessible investment to meet
                                                                                                                            $
         emergencies and unplanned expenses?


         Investments             Not applicable,  Not disclosed by client – go to ‘Superannuation’.
         Briefly detail your past experience with investments (eg term deposits, property, shares) and personal insurance.




         Are there any particular types of investments you want to have in your portfolio?                                          Yes         No

         If yes, what are they and why?




         Are there any types of investments you wish to avoid?                                                                      Yes         No

         If yes, what are they and why?




         Superannuation (mandatory for superannuation and insurance advice)                      Not applicable – go to ‘Retirement’.
                                                                                                    Client 1                         Client 2
         Have you made any personal contributions to any Australian
         superannuation fund in the past 3 financial years?                                      Yes           No              Yes            No

                                                                                                  $25,000                        $25,000
         Concessional contributions cap applicable to you
                                                                                                  $50,000                        $50,000
         Total concessional contributions made this financial year                         $                                $

         Remaining concessional cap this financial year                                    $                                $

         Total non-concessional contributions made in the past 3 financial                 $                                $
         years

         Remaining non-concessional cap                                                    $                                $



         Retirement        Not applicable,  Not disclosed by client – go to ‘Part C’ on page 13.
                                                                                                    Client 1                         Client 2
         At what age do you plan to retire?

         How much income per year do you think you will need in retirement?                 $                                                          pa

         Do you think that your current rate of savings will provide you with                            Yes  No  Not sure
         the retirement lifestyle you desire?

         Do you intend to leave an inheritance to your dependents?                                                Yes  No
         What sources of income do you expect to rely on in retirement?          (eg part-time work, social security benefits, self funded)




Part B – Goals and objectives                                                                                                                               v2.02
                                                                                                                                                                                              Page 13 of 48



   Part C
   Assets and liabilities
   Lifestyle assets    None,  Not disclosed by client,  Not in scope – go to ‘Investment assets’.
                                                                                  Purchase
   Description                                Owner          Current value                      Purchase date            Asset tested            Centrelink value        Security for loan?      Retain
                                                                                   amount
                                          C1  C2                                                                        Yes  No                                        Yes  No              Yes
   Family home
                                          Joint            $                 $                     /      /                                 $
                                                                                                                                                                                                  No
                                          C1  C2                                                                        Yes  No                                        Yes  No              Yes
   Contents
                                          Joint            $                 $                     /      /                                 $
                                                                                                                                                                                                  No
                                          C1  C2                                                                        Yes  No                                        Yes  No              Yes
   Motor vehicle 1
                                          Joint            $                 $                     /      /                                 $
                                                                                                                                                                                                  No
                                          C1  C2                                                                        Yes  No                                        Yes  No              Yes
   Motor vehicle 2
                                          Joint            $                 $                     /      /                                 $
                                                                                                                                                                                                  No
                                          C1  C2                                                                        Yes  No                                        Yes  No              Yes
   Holiday home
                                          Joint            $                 $                     /      /                                 $
                                                                                                                                                                                                  No
                                          C1  C2                                                                        Yes  No                                        Yes  No              Yes
   Boat / caravan
                                          Joint            $                 $                     /      /                                 $
                                                                                                                                                                                                  No
                                          C1  C2                                                                        Yes  No                                        Yes  No              Yes
   Other
                                          Joint            $                 $                     /      /                                 $
                                                                                                                                                                                                  No
   Investment assets
   Cash / fixed interest    None,  Not disclosed by client,  Not in scope – go to ‘Managed funds / shares / other’.
                                                                                  Purchase                                              Maturity              Reinvest         Security for
   Description                                Owner          Current value                      Purchase date         Income pa                                                                  Retain
                                                                                   amount                                                date                 income?            loan?
                                          C1  C2                                                                                                          Yes  No          Yes  No          Yes
                                          Joint            $                 $                        /   /      $        /      %      /       /
                                                                                                                                                                                                  No
                                          C1  C2                                                                                                          Yes  No          Yes  No          Yes
                                          Joint            $                 $                        /   /      $        /      %      /       /
                                                                                                                                                                                                  No
                                          C1  C2                                                                                                          Yes  No          Yes  No          Yes
                                          Joint            $                 $                        /   /      $        /      %      /       /
                                                                                                                                                                                                  No
                                          C1  C2                                                                                                          Yes  No          Yes  No          Yes
                                          Joint            $                 $                        /   /      $        /      %      /       /
                                                                                                                                                                                                  No
                                          C1  C2                                                                                                          Yes  No          Yes  No          Yes
                                          Joint            $                 $                        /   /      $        /      %      /       /
                                                                                                                                                                                                  No
                                          C1  C2                                                                                                          Yes  No          Yes  No          Yes
                                          Joint            $                 $                        /   /      $        /      %      /       /
                                                                                                                                                                                                  No
                                          C1  C2                                                                                                          Yes  No          Yes  No          Yes
                                          Joint            $                 $                        /   /      $        /      %      /       /
                                                                                                                                                                                                  No

v2.02                                                                                                                                                                            Part C – Assets and liabilities
Page 14 of 48


    Investment assets (continued)
    Managed funds / shares / other    None,  Not disclosed by client,  Not in scope – go to ‘Direct property’.
                                                                              Purchase                                              Units /         Regular     Reinvest   Security for
    Description                           Owner          Current value                       Purchase date          Income pa                                                             Retain
                                                                               amount                                               shares        investment    income       loan?
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No
                                      C1  C2                                                                                                                   Yes       Yes  No  Yes
                                      Joint             $                $                      /    /        $        /       %             $            pa
                                                                                                                                                                 No                   No


Part C – Assets and liabilities                                                                                                                                                                v2.02
                                                                                                                                                                                                   Page 15 of 48


   Investment assets (continued)
   Direct property         None,  Not disclosed by client,  Not in scope – go to ‘Liabilities’.
                                                                                          Purchase                                                                                  Security for
   Description                                      Owner          Current value                         Purchase date        Annual rent      Annual expenses      Property type                     Retain
                                                                                           amount                                                                                     loan?
                                                C1  C2                                                                                                                             Yes  No         Yes
                                                Joint            $                  $                       /    /       $                   $
                                                                                                                                                                                                       No
                                                C1  C2                                                                                                                             Yes  No         Yes
                                                Joint            $                  $                       /    /       $                   $
                                                                                                                                                                                                       No
                                                C1  C2                                                                                                                             Yes  No         Yes
                                                Joint            $                  $                       /    /       $                   $
                                                                                                                                                                                                       No
                                                C1  C2                                                                                                                             Yes  No         Yes
                                                Joint            $                  $                       /    /       $                   $
                                                                                                                                                                                                       No
                                                C1  C2                                                                                                                             Yes  No         Yes
                                                Joint            $                  $                       /    /       $                   $
                                                                                                                                                                                                       No
                                                C1  C2                                                                                                                             Yes  No         Yes
                                                Joint            $                  $                       /    /       $                   $
                                                                                                                                                                                                       No
                                                C1  C2                                                                                                                             Yes  No         Yes
                                                Joint            $                  $                       /    /       $                   $
                                                                                                                                                                                                       No
   Liabilities        None,  Not disclosed by client,  Not in scope – go to ‘Superannuation details’.
                                                                                                           Principal or   Loan           Monthly     Interest tax        Original    Original date
   Type                        Lender             Borrower            Balance            Interest rate                                                                                                Retain
                                                                                                          interest only   term          repayment    deductible?         amount         of loan
                                                C1  C2                                                  P&I  IO                                   Yes  No                                        Yes
   Home mortgage
                                                Joint            $                                  %                              $                                $                   /   /
                                                                                                                                                                                                       No
                                                C1  C2                                                  P&I  IO                                   Yes  No                                        Yes
   Investment loan
                                                Joint            $                                  %                              $                                $                   /   /
                                                                                                                                                                                                       No
                                                C1  C2                                                  P&I  IO                                   Yes  No                                        Yes
   Personal loan
                                                Joint            $                                  %                              $                                $                   /   /
                                                                                                                                                                                                       No
                                                C1  C2                                                  P&I  IO                                   Yes  No                                        Yes
   Credit cards
                                                Joint            $                                  %                              $                                $                   /   /
                                                                                                                                                                                                       No
                                                C1  C2                                                  P&I  IO                                   Yes  No                                        Yes
   Lease / HP
                                                Joint            $                                  %                              $                                $                   /   /
                                                                                                                                                                                                       No
   Reverse                                      C1  C2                                                  P&I  IO                                   Yes  No                                        Yes
   mortgage                                     Joint            $                                  %                              $                                $                   /   /
                                                                                                                                                                                                       No
                                                C1  C2                                                  P&I  IO                                   Yes  No                                        Yes
   Line of credit
                                                Joint            $                                  %                              $                                $                   /   /
                                                                                                                                                                                                       No
                                                C1  C2                                                  P&I  IO                                   Yes  No                                        Yes
   Margin loan
                                                Joint            $                                  %                              $                                $                   /   /
                                                                                                                                                                                                       No
                                                C1  C2                                                  P&I  IO                                   Yes  No                                        Yes
   Other
                                                Joint            $                                  %                              $                                $                   /   /
                                                                                                                                                                                                       No

v2.02                                                                                                                                                                                Part C – Assets and liabilities
Page 16 of 48


