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									                                            wealthmanagers
                                                             formerly called




     CONFIDENTIAL Client Interview Document

                                           Your Adviser: Linda Fraser CFP
                                           Experience:                 25 + years specifically in financial planning
                                           Qualifications:             Certified Financial Planner
                                           Professional Membership:    FPA Financial Planning Association
                                                                       EIA Ethical Investment Association


         4 more Wealth for our clients practices - Corporate Authorised Representative AFS No: 230858
                       Linda Fraser CFP – Authorised Representative AFS No: 286280, of
                    Wealth Managers Pty Ltd (“wealthmanagers”) ABN 27 086 558 134
                            Australian Financial Services Licence (AFSL) No 232701




                                    Telephone: 1300 308 300 Facsimile: 1300 308 400
                                        Email: wealthadvice@4morewealth.com.au
                                          Web Site: www.4morewealth.com.au




              All Postal: P O Box 6385, Business Centre, PARRAMATTA NSW 2150

     Offices in Sydney & Canberra & meetings at other locations by arrangement.


wealthmanagers Form – Confidential Client Data & Interview Record March 2006                                           Page 1 of 20
                                                                           Office & Contact Details




Linda Fraser CFP
                                                        Practice Name:                           for our   clients
                                                        Postal Address:          P O BOX 6385, Business Centre
                                                                                 PARRAMATTA NSW 2150
                                                        Telephone:               1300 308 300
                                                        Mobile:                  0417 227 675
                                                        Facsimile:               1300 308 400
                                                        Email:                 wealthadvice@4morewealth.com.au
                                                        Web Site:              www.4morewealth.com.au




  SYDNEY Office:                                             for our   clients      Telephone:   1300 308 300
                                            Suite 3, Ground Floor, Focus Business Centre,
                                            30 Cowper Street
                                            PARRAMATTA NSW 2150
                                                 ( NO MAIL to this street address please )




 CANBERRA Office:                                           for our   clients      Telephone:   1300 308 300
                                            Level 6, Executive Business Centre,
                                            39 London Circuit
                                            CANBERRA ACT 2600
                                                ( NO MAIL to this street address please )




wealthmanagers
Wealth Managers Pty Ltd ABN 27 086 558 134 Head Office details:
114 – 116 Murray Street, HOBART TAS 7000
GPO Box 529, HOBART TAS 7001
Telephone: 1800 008 992 Facsimile: 03 6215 5911
Web: www.wmanagers.com.au




wealthmanagers Form – Confidential Client Data & Interview Record March 2006                                         Page 2 of 20
                                          wealthmanagers
                                Australian Financial Services Licence No 232701




                                 Client Data Sheet and
                                   Interview Record
                                         Private and Confidential

   Client                                                                       Authorised       4 more Wealth
   Name(s):                                                                    Representative
                                                                                  Names:
                                                                                                 Linda Fraser CFP
   Interview Date:                                                             Client Referred
                                                                                           By:

   I/ We Confirm Receipt of your Financial Services Guide. Signed: X __________________________ Date: ___ / ___/ 2006

                                                             Signed: X __________________________ Date: ___ / ___/ 2006

   IMPORTANT: The Corporations Act requires that we, as Financial Planners, making an investment
                        recommendation must have reasonable grounds for making that recommendation. This
                        means we must conduct an appropriate assessment of your investment objectives, financial
                        situation and particular needs. Please read our Privacy Policy Statement.
                        The information requested in the pages that follow is necessary for the establishment of a
                        reasonable basis upon which an investment recommendation can be made, and it will be
                        used solely for that purpose.
                        Any advice we give may be inappropriate if it is based on incomplete or inaccurate
                        information. You should consider the appropriateness of the advice if that is the case and
                        consider your own circumstances before acting on any advice we provide.


Instructions: Please complete this form as best you can. If there are any sections you are unsure
of, then leave blank and we can complete them at the next interview.
Please bring along to the interview, the latest copies of your superannuation statements and either
copies of your life insurance policy documents or the latest premium notices available (see list page 20).
                                  AFS Licensee: Wealth Managers Pty Ltd “wealthmanagers”
                                 Australian Financial Services Licence No: 232701 ABN 27 086 558 134
                                  Administration Office: GPO Box 529 HOBART TAS 7001 ,
                                             Ph: 1800 008 992 Fax: (03) 6215 5911


wealthmanagers Form – Confidential Client Data & Interview Record March 2006                                    Page 3 of 20
Personal Information
                                                          Client 1                       Client 2


