Client Questionnaire

Step 1 of 7 - Client Details

Client
Title
Given Names*
Surname*
Date of Birth*
Date Format: DD slash MM slash YYYY
Smoker Status
Do you have a partner?
- Yes
Partner
Partner's Title
Partner's Given Names*
Partner's Surname
Partner's Date of Birth*
Date Format: DD slash MM slash YYYY
Partner's Smoker Status

Contact Details
Residential Address*
Postal Address
(if differs from Residential Address)
Phone (client)*
Phone (partner)
Email (client)
Email (partner)
Children
Do you have any children?
What are their names and ages?
Name Age

Employment Details (client)
Occupation
Occupation Status
Employer Name
Expected Income ($)
Any expected changes?
Employment Details (partner)
Occupation
Occupation Status
Employer Name
Expected Income ($)
Any expected changes?

Other Details (client)
Estimated Living Costs ($)
Do you have a Will?
Do you have Private health insurance?
Other Details (partner)
Estimated Living Costs per annum ($)
Do you have a Will?
Do you have Private health insurance?

Assets
List your assets and current market value
Description Value ($)
Liabilities
List Your Liabilities and current amount owing
(Please add details of any loans, credit card debt or other debts in the sections below)
Description Amount ($)

Superannuation & Superannuation Pensions
Super fund / Pension fund Estimated Balance ($) Owner
Personal Insurance Details
Personal Insurance Details
Insert Type (Life, TPD, Trauma, Income Protection), Sum Insured and Insurer
Type Sum Insured ($) Insurer
Financial Concerns
What keeps you awake at night?
eg. Debt, job security, providing for family, will I have enough to retire?

Final Questions (client)
The following Four (4) questions ask you to rank your response on a scale whereby 1 is very low and 10 is very high;
On a scale between 1 (very low complexity) to 10 (very high complexity) – how complex do you think are your financial circumstances?
On a scale between 1 (no concern) to 10 (very concerned) – How concerned are you about reaching your financial goals?
On a scale between 1 (not committed) to 10 (very committed) – How committed are you to making the necessary changes in your life to achieve your financial goals?
On a scale between 1 (no importance) to 10 (very important) – how important to you is a long term relationship with a financial planner that will help you achieve all of your financial goals?
Final Questions (partner)
The following Four (4) questions ask you to rank your response on a scale whereby 1 is very low and 10 is very high;
On a scale between 1 (very low complexity) to 10 (very high complexity) – how complex do you think are your financial circumstances?
On a scale between 1 (no concern) to 10 (very concerned) – How concerned are you about reaching your financial goals?
On a scale between 1 (not committed) to 10 (very committed) – How committed are you to making the necessary changes in your life to achieve your financial goals?
On a scale between 1 (no importance) to 10 (very important) – how important to you is a long term relationship with a financial planner that will help you achieve all of your financial goals?

Name	Age

Description	Value ($)

Description	Amount ($)

Super fund / Pension fund	Estimated Balance ($)	Owner

Client Questionnaire

Step 1 of 7 - Client Details

Client

Partner

Contact Details

Children

Employment Details (client)

Employment Details (partner)

Other Details (client)

Other Details (partner)

Assets

Liabilities

Superannuation & Superannuation Pensions

Personal Insurance Details

Financial Concerns

Final Questions (client)

Final Questions (partner)