          Notes




Part C – Assets and liabilities   v2.02
                                                                                                                                             Page 17 of 48

        Superannuation details
         None,  Not disclosed by client,  Not in scope – go to ‘Termination payments (Employer)’.
                                                     Fund 1                      Fund 2                      Fund 3                      Fund 4

        Product name / provider


        Investor / member                         C1  C2                    C1  C2                    C1  C2                    C1  C2
        Member number
        Investment option/s




        Current value                        $                           $                           $                           $

        Retain?                                     Yes          No           Yes          No           Yes          No           Yes          No
        Employer / SG contributions          $                      pa   $                      pa   $                      pa   $                      pa

        Concessional contributions           $                      pa   $                      pa   $                      pa   $                      pa

        Non-concessional contributions       $                      pa   $                      pa   $                      pa   $                      pa

        Date commenced                               /         /                 /         /                 /         /                 /         /

        Eligible for choice of fund                 Yes          No           Yes          No           Yes          No           Yes          No
        Binding nomination                          Yes          No           Yes          No           Yes          No           Yes          No
        Year nomination made
        Type of fund (eg retail, industry)
        Accumulation / defined benefit          Accumulation               Accumulation               Accumulation               Accumulation
                                                Defined benefit            Defined benefit            Defined benefit            Defined benefit
        Eligible service period                      /         /                 /         /                 /         /                 /         /

        Total taxable component              $                           $                           $                           $

        Total tax-free component             $                           $                           $                           $

        Preserved amount                     $                           $                           $                           $

        Restricted non-preserved             $                           $                           $                           $

        Unrestricted non-preserved           $                           $                           $                           $

        Exit fee                             $             /        %    $             /        %    $             /        %    $             /        %

        Management cost pa                   $             /        %    $             /        %    $             /        %    $             /        %

        Insurance cover                             Yes          No           Yes          No           Yes          No           Yes          No
        Other benefits provided



        Notes




v2.02                                                                                                                       Part C – Superannuation details
Page 18 of 48


         Superannuation details (continued)

                                                      Fund 5                      Fund 6                      Fund 7                      Fund 8

         Product name / provider


         Investor / member                         C1  C2                    C1  C2                    C1  C2                    C1  C2
         Member number
         Investment option/s




         Current value                        $                           $                           $                           $

         Retain?                                     Yes          No           Yes          No           Yes          No           Yes          No
         Employer / SG contributions          $                      pa   $                      pa   $                      pa   $                      pa

         Concessional contributions           $                      pa   $                      pa   $                      pa   $                      pa

         Non-concessional contributions       $                      pa   $                      pa   $                      pa   $                      pa

         Date commenced                               /         /                 /         /                 /         /                 /         /

         Eligible for choice of fund                 Yes          No           Yes          No           Yes          No           Yes          No
         Binding nomination                          Yes          No           Yes          No           Yes          No           Yes          No
         Year nomination made
         Type of fund (eg retail, industry)
         Accumulation / defined benefit          Accumulation               Accumulation               Accumulation               Accumulation
                                                 Defined benefit            Defined benefit            Defined benefit            Defined benefit
         Eligible service period                      /         /                 /         /                 /         /                 /         /

         Total taxable component              $                           $                           $                           $

         Total tax-free component             $                           $                           $                           $

         Preserved amount                     $                           $                           $                           $

         Restricted non-preserved             $                           $                           $                           $

         Unrestricted non-preserved           $                           $                           $                           $

         Exit fee                             $             /        %    $             /        %    $             /        %    $             /        %

         Management cost pa                   $             /        %    $             /        %    $             /        %    $             /        %

         Insurance cover                             Yes          No           Yes          No           Yes          No           Yes          No
         Other benefits provided



         Notes




Part C – Superannuation details                                                                                                                              v2.02
                                                                                                                        Page 19 of 48

        Termination payments (Employer)
         None,  Not disclosed by client,  Not in scope – go to ‘Income stream investments’.
        Termination details                                                    Client 1                          Client 2
        Employment start date                                                   /     /                          /      /

        Employment termination date                                             /     /                          /      /

        Is this a transitional termination payment?
        (ie employment contract in place as at 10/05/06)                      Yes       No                   Yes        No

        Any previous termination payments received?
        (this financial year)                                                 Yes       No                   Yes        No


        Super payments                                                         Client 1                          Client 2
        Total taxable component                                      $                                $

        Total tax-fee component                                      $                                $

        Other                                                        $                                $

        Total                                                        $                                $


        Preserved amount                                             $                                $

        Superannuation pension                                       $                           pa   $                          pa

        Payment date                                                            /     /                          /      /


        Leave payments                                                         Client 1                          Client 2
        Unused long service leave ( net              gross)        $                                $

        Unused annual leave ( net             gross)               $                                $

        Redundancy / early retirement – tax free                     $                                $

        Redundancy / early retirement – ETP                          $                                $

        Ex-gratia / golden handshake                                 $                                $

        Other                                                        $                                $

        Total                                                        $                                $


        Notes




v2.02                                                                                            Part C – Termination payments (Employer)
Page 20 of 48


         Income stream investments
          None,  Not disclosed by client,  Not in scope – go to ‘Estate details’.
                                                         Fund 1                          Fund 2                          Fund 3                          Fund 4

         Product name / provider


         Type of product
         Investor / owner                        C1  C2  Joint  C1  C2  Joint  C1  C2  Joint  C1  C2  Joint
         Investment option/s




         Current value                          $                               $                               $                               $

         Member number
         Retain?                                       Yes            No             Yes            No             Yes            No             Yes            No

         Date of purchase                                /         /                     /         /                     /         /                     /         /

         Original investment                    $                               $                               $                               $

         Units
         Residual capital value          N/A   $             /            %    $             /            %    $             /            %    $             /            %

         Have you named a reversionary                 Yes            No             Yes            No             Yes            No             Yes            No
         beneficiary?
                                                Name ______________________     Name ______________________     Name ______________________     Name ______________________
         If yes, please provide details
                                                DOB _____ / _____ / _________   DOB _____ / _____ / _________   DOB _____ / _____ / _________   DOB _____ / _____ / _________

         Rebate                                                            %                               %                               %                               %

         Eligible service period                         /         /                     /         /                     /         /                     /         /

         Income drawn                           $                         pa    $                         pa    $                         pa    $                         pa

         Payment frequency
         Minimum required payment               $             /            %    $             /            %    $             /            %    $             /            %

         Term / maturity date            N/A            /         /                     /         /                     /         /                     /         /

         Tax-free amount                        $                               $                               $                               $

         Centrelink / DVA deductible
                                                $                               $                               $                               $
         amount
         Total taxable component                $                               $                               $                               $

         Total tax-free component               $                               $                               $                               $

         Exit fee                               $             /            %    $             /            %    $             /            %    $             /            %

         Management cost pa                     $             /            %    $             /            %    $             /            %    $             /            %


         Additional information for income streams commenced prior to 01/07/07 which are being rolled over
         Unused undeducted purchase
                                                $                               $                               $                               $
         price
         Pre-1 July 1983 component              $                               $                               $                               $

         Is it a pre-1994 pension?                     Yes            No             Yes            No             Yes            No             Yes            No



Part C – Income streams                                                                                                                                                         v2.02
                                                                                                                                                          Page 21 of 48

        Estate details (mandatory for insurance advice)
         Not disclosed by client,  Not in scope – go to ‘Self managed super fund (SMSF)’.
                                                                          Client 1                                                    Client 2
        Do you have a Will?                                             Yes         No                                             Yes         No
        Does it reflect your current wishes?                  Yes  No              Not sure                           Yes  No                Not sure
        Date prepared                                                      /          /                                                 /          /

        Date last reviewed                                                 /          /                                                 /          /

        Location of Will

        Does your Will allow for a testamentary                         Yes              No                                        Yes             No
        trust?