Title e.g. Mr, Mrs, Ms, Miss, Dr


Surname


First Names


Street address




Mail address


Preferred method of contact                  Mail                              Mail
                                             Email                             Email
                                             Phone                             Phone
Work status                                  Full Time                         Full Time
                                             Part Time / Temporary             Part Time / Temporary
                                             Student                           Student
                                             Retired                           Retired
                                             Home Duties                       Home Duties

Occupation & Qualifications



Employer



Date of birth                                              /     /                       /     /

Marital status
Contact Information
Phone (Work)
OK to call at work ?
                                                         Yes / No                       Yes / No
Phone (Home)
Fax
OK to fax this number                                    Yes / No                       Yes / No
Mobile
Email address – Client 1



Email address – Client 2




wealthmanagers Form – Confidential Client Data & Interview Record March 2006                        Page 4 of 20
Miscellaneous Information                                     Client 1               Client 2

Tax File Number
(authority required)
Do you receive any
Centrelink / DVA Benefits
– type & amount
Retirement Information                                        Client 1               Client 2


Predicted date of retirement
Will you work part-time in                                  Yes / No                      Yes / No
retirement?
Your nominated longevity
(to age?)
Required retirement expenses
(annually in today’s dollars)
General Information                                    Client 1                           Client 2
Your current state of
health
Are your parents alive and                            Yes / No                           Yes / No
in good health?

Are your brothers/sisters                             Yes / No                           Yes / No
alive and in good health?

Are you a smoker?                                     Yes / No                           Yes / No

Is your Will current?                                 Yes / No                           Yes / No

Executor’s name
Date last reviewed                                      /      /                           /    /

Do you have an Enduring                               Yes / No                           Yes / No
Power of Attorney?

Attorney’s name

Date last reviewed                                      /      /                           /    /
Children / Dependants
                                               1                         2       3                     4

Name

Surname
Sex                                          M/F                        M/F     M/F                   M/F
Date of birth or age                        /   /                      /   /   /   /                 /   /
Number of years you think
further financial support
will be necessary
State of health




wealthmanagers Form – Confidential Client Data & Interview Record March 2006                         Page 5 of 20
Goals and Objectives
Short Term
1 – 2 Years




Medium Term
3 – 5 Years




Long Term
5+ Years




Other Professional Advisors
                                    Company                          Name      Phone
Solicitor / Lawyer

Accountant / tax agent

Previous financial advisor

Life insurance agent

General insurance
agent/broker

Banker

Other




wealthmanagers Form – Confidential Client Data & Interview Record March 2006           Page 6 of 20
Assets & Liabilities Statement
                                   Owner           Date                  Asset Value             Debt Balance   Repayments   Repayments     Loan Rate &    Maturity   Retain
                                                 Acquired                                                           ($)       Frequency      Institution    Date      (Y / N)
                                                                 At Purchase           Current

Residence
Car 1
Car 2
House Contents
Boat/Caravan



Investments or Personal Investments (including investment properties, shares, managed funds, etc) – please attach latest statements
1. Bank a/c’s, deposits
2.
3.
4.
5.
6.

7.

8.

9.

10.

11.
12.
13. Possible
inheritances



wealthmanagers Form – Confidential Client Data & Interview Record March 2006                                                 Page 8 of 20
Superannuation, Rollovers & Personal Pension Plans                                             Preserved Balance   Non- Preserved Balance            Insurance           Retain

Name of Fund                                      Owner           Balance           as at                          Restricted   Unrestricted      Death          TPD     (Y/N)

1.
2.
3.
4.
5.
6.
7.
8.

Business Assets (including Business Insurance), company assets, trust assets etc
Please include an officer & ownership structure summary ‘tree” of your business/companies/trusts on the back of this form
                                   Owner           Date         Asset Value at   Asset Value      Debt Balance     Repayments   Repayments     Loan Rate &    Maturity   Retain
                                                 Acquired         Purchase         Current                             ($)       Frequency      Institution    Date      (Y / N)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
12.


wealthmanagers Form – Confidential Client Data & Interview Record March 2006                                                    Page 9 of 20
Miscellaneous Debts & Liabilities
1. Credit cards


2. Hire purchase/Leases


3. Personal loans


4. Personal guarantees


5. Child maintenance


6. Spouse maintenance


7. Other



Estate Planning Issues
Do you have any particular requirements or problems on the fair distribution of your estate?                   Yes / No


Do you wish to leave specific assets to particular people?                                                     Yes / No


Do you have relatives or dependents who may challenge Your Will?                                               Yes / No


