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Page 1 of 14
ClientFinancialProfile
Client1 Client2/Partner(ifapplicable)
PersonalDetailsof:
Preparedby:
InterviewDate:
Thefollowingitems(ifapplicabletoyou)willassistincompletingthedataform,Pleaseprovideoriginalsorcopiesoftheapplicable
documentsforyourappointment:
€ Employment–recentpayslips
€ Tax–mostrecentATOnoticeofassessment
€ Investments–mostrecenttaxandendofyearstatements
€ Liabilities–Currentloanstatement/repaymentschedule
€ Superannuation–Mostrecentstatementfromfund/s
€ PersonalInsurance–Mostrecentcorrespondence(renewal/premiumnotice)
€ SocialSecurity–Centrelink/DVAAssessment
“HELPUSTOHELPYOU” byreadingtheinformationbelowbeforecompletingthisform
• Thisbookletisdesignedtoassistyourpersonaladvisertogatherinformationessentialforfuturerecommendations.
• Toensurethattherecommendationsareentirelyconsistentwithyourpersonalrequirements,itisabsolutelynecessary
foryoutoprovideaccurateandfullydetailedinformation.
• Ifyouareuncertainonhowtoansweraquestionpleaseconsultyouradviser.
• Theinformationyouprovidewillbetreatedwiththeutmostconfidentiality.
• Iftheinformationyouprovideisincompleteorinaccurate,youneedtobeawarethattherecommendationswemakeis
basedontheinformationyouprovide.
LicenseedetailsIndependentCapitalAdvisersPtyLtdABN95765269541POBox5667,CairnsQld4870T:0740314575F:0740345016E:[email protected]:378693
Client Financial Profile
Page 2 of 14
Thisinformationwillprovideyouradviserwithaninsightintowhatyourgoalsandobjectivesare.
1.1 Whatisyourreasonforseekingadvice?
• Forexample,thescopeofadviceissuperannuationplanning(iewhatareareasweprovidingadviceon)
1.2 LongTermNeedsandShortTermObjectives
• Inrelationtoyourfuturelifestylewhatdoyouconsidertobeyourmaingoals/importantconsiderations?Forexample,needsandobjectivesmayincludepayoffmortgage,purchaseacar,holidayetc
NeedsandObjectives TimeFrameeg6mths/5yrs Cost Priority(High/Medium/Low)
• Haveyoubeensatisfiedwiththeprogressyouhavemadeinthepastfewyearstowardsachievingyourgoals?Y/N
• Ifno.,whathasbeenthemainbarriertoyourprogress?
AdviserNotes
SECTION1–PreDiscovery(Whatareyourgoals?)
Client Financial Profile
Page 3 of 14
ContactDetails
• Preferredtitleeg
Mr,Mrs,Ms
• Surname
• Givenname(s)
• Preferredname
• Dateofbirth
• Maritalstatus
• Australianresident
• Ifno,countryof
residence
ResidentialAddress
• StreetNumber
• Suburb/Town
• State
• Postcode
PostalAddress(Pleasetickifsameasabove) o
• StreetNumber
• Suburb/Town
• State
• Postcode
Phone,FaxandEmail
• Homephone
• Businessphone
• Businessfax
• Mobile
• Preferredcontact
method
• Personalinterests
SECTION2–PERSONALDETAILS
Client Financial Profile
Page 4 of 14
Childrenand/orOtherDependants|CurrentorExpected
FullName DateofBirth Gender Relationship DependantY/N
EmploymentDetails
• Occupation/Title
• Jobdescription/duties
• Qualifications
• Employername
• Employmentstartdate
• Doyouworkoverseas?
• Ifyes,listrelevant
country(ies)
• Availablepersonalleave
days
• TaxFileNumber(TFN)
• Employmentstatus
€ Full-time
€ Casual
€ Homeduties
€ Selfemployed
€ PartTime–Hrs?
€ Unemployed
€ Retired
€ Full-time
€ Casual
€ Homeduties
€ Selfemployed
€ PartTime–Hrs?