        Executor/s
        Do you own any funeral bonds?                           Yes  No                                                    Yes  No
        Do you have a Power of Attorney?                        Yes  No                                                    Yes  No
        Type of Power of Attorney                              Enduring  Medical                                          Enduring  Medical
                                                               Limited  Other                                             Limited  Other
        Date last reviewed                                                 /          /                                                 /          /

        Power of Attorney granted to
                                                      Name   ___________________________________________________   Name   ___________________________________________________



                                                             ___________________________________________________          ___________________________________________________




                                                      Relationship     _________________________________________   Relationship     _________________________________________



        Location of Power of Attorney

        Do you have any specific estate planning                        Yes              No                                        Yes             No
        requirements / needs?

        If yes, provide details.




        Notes




v2.02                                                                                                                                              Part C – Estate details
Page 22 of 48


         Self managed super fund (SMSF)
          None,  Not disclosed by client,  Not in scope – go to ‘Private company’.
         Fund details
         Name of fund

         Type of fund                                                       ATO SMSF  Small APRA fund (SAF)  Non-complying
         Trustee type                                                              Individual trustees  Corporate trustee
         Are all members trustees of the Fund?                                                 Yes  No
         If no, name of non-member trustee

         Corporate trustee name (if applicable)

         Are all members directors of the corporate trustee?                                           Yes       No

         If no, name of non-member director/s

         Retain SMSF                                                                                   Yes       No

         Administrator of the Fund

         Retain administrator                                                                          Yes       No


         Establishment date                                                                              /    /

         ABN

         Are assets segregated?                                                                        Yes       No

         Current level of in-house assets owned by the Fund                                                                                  %

         Trust deed sighted                                                                            Yes       No

         Does the trust deed allow for borrowing to invest?                                            Yes       No

         Describe the Fund’s reserves and policy as set out in the trust deed.




         Member details

                                                      Member 1                 Member 2                 Member 3                 Member 4

         Given name

         Surname

         Eligible service date                         /    /                   /    /                   /    /                   /    /

                                                 Accumulation            Accumulation            Accumulation            Accumulation
         Accumulation / pension phase
                                                 Pension                 Pension                 Pension                 Pension

         Member balance                      $                         $                        $                        $

         Contributions                       $                    pa   $                   pa   $                   pa   $                   pa

         Pension drawn                       $                    pa   $                   pa   $                   pa   $                   pa

         Insurance via SMSF?                         Yes       No           Yes       No           Yes       No           Yes       No




Part C – Self managed super fund (SMSF)                                                                                                          v2.02
                                                                                                                           Page 23 of 48

        Asset details    None,  Not disclosed by client – go to 'Liabilities'.
                                              Balance -              Balance -     Purchase   Purchase
        Description                                                                                               Income     Retain
                                            accumulation             pension         date       value
        Pooled assets      None      Not disclosed by client
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
        Member 1 segregated assets        None      Not disclosed by client
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
        Member 2 segregated assets        None      Not disclosed by client
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
        Member 3 segregated assets        None      Not disclosed by client
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
        Member 4 segregated assets        None      Not disclosed by client
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
                                                                                                                              Yes
                                            $                    $                   /   /    $               $        pa
                                                                                                                              No
        Total                               $                    $                            $               $        pa



v2.02                                                                                             Part C – Self managed super fund (SMSF)
Page 24 of 48


         Liabilities       None,  Not disclosed by client – go to 'Expenses'.
                                                                      Interest            Principal or              Loan            Monthly
         Description                               Balance                                                                                        Retain
                                                                        rate             interest only              term           repayment
                                                                                          P&I  IO                                                Yes
                                              $                                 %                                              $
                                                                                                                                                   No
                                                                                          P&I  IO                                                Yes
                                              $                                 %                                              $
                                                                                                                                                   No
                                                                                          P&I  IO                                                Yes
                                              $                                 %                                              $
                                                                                                                                                   No
                                                                                          P&I  IO                                                Yes
                                              $                                 %                                              $
                                                                                                                                                   No
                                                                                          P&I  IO                                                Yes
                                              $                                 %                                              $
                                                                                                                                                   No
         Total                                $                                                                                $


         Expenses          None,  Not disclosed by client – go to 'Investment strategy'.
         Description                                                                                             Amount                   Tax deductible

                                                                                                      $                              pa    Yes    No
                                                                                                      $                              pa    Yes    No
                                                                                                      $                              pa    Yes    No
                                                                                                      $                              pa    Yes    No
                                                                                                      $                              pa    Yes    No
         Total                                                                                        $                              pa


         Investment strategy           Not disclosed by client – go to 'Private company'.
         Investment strategy sighted?                                                                             Yes         No

         Implementation date                                                                                         /     /

         Does the investment strategy prohibit any particular
         types of investments?                                                                                    Yes         No

         If yes, what are they?




         Investment strategy                                                     Specified ranges                              Current asset allocation

         Cash                                                          ____________________   % to ____________________%                                  %

         Fixed interest                                                ____________________   % to ____________________%                                  %

         Australian shares                                             ____________________   % to ____________________%                                  %

         International shares                                          ____________________   % to ____________________%                                  %

         Property and infrastructure                                   ____________________   % to ____________________%                                  %

         Direct property                                               ____________________   % to ____________________%                                  %

         Alternatives                                                  ____________________   % to ____________________%                                  %

         Other allowable assets                                        ____________________   % to ____________________%                                  %




Part C – Self managed super fund (SMSF)                                                                                                                       v2.02
                                      Page 25 of 48

        Notes




v2.02           Part C – Self managed super fund (SMSF)
Page 26 of 48


         Private company
          None,  Not disclosed by client,  Not in scope – go to ‘Trust’.
         Company details
         Registered company name
         Trading name
         ABN
         Company type
         Company purpose
         Nature of business / industry
         Establishment date                                                                                   /         /

         Number of employees
         Gross sales turnover                                            $                                                                                  pa

         Fixed business expenses                                         $                                                                                  pa

         Estimated net value                                             $


         Director / shareholder details
                                                    Director /                 Director /                    Director /                   Director /
                                                  shareholder 1              shareholder 2                 shareholder 3                shareholder 4

         Given name
         Surname
         Shareholder                                 Yes      No              Yes        No             Yes           No              Yes       No

         Shareholder equity                                       %                            %                                %                           %

         Shareholder loan amount              $                          $                          $                               $


         Investment details         None,  Not disclosed by client – go to ‘Liabilities’.
                                                                 Purchase              Purchase
         Description                      Current value                                                Expenses                 Income             Retain
                                                                   date                  value
                                          $                          /       /       $                 $           pa       $           pa     Yes      No
                                          $                          /       /       $                 $           pa       $           pa     Yes      No
                                          $                          /       /       $                 $           pa       $           pa     Yes      No
                                          $                          /       /       $                 $           pa       $           pa     Yes      No
                                          $                          /       /       $                 $           pa       $           pa     Yes      No
                                          $                          /       /       $                 $           pa       $           pa     Yes      No
         Total                            $                                          $                 $           pa       $           pa


         Liabilities    None,  Not disclosed by client – go to 'Trust'.
                                                                  Interest              Principal or         Loan            Monthly
         Description                              Balance                                                                                          Retain
                                                                    rate               interest only         term           repayment
                                          $                                      %      P&I  IO                           $                  Yes  No
                                          $                                      %      P&I  IO                           $                  Yes  No
                                          $                                      %      P&I  IO                           $                  Yes  No
         Total                            $                                                                                 $