Do you have any family member you wish to exclude from your estate?                                            Yes / No




wealthmanagers Form – Confidential Client Data & Interview Record March 2006                   Page 10 of 20
Income Source Statement (please supply copies of statements)
                                               Client 1                   Client 2             Joint                    Total
Gross salary (before tax)
Investment income
Entity&/or Other income
Trust distribution income
Business income
Personal super pension
and/or annuity income
Government income support
Gross income
Estimated taxable income
Summary of Expenses
                                                                                       Weekly            or Monthly        or Yearly
Housing (rent, mortgage, rates, insurance, repairs, etc)
Transport (registration, insurance, interest, petrol, repairs,
public transport)
Food
Health (incl insurance, doctor, chemist, dentist, glasses, etc)
Education (own or children)
Utilities (gas, electricity, phone)
Personal (clothes, entertainment, dining out)
Other (loans, life insurance, holidays, gifts)
Income tax


TOTAL EXPENSES


Estimated savings per annum
Life Insurance
Name of      Life     Policy no.              Type of cover (value)         Endowmen   Start   Maturit    Surrender    Premiu   Premiu
  life      office                                                            t/ WOL   date    y date      value (if     m        m
insured                               Death          TPD         Trauma        Term/                         any)               frequency
                                                                               Other




wealthmanagers Form – Confidential Client Data & Interview Record March 2006                                           Page 12 of 20
Income Protection Insurance
 Name of life      Life       Policy no.      Monthly benefit   Benefit period   Deferment       Date        Premium         Premium
   insured        office                                                          period      commenced                     frequency




General Insurance
Is your general insurance adequate (e.g. house, contents, car)                                Yes                  No
Is a review of general insurance required? (if yes, refer to broker)                          Yes                  No
Do you have health insurance?                                                                 Yes                  No
If yes, with which provider?
Do you have household workers compensation?                                                   Yes                  No

Investing & Investment Assets
                                                                    Client 1           Client 2           Joint             Entities
                                                                                                                            (Company, Trust,
                                                                                                                           Business, Estate etc)




GROSS Value of your/the non-lifestyle assets                    $                  $                $                  $



NET Value of your/the non-lifestyle assets                      $                  $                $                  $



Amount you/they currently wish to invest (if known)             $                  $                $                  $


Value of your/the portfolio you would like advice on            $                  $                $                  $


Net income required from investments (if any)                   $                  $                $                  $

Are your/the income requirements to be indexed?                     Yes / No           Yes / No         Yes / No             Yes / No


Is your current income surplus to your living                   $                  $                $                  $
expenses?
If so, by how much?
                                                                $                  $                $                  $




wealthmanagers Form – Confidential Client Data & Interview Record March 2006                                       Page 13 of 20
                                                                                        Client 1        Client 2
Are you aware of the effects on inflation on capital?                                   Yes / No       Yes / No
Are you satisfied with your level of liquidity?                                         Yes / No       Yes / No
Do you want investments that are easily managed?                                        Yes / No       Yes / No
Do you want planned funding for children’s (or grandchildren’s) educational             Yes / No       Yes / No
expenses?
Are you happy with your current retirement provisions?                                  Yes / No       Yes / No
Are environment, social or ethical considerations to influence your investment          Yes / No       Yes / No
strategy? See our detailed SRI questionnaire later in this document.



Please rank the following personal priorities: 1=High, 2=Medium, 3=Low


Client 1                                                            Rank              Details
Protect your income against sickness or accident
Protect your family and/or assets in the event of
death
Provide against serious illness or trauma
Plan for your retirement


Disability – Client 1
If a sickness/accident were to stop my/our income I/we would require $ _________ per week to
maintain my/our current lifestyle.


Premature Death – Client 1
To maintain/protect my family/partner’s current lifestyle I/we wish to be debt free   Yes / No ?
To maintain our current lifestyle I/we require $ ____________ per week.



Client 2                                                            Rank              Details
Protect your income against sickness or accident
Protect your family and/or assets in the event of
death
Provide against serious illness or trauma
Plan for your retirement


Disability – Client 2
If a sickness/accident were to stop my/our income I/we would require $ _________ per week to
maintain my/our current lifestyle.


Premature Death – Client 2
To maintain/protect my family/partner’s current lifestyle I/we wish to be debt free   Yes / No ?
To maintain our current lifestyle I/we require $ ____________ per week.



wealthmanagers Form – Confidential Client Data & Interview Record March 2006                       Page 14 of 20
Your Activities, Interests, Sports & Hobbies etc




I/We verify that the information provided in this questionnaire is accurate and complete and understand
that investment and risk management recommendations will be based on the information provided.

