Financial Fact Find A confidential analysis of needs, goals and … · 2016. 10. 10. · Financial...
Transcript of Financial Fact Find A confidential analysis of needs, goals and … · 2016. 10. 10. · Financial...
PO Box 288 Heidelberg VIC 3084 p: (03) 9497 2895 f: (03) 8648 6850 www.mccarthys.net.au
Financial Fact FindA confidential analysis of needs, goals and
your financial situation
Financial FactFinder
PersonalDetails
Important Notice to Customers Your Financial Adviser must have reasonable grounds for making an investment or insurance recommendation. Before making such a recommendation the Financial Adviser must ask you about your investment objectives, financial situation and your particular needs. The information requested in this form will be used strictly for that purpose.
Warning- The Financial Adviser could make inappropriate recommendations or give inappropriate advice if you fail to fully and accurately complete this form.
Office Use OnlyApplicationNo.: DateLodged://
Customer Spouse/Partner
Title
Surname
Given/PreferredName
HomeAddress
BusinessAddress
ContactPhone
DateofBirth
Sex
Smoker
ExpectedRetirementAge
Male Female Male Female
DependantsDateofBirth SexSchool OccupationName
Employment,Income&ExpenditureCustomer Spouse/Partner
Occupation
EmploymentStatus
BusinessStaus Sole Proprietor Partnership
Private Company Trust
Employee -FullTimePartTime Casual
Unemployed
Pensioner
Contractor
Other
Sole Proprietor Partnership
Private Company Trust
Employee -FullTimePartTime Casual
Unemployed
Pensioner
Contractor
Other
Note- Employment security is an integral part of the planning process and should be taken into consideration.
Employment,Income&ExpenditureAnyotherpersontobecontacted?E.g.Accountant,Solicitor,etc.
Name ContactNumber
P.O Box 288 Heidelberg Vic 3084 Phone: (03) 9497 2895 Fax: (03) 8648-6850Email: [email protected]
Phone:(03)94972895www.mccarthys.net.au
Yes No Yes No
Financial FactFinder
IncomeandExpenditure
Office Use OnlyApplicationNo.: DateLodged://
Customer Spouse/Partner
TotalIncome*
Includesalary,wages,rents,
investments,pensions,socialsecurityetc.
TotalHouseholdIncome(Combined)
MonthlyExpenses
e.g. rent, mortgage, food, clothing, utilities
Transport&Health
e.g. travel, car loans/registration, health funds
OtherExpenses
e.g. loans, credit card, superannuation,
insurances, education, entertainment
TotalExpenses
SuperannuationYourInvestmentPreferences
1.Inanyinvestmentplanning,arethere
anyinvestmentsyouwishtoaviod?
2.Inanyinvestmentplanning,arethere
anyinvestmentsyouwouldprefer?
DoyouhaveaWill?Ifso,whenwasyourWilllastreviewed?
Yes No
P.O Box 288 Heidelberg Vic 3084 Phone: (03) 9497 2895 Fax: (03) 8648-6850Email: [email protected]
TotalHouseholdExpenses(combined)
Surplus/Shortfall(incomelessexpenditure)
ActualSavings
Doyouexpectanysignificantchangein
incomeorexpensesinthenextyear?Yes No Give Details
Phone:(03)94972895www.mccarthys.net.au
Financial FactFinder
Assets&Liabilities
Assets
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P.O Box 288 Heidelberg Vic 3084 Phone: (03) 9497 2895 Fax: (03) 8648-6850Email: [email protected]
Value Description
Property(ies)-Residential
Property(ies)-Other
HouseholdGoods(eg.furniture,etc.)
PersonalItemsofValue
MotorVehicles
Investments(e.g.Stocks,etc.)
OtherAssets
TotalAssets
LiabilitiesValue Description
Mortgage-Residence
Mortgage-OtherProperties
Rent
HirePurchase/s
PersonalLoan(s)
CreditCard(s)
OtherLiabilities
TotalAssets
Phone:(03)94972895www.mccarthys.net.au
Financial FactFinderCurrentInvestments
Office Use OnlyApplicationNo.: DateLodged://
Notes
P.O Box 288 Heidelberg Vic 3084 Phone: (03) 9497 2895 Fax: (03) 8648-6850Email: [email protected]
Company Purchase Units Held/Fixed Rate Current Value Owner DebtInvestmentType
PersonalInsuranceMemberName
PolicyNo.
PolicyOwner
Insurer PolicyType
AnnualPremium
SumInsured
Superannuation Customer Spouse/Partner
FundName
DateJoinedFund
TypeofFund
Contribution(e.g.5%ofsalary)
CurrentRetirementValue
EstimatedRetirementValue
Isthereprovisionforyoutotopuporsalarysacrifice?