Part C – Private company                                                                                                                                     v2.02
                                                                                                                                                 Page 27 of 48

        Trust
         None,  Not disclosed by client,  Not in scope – go to ‘Personal insurance’.
        Trust details
        Name of trust

        Trust type

        Trust purpose

        Establishment date                                                                                       /        /

        Trustee type                                                                           Individual trustees  Corporate trustee
        Individual trustee/s (if applicable)



        Corporate trustee name (if applicable)

        Directors of corporate trustee (if applicable)




        Beneficiary details
        Beneficiaries                                   Beneficiary 1                Beneficiary 2            Beneficiary 3                Beneficiary 4

        Given name
        Surname
        Income distributed                         $                    pa   $                       pa   $                       pa   $                   pa


        Investment details            None,  Not disclosed by client – go to ‘Liabilities’.
                                                                    Purchase              Purchase
        Description                            Current value                                              Expenses                Income          Retain
                                                                      date                  value
                                               $                         /       /        $               $          pa       $            pa    Yes    No
                                               $                         /       /        $               $          pa       $            pa    Yes    No
                                               $                         /       /        $               $          pa       $            pa    Yes    No
                                               $                         /       /        $               $          pa       $            pa    Yes    No
                                               $                         /       /        $               $          pa       $            pa    Yes    No
                                               $                         /       /        $               $          pa       $            pa    Yes    No
                                               $                         /       /        $               $          pa       $            pa    Yes    No
        Total                                  $                                          $               $          pa       $            pa


        Liabilities      None,  Not disclosed by client – go to 'Personal insurance'.
                                                                        Interest           Principal or         Loan           Monthly
        Description                                    Balance                                                                                    Retain
                                                                          rate            interest only         term          repayment
                                               $                                      %     P&I  IO                         $                  Yes  No
                                               $                                      %     P&I  IO                         $                  Yes  No
                                               $                                      %     P&I  IO                         $                  Yes  No
        Total                                  $                                                                              $




v2.02                                                                                                                                              Part C – Trust
Page 28 of 48


         Personal insurance
          Not in scope – go to ‘Part D’ on page 35.
         Application information  Not disclosed by client – go to ‘Current policy details’.
                                                                                      Client 1                           Client 2
         Have you smoked tobacco or any other substance
         at any time during the last 12 months?
                                                                                     Yes       No                     Yes       No

         Number of weeks that you could maintain your
         standard of living without your primary income
         Have you had an application for personal
         insurance rejected for any reason?
                                                                                     Yes       No                     Yes       No

         Are you claiming or have you ever claimed a
         benefit from any source
                                                                                     Yes       No                     Yes       No

         Are you aware of any reason or impediment to you
         obtaining life or disability cover from an insurer?
                                                                                     Yes       No                     Yes       No


         Current policy details              None,  Not disclosed by client – go to ‘Insurance analysis’.
                                                      Policy 1               Policy 2                   Policy 3               Policy 4
         Policy owner
         Life insured                            C1  C2  Joint  C1  C2  Joint  C1  C2  Joint  C1  C2  Joint
         Insurance company
         Policy number
         Policy type
         Date commenced                                /     /                /        /                 /    /                 /        /

         Renewal date                                  /     /                /        /                 /    /                 /        /

         Amount of term life cover              $                      $                          $                      $

         Amount of TPD cover                    $                      $                          $                      $

         Amount of trauma cover                 $                      $                          $                      $

         Income protection benefit              $                pm    $                    pm    $                pm    $                   pm

         Premium                                $                pm    $                    pm    $                pm    $                   pm

         Premium type                            Level  Stepped  Level  Stepped  Level  Stepped  Level  Stepped
         Indexed to CPI?                          Yes  No         Yes  No         Yes  No         Yes  No
         Superannuation policy?                   Yes  No         Yes  No         Yes  No         Yes  No
         Continuation option?                     Yes  No         Yes  No         Yes  No         Yes  No
         Retain policy?                           Yes  No         Yes  No         Yes  No         Yes  No
         Exclusions / Loadings?                   Yes  No         Yes  No         Yes  No         Yes  No
         For income protection
         Policy type (ie standard / plus)
         Waiting period
         Benefit period
                                                      Agreed                Agreed                    Agreed                Agreed
         Agreed or indemnity?
                                                      Indemnity             Indemnity                 Indemnity             Indemnity
         Super continuance?                          Yes  No              Yes  No                  Yes  No              Yes  No
         Accident option?                            Yes  No              Yes  No                  Yes  No              Yes  No
         Increasing claims option?                   Yes  No              Yes  No                  Yes  No              Yes  No
         TPD option?                                 Yes  No              Yes  No                  Yes  No              Yes  No
         Is the benefit indexed?                     Yes  No              Yes  No                  Yes  No              Yes  No

Part C – Personal insurance                                                                                                                       v2.02
                                                                                                                                         Page 29 of 48

        Insurance analysis (Term life, TPD, trauma) – Client 1
         Not in scope.  Completed separately.
        Lump sum needs                                                                        Term life            TPD                Trauma
        Clear debts
          Home mortgage                                                                $                   $                    $

          Investment loan                                                              $                   $                    $

          Personal loan                                                                $                   $                    $

          Credit cards                                                                 $                   $                    $

          Lease / HP                                                                   $                   $                    $

          Reverse mortgage                                                             $                   $                    $

          Line of credit / home equity loan                                            $                   $                    $

          Margin loan                                                                  $                   $                    $

          Other                                                                        $                   $                    $

        Funeral costs                                                                  $                   N/A                  N/A

        Medical / lifestyle                                                            N/A                 $                    $

        Emergency funds (three to four months of normal income)                        $                   $                    $

        Recovery income                                                                N/A                 $                    $

        Capital needs / miscellaneous costs and expenses                               $                   $                    $

        Sub total                                                             =A       $                   $                    $

        Gross income needs                                                                    Term life            TPD                Trauma
        Education funding                Income required $___________________ pa
                                                                                       $                   $                    $
                                         Number of years _________________________
        Income required                  Income required $___________________ pa
        (ie regular living expenses)                                                   $                   $                    $
                                         Number of years _________________________
        Child care / education           Income required $___________________ pa
                                                                                       $                   $                    $
                                         Number of years _________________________
        Other income                     Income required $___________________ pa
                                                                                       $                   $                    $
        _____________________            Number of years _________________________
        Other income                     Income required $___________________ pa
                                                                                       $                   $                    $
        _____________________            Number of years _________________________
        Other income                     Income required $___________________ pa
                                                                                       $                   $                    $
        _____________________            Number of years _________________________
        Other income                     Income required $___________________ pa
                                                                                       $                   $                    $
        _____________________            Number of years _________________________
        Sub total                                                             =B       $                   $                    $

        Years                      1       2             3            4                 5          6         7        8            9          10
        Lump sum factor          1.000   1.963         2.889        3.781             4.640      5.466     6.262    7.028        7.765      8.475
        Years                     11       12           13            14               15          16       17        18          19          20
        Lump sum factor          9.158   9.816        10.449        11.058           11.645      12.210   12.753    13.276      13.780      14.265
        Years                     21       22           23            24               25          26       27        28          29          30
        Lump sum factor         14.732   15.181       15.613        16.030           16.430      16.816   17.188    17.545      17.889      18.220
        Years                     31       32           33            34               35          36       37        38          39          40
        Lump sum factor         18.539   18.846       19.142        19.426           19.700      19.963   20.217    20.461      20.696      20.923
        Years                     41       42           43            44               45          46       47        48          49          50
        Lump sum factor         21.141   21.350       21.552        21.746           21.934      22.114   22.287    22.454      22.614      22.769

        Assumption: earning rate of 7.00% pa



v2.02                                                                                                                        Part C – Personal insurance
Page 30 of 48


         Insurance analysis (Term life, TPD, trauma) – Client 1 (continued)
         Existing provisions                                         Term life       TPD       Trauma
         Financial assets to be realised (net of CGT)
                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