€ Unemployed
€ Retired
• Ifself-employed,what
structure?
€ Trust
€ Company
€ SoleTrader
€ Partnership
€ Trust
€ Company
€ SoleTrader
€ Partnership
• ProposedRetirementAge:
• DateofRetirement
AdviserNotes
Client Financial Profile
Page 5 of 14
InsertNETIncome–AnnualAmounts
Wages/Salary
Bonuses
Centrelink/DVA/Otherbenefits
Investment/RentalIncome
OtherIncome
TotalAnnualIncome
Outgoings–AnnualAmounts
Client1(orjoint) Client2/Partner(ifapplicable)
HomeMortgage/Rent
Rates
HouseRepairs/Maintenance
Electricity/Gas/Phone
HouseInsurance
CarMaintenance/Registration/Insurance
GeneralLiving–Food,clothingetc
InsurancePremiums
Health–Insurance,medicaletc
Education–Fees,books,uniforms
Holidays
Entertainment/Other
TotalAnnualOutgoings
Total
Total
AnnualSurplus/(Deficit)
Whatisthelikelypatternofyourexpensesoverthenext5years?: �Decrease�Same �Increase
• Whatisyourcurrentsavingsabilitypermonth?
• Whatannualincomewouldyouideallylikeinretirementtoallowyoutohaveacomfortablelife?
SECTION3–INCOMINGS&OUTGOINGS
$ $
$ $
$
$
Client Financial Profile
Page 6 of 14
AssetsandLiabilities–Thisinformationassistwithtaxeffectivenessandcapitalgainspurposes
Assets Owner(s) PurchasePrice$ CurrentValue$ Notes
• PrincipalResidence
• HolidayHome/Rental
Property
• BankAccounts
• Contents/Personal
Property
• MotorVehicles
• ManagedFunds
Totalassets $
Liabilities Owner(s) AmountOwing$InterestRateon
loan%
RepaymentsPrincipal
&InterestorInterest
Only
• HomeMortgage
• CarLoan
• PersonalLoan
• Contents/Personal
Property
• MotorVehicles
• InvestmentLoan
Totalliabilities $
Networth (TotalAssetslessTotalLiabilities) $
AdviserNotes
SECTION4–ASSETS&LIABILITIES
Client Financial Profile
Page 7 of 14
SuperannuationAssetsandIncomeStreams
FundName Owner(s) ValuePensionAmount
(ifapplic.)
Insurance
Type
Sum
InsuredPremium
SuperannuationContributions
Client1 Client2
Haveyoumadeanysupercontributionstoany
superannuationfundinthecurrentorprevioustwo
financialyears?
Y/N Y/N
Ifyes,pleaseprovidefulldetailsofamount(s) $ $
Beneficiaries
Name PercentageBenefit
AdviserNotes
SECTION5-SUPERANNUATION
Client Financial Profile
Page 8 of 14
Client1 Client2
• Doyouhaveawill?
• WhatdatewastheWilllastreviewed?
• IsthereaPowerofAttorney(PoA)inplace?
• Ifyes,whattype?Enduring/Other?
• NominatedAttorney
• Whatdatewasthe(PoA)lastreviewed?
• NameofSolicitor• ContactNumber
• NameofAccountant• ContactNumber
Detailsofanylegalobligations(ieGuarantor):
AdviserNotes
SECTION6–ESTATEPLANNING
Client Financial Profile
Page 9 of 14
Insuranceisanessentialpartoffinancialplanning.Itisimportantyouensurethatyouhaveadequatecoverforallaspects(personalandbusiness)
ofyourlife.Inhelpingyoutoassesstheadequacyofyourinsurances,pleaseanswerthefollowing:
InsuranceDetailsincludingLife,TPD,Trauma,IncomeProtection(IP)andBusinessExpenses
Pleaseprovidedetailsofexistinginsurancepoliciesorriderbenefits
Name of Insured
Person
Whoownsthepolicy?
egspouse/superfundTypeegLife/TPD Insurer SumInsured
Premium Amount &
howoften?