Accumulation Defined
Pension Lump Sum
Accumulation Defined
Pension Lump Sum
By Employer By Yourself By Employer By Yourself
Yes No Yes No
DoanyofthesepolicieshaveLoadingsorExclusions? Yes No
List
Phone:(03)94972895www.mccarthys.net.au
Financial FactFinderSavings
SavingsGoals
Office Use OnlyApplicationNo.: DateLodged://
P.O Box 288 Heidelberg Vic 3084 Phone: (03) 9497 2895 Fax: (03) 8648-6850Email: [email protected]
Amount Needed When
PersonalPrioritiesRankpersonalprioritiesinorderofimportance.e.g.1=highest
Protectincomeagainstsicknessoraccident
Protectfamilyand/orassetsintheeventofdeath
Provideagainstseriousillnessortrauma
Planforretirement
Saveforshortterm(depositforhome,overseasholiday)
Saveformediumterm(earlymortgagerepayment,children’s
Others(describe)
Rank Details
FutureNeedsInsuranceNeeds-Disability
Grossannualincome(beforetax)
Lessbusinessexpenses
Netannualincome(beforetax)
Maximumallowableannualbenefit(75%ofnetannualincome)
Divideannualbenefitby12(=monthlybenefit)
Lessexistinginsurance
Insuredmonthlybenefitshortfall(beforetax)
Customer Spouse/Partner
Gross income is the total of earned income ie before tax earnings derived from personal exertion, including salary, fees, commission, bonuses, fringe benefits or similar payments that would cease on disablement
BusinessExpensesareexpensesincurredbyyouintheprocessofearningincomefromyourprofession,businessorpartnership
Phone:(03)94972895www.mccarthys.net.au
Financial FactFinderInsuranceNeeds
Life&Retirement
Office Use OnlyApplicationNo.: DateLodged://
P.O Box 288 Heidelberg Vic 3084 Phone: (03) 9497 2895 Fax: (03) 8648-6850Email: [email protected]
Finalexpensesfund(debts,expenses,legals,medicals,emergencies,funeralfees)
MortgageDischarge
EducationAmounttopayeducationfeesforyourchildren
TraumaneedsFundtocoverout-of-pockethealthcarecosts,eg:excessoverhealthinsurance,medications,physiotherapyetc
Additionalexpensesofapermanentnature,wheelchairs,homealterationsetc:
Income1.Incomeforyourspouse/partner 2.Incomeforyourchildren
Retirementincome
Additionalincome:incomeprotectiononlycovers75%,wouldyouneedextra?
TotalFundsrequired
Lesscashavailableorassetsthatcanbereadilycashed
Shortfall/surplus
Customer Spouse/Partner
Additional Notes
Phone:(03)94972895www.mccarthys.net.au
Financial FactFinderAcknowledgementTheinformationprovidedinthisFinancialFactFinderiscompleteandaccuratetothebestofmyknowledge.I/Weunderstandthatmy/ourSOAwillbebasedsolelyontheinformationsuppliedandmy/ourscopeofadviceabove.I/weunderstandthatapolicypurchasedwithoutthecompletionofaFactFinder,orfollowingapartialorinaccuratecompletion,maynotbeappropriatetomy/ourneeds.
I/Weunderstandthatbyrestrictingtheadvicesought,I/weriskmakingafinancialcommitmenttoapolicythatmaynotbeappropriatetomy/ourneeds.
I/WeconfirmthatI/WehavereceivedacopyoftheFinancialServicesGuide(s)andMillennium3’sPrivacyState-ment(whererequested)andhavereadthesedocuments.I/weacceptthatmyadvisermaysendme/usinformationaboutitsservicesfromtimetotime.I/weunderstandthatI/wemaynotifyyouofmy/ourdecisionnottoreceivefurtherinformationbycontactingyoudirectly.
I/WeacknowledgethatinaccordancewiththeprovisionssetoutoftheAnti-MoneylaunderingandCounterTerror-ismFinancingAct,thatmyidentificationinformationwillberequiredbeforeanyfinancialservicesorproductsareap-pliedfor,andthatthisinformationwillbeprovidedtotheparticularproductissuer(s)andtotheDesignatedBusinessGrouptowhichMillennium3FinancialServicesPtyLtdisaparty.
I/WeacknowledgethattheinformationcontainedinthisFactFindmaybesenttoseveralInsurersforthepurposeofobtainingaPre-assessmentoflikelyunderwritingterms.
I/Wegivepermissionformy/ourtaxfilenumbertobestoredinasecureformatbymyadviserinaccordancewithlegislativerequirements;
I/wegivepermissionformy/ourtaxfilenumbertobeforwardedtofinancialinstitutionsasrequired.
Client(s)Signature(s)
Adviser’sName
Adviser’sSignature Date
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P.O Box 288 Heidelberg Vic 3084 Phone: (03) 9497 2895 Fax: (03) 8648-6850Email: [email protected]
Phone:(03)94972895www.mccarthys.net.au
Financial FactFinderLetterofAppointment
TOWHOMITMAYCONCERN
Effectivefromthebelowdate,I/WeherebyappointLaurenceMcCarthy,AuthorisedBrokerRepresentativeofMil-lennium3FinancialServicesPtyLtdasourInsuranceBroker/FinancialAdviser.Asourappointedadviser,LaurenceMcCarthyisauthorisedtoobtaininformationregardingpolicies,premiumsandclaimsandtomanagemyexistingandnewinsurancerequirementsasnecessary.Ihavereceived,readandacceptedtheFinancialServicesGuideprovided.Regards,
I/wegivepermissionformy/ourtaxfilenumbertobeforwardedtofinancialinstitutionsasrequired.
Client(s)Name(s)
Client’sSignature(s)
Date
Office Use OnlyApplicationNo.: DateLodged://
Laurence McCarthy is a Corporate Authorised Representative ofMillennium3 Financial Services Pty Ltd ABN 61 094 529 987
Australian Financial Services LicenseeAustralian Financial Services Licence number 244252
P.O Box 288 Heidelberg Vic 3084 Phone: (03) 9497 2895 Fax: (03) 8648-6850Email: [email protected]
LifeInsured PolicyNumber Insurer
Phone:(03)94972895www.mccarthys.net.au