         Lifestyle assets to be realised (net of CGT)
           Family home                                           $               $         $

           Contents                                              $               $         $

           Motor vehicle 1                                       $               $         $

           Motor vehicle 2                                       $               $         $

           Holiday home                                          $               $         $

           Boat / caravan                                        $               $         $

           Other                                                 $               $         $

         Existing level of insurance cover                       $               $         $

         Subtotal                                          =D    $               $         $

         Summary – Client 1                                          Term life       TPD       Trauma
           A       Lump sum needs                                $               $         $

           B       Gross income needs                            $               $         $
                   Cover required before
           C                                            =(A+B)   $               $         $
                   existing provisions
           D       Less existing provisions                      $               $         $

           E       Required level of cover              =(C-D)   $               $         $


         Notes




Part C – Personal insurance                                                                             v2.02
                                                                                                                                         Page 31 of 48

        Insurance analysis (Term life, TPD, trauma) – Client 2
         Not in scope.  Completed separately.
        Lump sum needs                                                                        Term life            TPD                Trauma
        Clear debts
          Home mortgage                                                                $                   $                    $

          Investment loan                                                              $                   $                    $

          Personal loan                                                                $                   $                    $

          Credit cards                                                                 $                   $                    $

          Lease / HP                                                                   $                   $                    $

          Reverse mortgage                                                             $                   $                    $

          Line of credit / home equity loan                                            $                   $                    $

          Margin loan                                                                  $                   $                    $

          Other                                                                        $                   $                    $

        Funeral costs                                                                  $                   N/A                  N/A

        Medical / lifestyle                                                            N/A                 $                    $

        Emergency funds (three to four months of normal income)                        $                   $                    $

        Recovery income                                                                N/A                 $                    $

        Capital needs / miscellaneous costs and expenses                               $                   $                    $

        Sub total                                                             =A       $                   $                    $

        Gross income needs                                                                    Term life            TPD                Trauma
        Education funding                Income required $___________________ pa
                                                                                       $                   $                    $
                                         Number of years _________________________
        Income required                  Income required $___________________ pa
        (ie regular living expenses)                                                   $                   $                    $
                                         Number of years _________________________
        Child care / education           Income required $___________________ pa
                                                                                       $                   $                    $
                                         Number of years _________________________
        Other income                     Income required $___________________ pa
                                                                                       $                   $                    $
        _____________________            Number of years _________________________
        Other income                     Income required $___________________ pa
                                                                                       $                   $                    $
        _____________________            Number of years _________________________
        Other income                     Income required $___________________ pa
                                                                                       $                   $                    $
        _____________________            Number of years _________________________
        Other income                     Income required $___________________ pa
                                                                                       $                   $                    $
        _____________________            Number of years _________________________
        Sub total                                                             =B       $                   $                    $

        Years                      1       2             3            4                 5          6         7        8            9          10
        Lump sum factor          1.000   1.963         2.889        3.781             4.640      5.466     6.262    7.028        7.765      8.475
        Years                     11       12           13            14               15          16       17        18          19          20
        Lump sum factor          9.158   9.816        10.449        11.058           11.645      12.210   12.753    13.276      13.780      14.265
        Years                     21       22           23            24               25          26       27        28          29          30
        Lump sum factor         14.732   15.181       15.613        16.030           16.430      16.816   17.188    17.545      17.889      18.220
        Years                     31       32           33            34               35          36       37        38          39          40
        Lump sum factor         18.539   18.846       19.142        19.426           19.700      19.963   20.217    20.461      20.696      20.923
        Years                     41       42           43            44               45          46       47        48          49          50
        Lump sum factor         21.141   21.350       21.552        21.746           21.934      22.114   22.287    22.454      22.614      22.769

        Assumption: earning rate of 7.00% pa



v2.02                                                                                                                        Part C – Personal insurance
Page 32 of 48


         Insurance analysis (Term life, TPD, trauma) – Client 2 (continued)
         Existing provisions                                         Term life       TPD       Trauma
         Financial assets to be realised (net of CGT)
                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

                                                                 $               $         $

         Lifestyle assets to be realised (net of CGT)
           Family home                                           $               $         $

           Contents                                              $               $         $

           Motor vehicle 1                                       $               $         $

           Motor vehicle 2                                       $               $         $

           Holiday home                                          $               $         $

           Boat / caravan                                        $               $         $

           Other                                                 $               $         $

         Existing level of insurance cover                       $               $         $

         Subtotal                                          =D    $               $         $

         Summary – Client 2                                          Term life       TPD       Trauma
           A       Lump sum needs                                $               $         $

           B       Gross income needs                            $               $         $
                   Cover required before
           C                                            =(A+B)   $               $         $
                   existing provisions
           D       Less existing provisions                      $               $         $

           E       Required level of cover              =(C-D)   $               $         $


         Notes




Part C – Personal insurance                                                                             v2.02
                                                                                                                              Page 33 of 48

        Insurance analysis (Income protection) – Client 1 and Client 2
         Not in scope.  Completed separately.
        Income protection                                                                                Client 1            Client 2

          A     Annual income from main occupation                                                   $              pa   $              pa
                (Less all applicable business expenses and super, but before tax)

          B     Maximum allowable annual benefit                                       = A * 0.75    $              pa   $              pa

          C     Super continuance amount (per annum)                                                 $              pa   $              pa

          D     Proposed cover (per annum)                                               =B+C        $              pa   $              pa

          E     Income not affected by disability (per annum)                                        $              pa   $              pa

          F     Existing cover (annual benefit)                                                      $              pa   $              pa

          G     Existing provisions (per annum)                                           =E+F       $              pa   $              pa

          H     Required level of cover (per month)                                 = (D - G) / 12   $              pm   $              pm


        Notes




v2.02                                                                                                               Part C – Personal insurance
Page 34 of 48


         Insurance analysis (Business expense insurance) – Client 1 and Client 2
          Not in scope  Completed separately
         Business expenses insurance cover
         Business expenses insurance cover required (per annum)                                     $                                 pa
         Use the business expense planner below if you need to calculate your annual expenditure.

         Estimated Client 1 share of business overheads expenses                                                                           %

         Estimated Client 2 share of business overheads expenses                                                                           %

         Estimated Other share of business overheads expenses                                                                              %

         Is your work area separate from your residence?                                                          Yes        No

         What percentage of the business is owned by:                                               Client 1           %   Client 2        %


         Business expense planner
         Item                                           Amount           Item                                              Amount
         Rent and lease costs                                            Taxes and interest
         Premises rent / lease payments            $                     Property rates and taxes                  $

         Lease costs of equipment and              $                     Mortgage interest payments                $
         vehicles
         Sub total                                 $                     Sub total                                 $

         Insurance                                                       Fees
         Business insurance premiums               $                     Accounting / audit fees                   $

         General insurance premiums                $                     Professional fees                         $

         Work cover insurance premiums             $                     Subscriptions                             $

         Sub total                                 $                     Sub total                                 $

         Utilities                                                       Maintenance and depreciation
         Telephone                                 $                     Cleaning                                  $

         Electricity                               $                     Depreciation of equipment                 $

         Gas                                       $                     Sub total                                 $

         Water                                     $

         Heating                                   $

         Sub total                                 $

         Non-income producing staff                                      Other
         Salaries                                  $                     Other expenses                            $

         Superannuation contributions              $                     Subtotal                                  $

         Sub total                                 $

         Total                                                                                                     $


         Notes




Part C – Business insurance                                                                                                                v2.02
                                                                                                                        Page 35 of 48


        Part D
        Risk profile questionnaire
         Not in scope – go to ‘Part E’ on page 40.
        Your personal investment style
        The amount of risk an investor is willing to accept is known as their ‘risk profile’. Assessing a client's
        tolerance to investment risk is a key aspect of portfolio construction and is critical to determining
        appropriate asset allocation, the recommended investments and expected returns.
        The following questions are designed to help me determine your risk profile. Investigating your financial
        needs, circumstances and objectives will assist us in developing an investment strategy and
        recommendations to suit your specific requirements.