LynchPin Financial Services Pty Ltd accepts no liability for any advice given on the basis of inaccurate or
incomplete information. I/We give permission for my/our tax file number(s) as provided, to be forwarded to
financial institutions as requested or as necessary and to be retained on your files.

I/we give authority for you to send me/us emails at the email address supplied which relate to investment
opportunities and/or information you become aware which may be of interest to me/us.




x ……………………………………….. Date:                                 /   /     x ……………………………………….. Date:                 /      /


Client 1 Signature                                                      Client 2 Signature




                          L Fraser’s signature: ……………………………………….                         Date:   /   /2006




wealthmanagers Form – Confidential Client Data & Interview Record March 2006                         Page 15 of 20
Initial Risk Stance Acceptance and Instructions



                                                                                  Client      Spouse/partner           Joint      Nominated
                                                                               requirements    requirements        requirements    deviation

 EXAMPLE                                AGGRESSIVE
                                                                               ______ %       ______ %             ______ %       _____
 10%
                                    ENTREPRENEURIAL
                                                                               ______ %       ______ %             ______ %       _____
 40%
                                        MODERATE                               ______ %       ______ %             ______ %       _____
 40%
                                     CONSERVATIVE                              ______ %       ______ %             ______ %       _____
 10%

                             BASIC LIFESTYLE UNDERWRITING                      ______ %       ______ %             ______ %       _____

                                    RISK MANAGEMENT                            ______ %       ______ %             ______ %       _____
                                                                       6
               1         2          3          4             5
 100%


A] COMPLETE and DELETE paragraphs which are not applicable:

□    I/We have not had our risk stance determined at this stage. Please arrange to do this for me/us.

Or      □I/We hereby acknowledge that the above risk stance nomination is consistent with my/our risk
requirements and profile, which has been determined. I/We have had the concept of risk explained to
me/us and am/are happy to proceed on this basis. Please use this risk stance nomination in any
investment or insurance advice you may provide to me/us.


B] COMPLETE and DELETE paragraphs which are not applicable:

□   I/We agree to pay $ ________________ being your fee for a Statement of Advice (SOA) and its
preparation costs. I/We understand that this fee will be/will not be waived, reduced or offset if I/we
proceed to engage further services with your practice and/or place investments recommended in the SOA.
I/We am/are hereby commissioning a SOA to be prepared on my/our behalf.

Or     □  I/We agree to pay $ ________________ as a flat $ ongoing services fee per annum at the level of
service and applicable fee, as per your Ongoing Services Agreement, also duly agreed upon and signed.

Or     □  I/We are still considering your services, so we would like a further meeting and I/we thus do not
wish to commission any work at this stage.

Or     □  I/We would like you to prepare a QUOTE for your services & fees. I/We understand this quote is
at no charge and is without obligation for me/us to contract your services.




x ……………………………………….. Date:                                /       /   x ……………………………………….. Date:                                    /    /

Client 1 Signature                                                      Client 2 Signature




                          L Fraser’s signature: ……………………………………….                              Date:            /           /



wealthmanagers Form – Confidential Client Data & Interview Record March 2006                                               Page 16 of 20
Sustainable Responsible Investing (SRI)
As SRI specialists, we can overlay your specific views, criteria, parameters & values for your existing and/or
new investments within all or part of your portfolio, supported by detailed, specialist SRI research.


Client 1 Name: …………………………………………………………………………………………………………..


         My/our particular values-based interest is in companies involved with, improving or actively
         supporting:

         □   renewable energy                                         □   sustainability-focused improvements
         □   renewable resources                                      □   wildlife &/or land & sea conservation
         □   sustainable development businesses                       □   high corporate governance
         □   alternative natural medicines & tonics                   □   social improvement & education
         □   third world aid & development                            □   wildlife preservation
         □   health                                                   □   biotechnology
         □   pollution control                                        □   anti-discrimination & tolerance
         □   workplace safety                                         □   recycling
         □   ethical issues                                           □   re-vegetation
         □   water management                                         □   improved human rights
         □   innovative sustainability-focused start-ups              □   philanthropy
         □   aid for homeless                                         □   native bush-care
         □   child labour-free supply chains

         □ other _______________________________

         □ all of the above                                           □ none of the above


         I/we would like to EXCLUDE companies within my/our portfolio involved in/researched and found
         to have activities which are in conflict with my/our values, such as:

         □   ignoring alternative renewable resource options                        □ pollution
         □   environment damage                                                     □ vivisection (testing on animals)
         □   weak corporate governance                                              □ unfavourable shareholder practices
         □   worker exploitation                                                    □ child labour
         □   uranium mining                                                         □ armaments
         □   pornography                                                            □ discrimination
         □   alcohol                                                                □ animal cruelty
         □   genetic modification                                                   □ tobacco
         □   sweatshop labour                                                       □ gaming

         □ other _______________________________

         □ all of the above                                                         □ none of the above


         Client 1 Signature:

x …………………………………………………………………..                                              Dated:    ………… / ………… /2006


wealthmanagers Form – Confidential Client Data & Interview Record March 2006                                Page 17 of 20
Sustainable Responsible Investing (SRI)
As SRI specialists, we can overlay your specific views, criteria, parameters & values for your existing and/or
new investments within all or part of your portfolio, supported by detailed, specialist SRI research.


Client 2 Name: …………………………………………………………………………………………………………..


         My/our particular values-based interest is in companies involved with, improving or actively
         supporting:

         □   renewable energy                                         □   sustainability-focused improvements
         □   renewable resources                                      □   wildlife &/or land & sea conservation
         □   sustainable development businesses                       □   high corporate governance
         □   alternative natural medicines & tonics                   □   social improvement & education
         □   third world aid & development                            □   wildlife preservation
         □   health                                                   □   biotechnology
         □   pollution control                                        □   anti-discrimination & tolerance
         □   workplace safety                                         □   recycling
         □   ethical issues                                           □   re-vegetation
         □   water management                                         □   improved human rights
         □   innovative sustainability-focused start-ups              □   philanthropy
         □   aid for homeless                                         □   native bush-care
         □   child labour-free supply chains

         □ other _______________________________

         □ all of the above                                           □ none of the above


         I/we would like to EXCLUDE companies within my/our portfolio involved in/researched and found
         to have activities which are in conflict with my/our values, such as:

         □   ignoring alternative renewable resource options                      □ pollution
         □   environment damage                                                   □ vivisection (testing on animals)
         □   weak corporate governance                                            □ unfavourable shareholder practices
         □   worker exploitation                                                  □ child labour
         □   uranium mining                                                       □ armaments
         □   pornography                                                          □ discrimination
         □   alcohol                                                              □ animal cruelty
         □   genetic modification                                                 □ tobacco
         □   sweatshop labour                                                     □ gaming

         □ other _______________________________

         □ all of the above                                                       □ none of the above

         Client 2 Signature:

         x …………………………………………………………………..                                           Dated:   ………… / ………… / 2006



wealthmanagers Form – Confidential Client Data & Interview Record March 2006                               Page 18 of 20
Comments / Client’s Instructions (please add extra pages if needed):




x ……………………………….. Date:                            /   / 2006    x …………………………………….. Date:               /   / 2006


Client 1 Signature                                               Client 2 Signature




                      L Fraser’s signature: ……………………………………….                          Date:   /   /2006




wealthmanagers Form – Confidential Client Data & Interview Record March 2006                        Page 19 of 20
List of copies of documents I/we have attached (please tick):


Copies of my/our/the statements of:

□     listed share holdings:                                                   …………………………………………….
□     investment property holdings:                                            …………………………………………….
□     managed fund holdings:                                                   …………………………………………….
□     superannuation funds:                                                    …………………………………………….
□     allocated pension holdings:                                              …………………………………………….
□     annuity holdings:                                                        …………………………………………….
□     bank account holdings:                                                   …………………………………………….
□     cash management account holdings:                                        …………………………………………….
□     term deposit holdings:                                                   …………………………………………….
□     other income investment holdings:                                        …………………………………………….
□     income insurance policy/ies:                                             …………………………………………….
□     life (dearth) insurance policy/ies:                                      …………………………………………….
□     total disability insurance policy/ies:                                   …………………………………………….
□     business keyman insurance policy/ies:                                    …………………………………………….
□     other insurance policy/ies:                                              …………………………………………….
□     other investment holdings:                                               …………………………………………….
□     home/residential loans:                                                  …………………………………………….
□     investment loans                                                         …………………………………………….
□     other loans                                                              …………………………………………….
□     ______________________________________                                   …………………………………………….
□     ______________________________________                                   …………………………………………….
□     ______________________________________                                   …………………………………………….
□     ______________________________________                                   …………………………………………….
□     ______________________________________                                   …………………………………………….
□     ______________________________________                                   …………………………………………….




wealthmanagers Form – Confidential Client Data & Interview Record March 2006              Page 20 of 20

								
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