GeneralInsuranceDetails(IndependentCapitalAdvisersPtyLtdisnotlicensedtoprovidegeneralinsuranceadvice)
Provider SumInsured
Home
Contents
MotorVehicle
PrivateHealth
Other:
AdviserNotes
SECTION7–EXISTINGINSURANCES
Client Financial Profile
Page 10 of 14
• Provideandaftertaxincomeof:$__________
• Providecapitalgrowthof________________%,orinlinewithinflation(subjecttoinvestmentprofile)
• Maintainanemergencyfundof:$__________
• Forseeablefuturelargeexpenses(overseasholiday,homerenovations,etc):$__________
• Doyouknowofanyfurthercircumstancesthatmayaffectyourfinancialsituationinthenearfuture?Y/N
IfYes,whatarethey?
• Doyouhaveanyconcernsorlimitsinregardtoassetsplittingwithyourpartnertoreducetaxation?Y/N
• Wouldyouconsidertakingoutaloantofundyourinvestmentatanystage?Y/N
IfYes,whatisthelevelofgearingyouarepreparedtoaccept?_________%
Howimportanttoyouarethefollowing?Ahighernumberindicatesgreaterconcerns.Range1–5
1.Notconcerned2.SlightlyConcerned3.Concerned4.VeryConcerned5.ExtremelyConcerned
• Howconcernedareyouabouthavingyourportfoliokeeppacewithinflation?
• Howconcernedareyouabouttaxeffectiveinvestmentsandplacements?
• Towhatextentareyouconcernedaboutcapitalstabilityofyourinvestments?
• Howconcernedareyouthatcashbemadeavailabletomeetemergenciesorotherinvestmentopportunities?
• Howconcernedareyouaboutgeneratingmaximumincomeforyourportfolio?
• Towhatextentareyouconcernedaboutmaximisingthevalueofyourestate?
• Willyouworryifyourinvestmentsgodowninvalueintheshortterm,buthavethepotentialforlongtermgrowth?
Regardingyourincomeneeds,doyouwishto(PleaseSelectOneofTheFollowing):
• Liveoffincome,preservecapital: Yes No
• Liveoffincomeandcapital,noneedtopreserveassetsforestate: Yes No
• Liveoffincomeandcapital,butwouldliketohavesomeassetslefttoestate: Yes No
• Notliveoffincomeorcapital: Yes No
SECTION8–INVESTMENTOBJECTIVES
InvestmentProfile
IncomeNeeds
Client Financial Profile
Page 11 of 14
Client1 Client2/Partner(ifapplicable)
• Experience with financial products and in
particularmanagedinvestments
€ Good
€ Fair
€ Unfamiliar
€ Good
€ Fair
€ Unfamiliar
• Yourabilitytounderstandfinancialtermsand
toexpressyourpreference?
€ Good
€ Fair
€ Unfamiliar
€ Good
€ Fair
€ Unfamiliar
• Areyouoryourpartnerexpectingtoreceiveaninheritanceinthenearfuture?Y/N
Ifyes,detailsieAmount$andwhen
PleaseInitial
Conservative Longtermandsecureincomestream.Minimalgrowthoncapitalinvested.
Preservationofcapitalinvested.
ModeratelyConservative Stableincomestreams.Modestgrowthoncapitalinvested.
Lowtomoderatecapitalvolatility.
Balanced Moderategrowthoncapitalinvested.Moderateincomestream.
Moderatelevelofcapitalvolatility.
Assertive Highlevelofgrowthoncapitalinvested.Incomeisincidental.
Highlevelofcapitalvolatility.
Aggressive Veryhighlevelofgrowthoncapitalinvested.Veryhighlevelofcapital
volatility. Understandsandacceptsrisk.
• Completetheaboveforeachclient/partner •
KnowledgeofFinancialMatters
InvestorType
Client Financial Profile
Page 12 of 14
IncomeProtectionNeeds–Howwouldyoureplaceyourincomeintheeventoftemporaryorpermanentlossof
yourcurrentincome.