        Question 1 (Your liquidity requirements, ie having access to your funds)
        Apart from any short-term and ongoing needs for access to cash, how long do you envisage it will be before you
        require access to most of your funds?
        1.   1 year or less.
        2.   2 to 3 years.
        3.   3 to 5 years.
        4.   5 years or more.

        Score          Client 1:                      Client 2:               Joint:                     Other:


        Question 2 (Your investment experience)
        How familiar are you with investment markets?
        1.   I have no experience at all.
        2.   I have a basic understanding of investment markets.
        3.   I have a strong understanding of investment markets.
        4.   I am an experienced investor.

        Score          Client 1:                      Client 2:               Joint:                     Other:


        Question 3 (Your attitude to risk)
        How comfortable are you with putting your initial investment at risk to achieve a higher level of return?
        1.   I am not prepared to accept any loss of my initial investment.
        2.   I am prepared to accept minor losses to my initial investment.
        3.   I understand that in seeking higher returns I may have to accept some loss of my initial investment.
        4.   In seeking a higher return, I am prepared to accept a loss of my initial investment.

        Score          Client 1:                      Client 2:               Joint:                     Other:


        Question 4 (Your investment objectives)
        What do you want to achieve from your investments?
        1.   I want a source of income. I am not particularly concerned about my initial investment growing in value.
        2.   My priority is to generate income. However, I would like to see my initial investment grow over time.
        3.   My priority is the capital growth of my initial investment. However, I would like to generate some income.
        4.   My focus is on investment growth. I am not interested in generating income.

        Score          Client 1:                      Client 2:               Joint:                     Other:




v2.02                                                                                                  Part D – Risk profile questionnaire
Page 36 of 48


          Question 5 (Your concerns about inflation)
          How important is it to you that the value of your initial investment keeps pace with or exceeds the rate of inflation over
          your investment time frame?
          1.   Not important.
          3.   Important.
          5.   Extremely important.

          Score           Client 1:                  Client 2:                   Joint:                       Other:


          Question 6 (Your concerns about taxation)
          When investing, how important is it for you to minimise your income tax? Bear in mind that tax-minimisation strategies
          may involve taking some risk with your initial investment.
          1.   Not at all.
          2.   Slightly important.
          3.   Important.
          4.   Very important.

          Score           Client 1:                  Client 2:                   Joint:                       Other:


          Question 7 (Your attitude to capital loss)
          How would you react if the value of your portfolio fell by more than 20% in any year?
          1.   I would consider redeeming all my assets and transferring them to cash.
          2.   I would be concerned and consider changing my investment strategy.
          3.   I would be confident that my strategy remains appropriate for my time horizon and would make no changes.
          4.   I would consider investing more to take advantage of the lower entry prices.

          Score           Client 1:                  Client 2:                   Joint:                       Other:


          Question 8 (Your investment preferences)
          Which one of the following best describes your attitude to market volatility when choosing an investment?
          1.   I prefer investments that are not affected by market volatility so the value of my capital will not fluctuate.
          2.   I prefer investments with a low risk of volatility; however, I am happy to have a small portion of my portfolio
               invested in assets with potentially higher levels of short-term capital fluctuation.
          3.   I prefer to spread my investments across the different asset classes and accept that some capital fluctuation will
               occur as a result.
          4.   I am comfortable including investments with a higher degree of capital fluctuation in my portfolio, but like to
               maintain a small amount of stable investments to smooth returns over time.
          5.   I am comfortable investing the majority of my portfolio in assets with higher levels of capital fluctuation.

          Score           Client 1:                  Client 2:                   Joint:                       Other:


          Question 9 (Your attitude to gearing – please tick the appropriate box)
          Gearing strategies can magnify your gains, but also your losses. Would you be prepared to borrow to invest?
              I would not consider borrowing to invest.
              I would be prepared to borrow up to 25% of my total investment.
              I would be prepared to borrow up to 50% of my total investment.
              I would be prepared to borrow up to 70% of my total investment.




Part D – Risk profile questionnaire                                                                                                    v2.02
                                                                                                                                                                                       Page 37 of 48

        Add up the scores to these questions and write the total into the appropriate box below.


        Final score       Client 1:                                   Client 2:                                   Joint:                                       Other:

        Refer to the client risk profiles below and write the corresponding risk profile into the appropriate box below.
                          Client 1:                                   Client 2:                                   Joint:                                        Other:
        Risk profile
                          _________________________________________   _________________________________________   _________________________________________     _________________________________________




        Notes




        Client risk profiles
        Defensive (8 to 11)
        Your investment style suggests you do not wish to take on any investment risk. Your main priority is safeguarding
        your investment capital, and you are prepared to sacrifice higher returns for peace of mind. Generally, the most
        appropriate strategy for someone with a defensive risk profile is to invest 90% in income and 10% in growth assets.
        Defensive investors should be prepared to accept negative returns approximately one year in every 20. A defensive
        approach is usually appropriate for investment terms of one to two years.
        Conservative (12 to 17)
        Your investment style suggests you are prepared to accept a small amount of risk; however, your priority remains
        preserving your capital over the medium to long term. Generally, the most appropriate strategy for someone with a
        conservative risk profile is to invest 70% in income and 30% in growth assets. Conservative investors should be
        prepared to accept negative returns approximately one year in every eight. A conservative approach is usually
        appropriate for investment terms of two to three years.
        Moderate (18 to 25)
        Your investment style suggests you have some understanding of investment markets and their behavior, and are
        prepared to take short-term risks to gain long-term capital growth. Generally, the most appropriate strategy for
        someone with a moderate risk profile is to invest 40% in income and 60% in growth assets. Moderate investors
        should be prepared to accept negative returns approximately one year in every six. A moderate approach is usually
        appropriate for investment terms of three to four years.
        Growth (26 to 30)
        Your investment style suggests you are seeking a greater growth component in your investment portfolio, with some
        income to smooth volatility in your returns. Although you remain cautious of taking on extreme levels of risk, your
        general understanding of investment markets enables you to feel comfortable with short-term risk. Generally, the most
        appropriate strategy for someone with a growth risk profile is to invest 20% in income and 80% in growth assets.
        Growth investors should be prepared to accept negative returns approximately one year in every five. A growth
        approach is usually appropriate for investment terms of four to five years.
        Aggressive (31 to 34)
        Your investment style suggests you are prepared to sacrifice short-term safety to maximise the value of your
        investments through long-term capital growth. However, you do not wish to make unbalanced investment decisions.
        Generally, the most appropriate strategy for someone with an aggressive risk profile is to invest 100% in growth
        assets. Aggressive investors should be prepared to accept negative returns approximately one year in every four. An
        aggressive approach is usually appropriate for investment terms of five to seven years.

        High alpha (31 to 34)
        A sub-class of the aggressive investment style is high alpha. While the recommendation for high alpha investors is
        also to invest 100% in growth assets, a high alpha investment portfolio typically has a larger exposure to Australian
        shares than a purely aggressive investment strategy. As high alpha portfolios are likely to experience more volatility
        than aggressive portfolios, high alpha investors should be prepared to accept negative returns approximately one
        year in every three. A high alpha approach is usually appropriate for a term of investment of more than seven years.



v2.02                                                                                                                                                         Part D – Risk profile questionnaire
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          Asset classes
          Each investment risk profile is supported by asset allocation guidelines designed to match your
          investment experience and risk tolerance with your expectations for investment returns.
          The asset allocation for each risk profile is shown in the table below.
                                                                            Strategic asset allocation
          Asset class                       Defensive          Conservative    Moderate      Growth       Aggressive       High alpha
                                             (90/10)             (70/30)        (40/60)      (20/80)        (0/100)          (0/100)
          Income
           Cash                                 30%                  30%            5%        5%             0%                   0%
           Fixed interest                       60%                  40%           35%        15%            0%                   0%
          Growth
           Australian shares                    5%                   15%           30%        40%            50%              55%
           International shares                 3%                   10%           20%        25%            40%              40%
          Income and growth
           Property / infrastructure            2%                   5%            10%        15%            10%                  5%
          Total                                 100%               100%            100%       100%          100%              100%

          As client circumstances differ, and portfolio values vary over time, an acceptable portfolio
          recommendation must remain within ten points of the strategic asset allocation for each asset class. For
          example, if the target asset allocation for Australian shares is 30%, the recommended allocation should
          be between 20% and 40%. In addition, the portfolio must remain within ten points of the strategic asset
          allocation benchmark (ie the growth to income ratio).
          Minor variations in your asset allocation will occur from time to time and, if appropriately managed, will not
          generally have a material effect on the long-term performance of your investment portfolio. Significant
          variations from these benchmarks may also occur for a variety of reasons, and will be addressed in your
          Statement of Advice or other documentation.

          Risk profile
          The relationship between risk and return
                           Return


                  Higher                                                                                           Aggressive
                  Return                                                                        Growth
                                                                                                                          X
                                                                                                    X
                                                                            Moderate                                   31 to 34
                                                                                               26 to 30                 points
                                                                               X                points
                  Medium                              Conservative          18 to 25
                  Return
                                                                             points
                                                           X

                                    Defensive           12 to 17
                                                         points

                  Lower
                  Return
                                        X


                                      8 to 11
                                      points

                                                                                                                                   Risk

          This table is for illustrative purposes only.




Part D – Risk profile questionnaire                                                                                                       v2.02
                                                                                                                        Page 39 of 48

        If your adviser identifies that you appear to be unable to reach your stated financial goals
        because they conflict with your risk tolerance, do you want to make 'Reaching your financial               Yes       No
        planning objectives' the priority?
        If yes, provide details.




        Notes




v2.02                                                                                                  Part D – Risk profile questionnaire
Page 40 of 48


         Part E
         Declarations
         Client declaration
         I declare that:
             The advice I am seeking from my adviser is:




             The information I have marked as being ‘Not in scope’ in this document and the matters detailed in the table
              below are to be excluded from the advice.




             If I have not disclosed any information in this document or declined to provide full personal information, I
              understand that my adviser may not be able to fully assess my financial needs, circumstances and objectives. As
              a result, any recommendation/s may not be appropriate to my particular financial situation.
             All the information provided to my adviser in this document is true, current and correct.
             The information relating to ‘Part A’ of this document was provided to my adviser separately in the ‘Client
              Questionnaire’ dated ____________ / ____________ / __________________ .
             I have received a copy of my adviser’s Financial Services Guide.
             My adviser explained that a detailed breakdown of all fees and/or fee-for-service charges related to the
              placement of my investments will be included in the Statement of Advice that will be prepared for me.
             I have read and understood the statements about my privacy. I consent to the uses described and the
              disclosures set out in this document.
             I wish to proceed with the preparation and presentation of a Statement of Advice based on the above, at a fee of
              $______________________ payable to Financial Wisdom Limited. I understand that this fee is non-refundable.
             Any fees incurred for establishing my investments and the provision of ongoing service in relation to regular
              reviews of my portfolio will be agreed to after I have signed the ‘Agreement to Proceed’ section within the
              Statement of Advice.




                                                      /       /                                                          /      /
         Client 1 signature                           Date                  Client 2 signature                           Date

         Adviser declaration
         I declare that:
            The information contained in this financial needs analysis is an accurate and complete record of the information
             provided by the client, and acknowledged by the client signing and dating above.
            The client was given a copy of the Financial Services Guide before any investment advice or service was
             provided.
            The preparation of the client’s Statement of Advice will be based on the above information and any other
             documentation provided.



                                                          /       /
         Adviser’s signature                              Date


Part E – Declarations                                                                                                               v2.02
                                                                                                                                  Page 41 of 48


        Forms
        Identification form for individual and sole traders

        GUIDE TO COMPLETING THIS FORM
        o Complete all applicable sections of this form in BLOCK LETTERS.
          Provision of this information is required by law.
          The individual’s identity must be verified before the product / service can be provided.
        o Complete one form for each individual.
        o Contact Risk Management and Compliance if the individual is unable to provide either the Primary or
          Secondary ID documents.

        SECTION 1: PERSONAL DETAILS
        Surname                                                                                                           Date of Birth
                                                                                                                           dd/mm/yyyy



        Full Given Name(s)


        Residential Address (PO Box is not acceptable)
        Street


        Suburb                                                  State                Postcode              Country




        COMPLETE THIS PART IF INDIVIDUAL IS A SOLE TRADER
        Full Business Name (if any)                                                                        ABN (if any)




        Principal Place of Business (if any) (PO Box is not acceptable)
        Street


        Suburb                                                  State                Postcode              Country




        SECTION 2: IDENTIFICATION PROCEDURE


        o Verify the individual’s full name; and EITHER their date of birth or residential address.
        o      Complete EITHER Part A or Part B. (Note: Part B should only be completed if the individual does not own a
               document from Part A.)


        PART A – ACCEPTABLE PRIMARY ID DOCUMENTS
        Tick      Select ONE valid option from this section only
        
                  Australian State / Territory driver’s licence containing a photograph of the person

                  Australian passport (a passport that has expired within the preceding 2 years is acceptable)

                  Card issued under a State or Territory for the purpose of proving a person’s age containing a photograph of the person

                  Foreign passport or similar travel document containing a photograph and the signature of the person *




v2.02                                                                                                                                   Part E – Forms
Page 42 of 48



         PART B – ACCEPTABLE SECONDARY ID DOCUMENTS
         Tick
                   Select ONE valid option from this section
         

                   Australian birth certificate

                   Australian citizenship certificate

                   Pension card issued by Centrelink

                   Health card issued by Centrelink

                   National identity card issued by a foreign government containing a photograph of the person in whose name the card was
                   issued *
         Tick
                   AND ONE valid option from this section
         
                   A document issued by the Commonwealth or a State or Territory within the preceding 12 months that records the provision
                   of financial benefits and contains the individuals name and residential address

                   A document issued by the Australian Taxation Office within the preceding 12 months which contains the individuals name
                   and residential address

                   A document issued by a local government body or utilities provider within the preceding 3 months which records the
                   provision of services to that address or to that person (the document must contain the individuals name and residential
                   address)

                   Foreign driver's licence that contains a photograph of the person in whose name it issued and the individuals date of birth *

                   If under the age of 18, a notice that:
                   o was issued to the customer by a school principal within the preceding 3 months; and
                   o contains the customers name and residential address; and
                   o records the period of time that the customer attended at that school
         * Documents that are written in a language that is not English, must be accompanied by an English translation prepared by an accredited translator.


         ID RECORD                              Document 1                                                     Document 2

         Verified From                           Original             Certified Copy                          Original             Certified Copy
         Copy of ID Document                     Attached             Alternative Agreed                      Attached             Alternative Agreed
         (copy must be legible)                 (go to Section 3)     (complete ID Document Details            (go to Section 3)     (complete ID Document Details
                                                                      below)                                                         below)


         ID DOCUMENT                            Document 1                                                     Document 2
         DETAILS
         Document Issuer

         Issued Date

         Expiry Date

         Document Number

         English Translation                     N/A                  Attached                                N/A                  Attached

         SECTION 3: FINANCIAL PLANNER DETAILS – identification and verification conducted by:

         Date Verified (dd/mm/yyyy)


         Financial Planner’s Name                                                                                        Phone No.


         AFS Licensee Name                       Financial Wisdom Limited                                                AFSL No.         231138




Part E – Forms                                                                                                                                                       v2.02
                                                                                                                                  Page 43 of 48

        Identification form for individual and sole traders

        GUIDE TO COMPLETING THIS FORM
        o Complete all applicable sections of this form in BLOCK LETTERS.
          Provision of this information is required by law.
          The individual’s identity must be verified before the product / service can be provided.
        o Complete one form for each individual.
        o Contact Risk Management and Compliance if the individual is unable to provide either the Primary or
          Secondary ID documents.

        SECTION 1: PERSONAL DETAILS
        Surname                                                                                                           Date of Birth
                                                                                                                           dd/mm/yyyy



        Full Given Name(s)


        Residential Address (PO Box is not acceptable)
        Street


        Suburb                                                  State                Postcode              Country




        COMPLETE THIS PART IF INDIVIDUAL IS A SOLE TRADER
        Full Business Name (if any)                                                                        ABN (if any)




        Principal Place of Business (if any) (PO Box is not acceptable)
        Street


        Suburb                                                  State                Postcode              Country




        SECTION 2: IDENTIFICATION PROCEDURE


        o Verify the individual’s full name; and EITHER their date of birth or residential address.
        o      Complete EITHER Part A or Part B. (Note: Part B should only be completed if the individual does not own a
               document from Part A.)