InsertName: InsertName:
• Doyouhaveanalternativesourceofincomein
theeventofseriousillnessordisability?Y/N Y/N
• Howmanydayscouldyougowithoutyour
regularincome?ie30/60/90
• Intheeventyouareunabletoworkforalong
periodoftimeduetoillnessoraccident,how
longwouldyoulikeyourincomeprotection
paymentstocontinuee.g.2,5years,uptoage
60,uptoage70?
• Whatminimumpercentageordollaramountof
yourcurrentgrossincomewouldyouneedto
maintainyourlifestyle(NBmaximum75%)?
• Replacesuperannuationcontributions? Y/N Y/N
9.2 LumpSumInsuranceNeeds
Death TPD Trauma
InsertName/s:
Indicatewho requires the cover In the event of death, TPD or amedical
event.
Ifso,whataretheamountsthatyouwouldrequire?
• Repaymortgage(s) $ $ $
• Repaypersonaldebt(s) $ $ $
• Providefundsforfuneralcosts $ $ $
• Providefundsforemergencye.g.cashinbank $ $ $
• Providealumpsumforhomeandlifestylealterationse.g.access
ramps$ $ $
• Providealumpsumformedicalcostse.g.majoroperations $ $ $
• Other: $ $ $
• Numberofyearsincomerequiredforchildren’seducation
• Amountrequiredeachyearforchildren’seducation $ $ $
• Numberofyearsincomerequiredforspouse/partner
• Amountrequiredeachyearforspouse/partner $ $ $
Sub-total $ $ $
Self-insurancee.g.saleofassets,existinginsurance $ $ $
Total $ $ $
SECTION9–PERSONALINSURANCENEEDSANALYSIS
Client Financial Profile
Page 13 of 14
AdviserNotes
DocumentationChecklist
TheinformationrecordedinthisClientDataFormwasprovidedduringadiscussionheldon
TheFSGandAdviserProfilewereprovidedtotheabovementionedclient(s)on
TheversionnumberoftheFSGprovidedwas
Theclient’sriskprofilequestionnairewascompletedon
AdviserSignatureandARNumber
Page 14 of 14
15.0 ClientDeclaration
Weherebydeclarethat:
• A Financial Services Guide (FSG) version Oct 2011 and Adviser Profile were provided to us and we have read and understood both
documents
• TheinformationprovidedinthisClientDataForm–FinancialPlanningisatruereflectionofmy/ourpersonalfinancialsituation,needsand
objectives.I/Weam/arenotawareofanyotherinformationthatwouldberelevanttothemakingofarecommendationbymy/ouradviser
• WeunderstandthatwherewehavenotcompletedsomeofthesectionswithinthisClientDataForm–FinancialPlanning,my/ouradviser
isobligedtowarnusthathis/heradvicemaybebasedonincompleteorinaccurateinformation
• WeconfirmthatwehavecompletedtheClientRiskProfileQuestionnaire.Wehavereadandunderstoodmy/ouragreedriskprofileand
additionally,weunderstandthatthisprofilewillbeconsideredintheadviceprocess
• Wegivepermissionformy/ourTaxFileNumber,asprovidedinsection2toberetainedonfilebymy/ouradviser
• Wegivepermissionforthisinformationtoberetainedandusedforthepreparationofmy/ourrelevantadvicedocumentandinrelationto
anyinvestmentwhichweholdormayholdandweunderstandthatanyadviceand/orfinancialplanningrecommendationswillbebased
ontheinformationsuppliedinthisClientFinancialProfile.Weacknowledge,inaccordancewiththeElectronicTransactionsAct(1999),thisClientFinancialProfilemaybeelectronicallystoredsecurelyforrecord-keepingpurposesbymy/ouradviser
• Weauthorisemy/ouradvisertocontactthefinancialproductprovidersthatcurrentlymanagethefinancialproductsthatweholdaslisted
in this Client Financial Profile, or as otherwise notified to my/our adviser, in order for my/our adviser to ascertain my/our financial
circumstances.
Client1
Signature
Fullname Date
Client2
Signature
Fullname Date
AdviserNotes