        PART A – ACCEPTABLE PRIMARY ID DOCUMENTS
        Tick      Select ONE valid option from this section only
        
                  Australian State / Territory driver’s licence containing a photograph of the person

                  Australian passport (a passport that has expired within the preceding 2 years is acceptable)

                  Card issued under a State or Territory for the purpose of proving a person’s age containing a photograph of the person

                  Foreign passport or similar travel document containing a photograph and the signature of the person *




v2.02                                                                                                                                   Part E – Forms
Page 44 of 48



         PART B – ACCEPTABLE SECONDARY ID DOCUMENTS
         Tick
                   Select ONE valid option from this section
         

                   Australian birth certificate

                   Australian citizenship certificate

                   Pension card issued by Centrelink

                   Health card issued by Centrelink

                   National identity card issued by a foreign government containing a photograph of the person in whose name the card was
                   issued *
         Tick
                   AND ONE valid option from this section
         
                   A document issued by the Commonwealth or a State or Territory within the preceding 12 months that records the provision
                   of financial benefits and contains the individuals name and residential address

                   A document issued by the Australian Taxation Office within the preceding 12 months which contains the individuals name
                   and residential address

                   A document issued by a local government body or utilities provider within the preceding 3 months which records the
                   provision of services to that address or to that person (the document must contain the individuals name and residential
                   address)

                   Foreign driver's licence that contains a photograph of the person in whose name it issued and the individuals date of birth *

                   If under the age of 18, a notice that:
                   o was issued to the customer by a school principal within the preceding 3 months; and
                   o contains the customers name and residential address; and
                   o records the period of time that the customer attended at that school
         * Documents that are written in a language that is not English, must be accompanied by an English translation prepared by an accredited translator.


         ID RECORD                              Document 1                                                     Document 2

         Verified From                           Original             Certified Copy                          Original             Certified Copy
         Copy of ID Document                     Attached             Alternative Agreed                      Attached             Alternative Agreed
         (copy must be legible)                 (go to Section 3)     (complete ID Document Details            (go to Section 3)     (complete ID Document Details
                                                                      below)                                                         below)


         ID DOCUMENT                            Document 1                                                     Document 2
         DETAILS
         Document Issuer

         Issued Date

         Expiry Date

         Document Number

         English Translation                     N/A                  Attached                                N/A                  Attached

         SECTION 3: FINANCIAL PLANNER DETAILS – identification and verification conducted by:

         Date Verified (dd/mm/yyyy)


         Financial Planner’s Name                                                                                        Phone No.


         AFS Licensee Name                       Financial Wisdom Limited                                                AFSL No.         231138




Part E – Forms                                                                                                                                                       v2.02
                                                                                                                                                                                                                               Page 45 of 48




        Client authorisation
        The financial adviser can use this form to request additional information from other
        institutions.


        To whom it may concern


        I,   _____________________________________________________________________________________   whose date of birth is                                    ________________   /   ________________   /   _________________________________

             Client 1 name                                                                                                                                     Client 1 date of birth

        of (insert full address)

        ______________________________________________________________________________________________________________________________________________________________________________________________________________




        _____________________________________________________________________________________________________________________________ _________________________________________________________________________________



        Request that all relevant information about my investments, insurance, superannuation, bank
        accounts, Centrelink entitlements or other financial information be released on request to my
        adviser listed below:


        ____________________________________________________________________________   , authorised representative of Financial Wisdom Limited
        Adviser name


        ____________________________________________________________________________                 ____________________________________________________________________________

        Adviser signature                                                                            Adviser telephone number


        Financial Wisdom Limited is an Australian Financial Services Licensee, ABN 70 006 646 108,
        AFSL No. 231138. Financial Wisdom Limited’s address is Level 16, 52 Martin Place, Sydney,
        NSW, 2000.
        Please also accept a photocopy or facsimile copy of this letter as authority. The original will stay
        on file at:

        ______________________________________________________________________________________________________________________________________________________________________________________________________________




        _____________________________________________________________________________________________________________________________ _________________________________________________________________________________




        Yours faithfully




        _____________________________________________________________________________                ________________   /   ________________   /   _________________________________

        Client 1 signature                                                                           Date




v2.02                                                                                                                                                                                                                              Part E – Forms
Page 46 of 48




         Client authorisation
         The financial adviser can use this form to request additional information from other
         institutions.


         To whom it may concern


         I,   _____________________________________________________________________________________   whose date of birth is                                    ________________   /   ________________   /   _________________________________

              Client 2 name                                                                                                                                     Client 2 date of birth

         of (insert full address)

         _____________________________________________________________________________________________________________________________ _________________________________________________________________________________




         ______________________________________________________________________________________________________________________________________________________________________________________________________________



         Request that all relevant information about my investments, insurance, superannuation, bank
         accounts, Centrelink entitlements or other financial information be released on request to my
         adviser listed below:


         ____________________________________________________________________________   , authorised representative of Financial Wisdom Limited
         Adviser name


         ____________________________________________________________________________                 ____________________________________________________________________________

         Adviser signature                                                                            Adviser telephone number


         Financial Wisdom Limited is an Australian Financial Services Licensee, ABN 70 006 646 108,
         AFSL No. 231138. Financial Wisdom Limited’s address is Level 16, 52 Martin Place, Sydney,
         NSW, 2000.
         Please also accept a photocopy or facsimile copy of this letter as authority. The original will stay
         on file at:

         _____________________________________________________________________________________________________________________________ _________________________________________________________________________________




         ___________________________________________________________________________________________________________________________________________________________________________ ___________________________________




         Yours faithfully




         _____________________________________________________________________________                ________________   /   ________________   /   _________________________________

         Client 2 signature                                                                           Date




Part E – Forms                                                                                                                                                                                                                                    v2.02
                                                                                                        Page 47 of 48




        Tax file number collection
        The collection of tax file numbers (TFNs) by an Australian Financial Services Licence (AFSL) holder
        and its authorised representatives is authorised under tax and privacy laws and the use and disclosure of
        this information is strictly regulated under those laws. Providing your TFN to an investment body or
        regulated superannuation fund is not compulsory, but there may be tax implications for your dividends,
        interest, distributions and superannuation contributions if you do not provide your TFN to an investment
        body or regulated superannuation fund or claim an exemption.
        For more information about the use of TFNs, please phone your nearest Australian Tax Office.

        I
                         Client 1 (print name)
        I
                         Client 2 (print name)

        permit Financial Wisdom Limited and its authorised representative to retain my TFN, subject to the
        following conditions:

        1. That Financial Wisdom Limited and its authorised representatives agrees to use and/or disclose my
           TFN for tax-related purposes only, specifically for quoting on current and future investment and
           superannuation applications, unless otherwise indicated by me.

        2. That Financial Wisdom Limited and its authorised representatives maintain the necessary security to
           ensure that my TFN information is protected, by such safeguards as are reasonable in the
           circumstances to prevent loss, unauthorised access, use, modification or disclosure, and any other
           misuse.

        3. That Financial Wisdom Limited and its authorised representatives will remove and destroy all records
           of my TFN should I so instruct and immediately upon my ceasing to be a client of Financial Wisdom
           Limited.
        I acknowledge that Financial Wisdom Limited and its authorised representatives are acting on my behalf
        in the conduct of my affairs.

                                                     Client 1                              Client 2

        TFN                    
        Signature

        Date                                         /          /                          /       /


        Adviser name

        Signature

        Date                                     /         /


        Financial Wisdom Limited is an Australian Financial Services Licensee, ABN 70 006 646 108, AFSL
        231138. Financial Wisdom Limited’s address is Level 16, 52 Martin Place, Sydney, NSW, 2000.



v2.02                                                                                                        Part E – Forms
Page 48 of 48


         Notes




Part E – Notes   v2.02

								
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