electronic data collection form

8/13/2019 Electronic Data Collection Form

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FINANCIAL PLANNING

DATA COLLECTION FORM(CONFIDENTIAL)

IMPORTANT NOTICE TO CLIENTThe Corporations Law requires that an advisor making investment recommendations must have reasonable

grounds for making those recommendations. This means that an advisor must conduct an appropriate

investigation as to the financial objectives, situation and particular needs of the client. The information

requested in this form is necessary to enable recommendations to be made and will be used solely for that

purpose. We accept no liability for any advice given on the basis of inaccurate or incomplete information.

NameDate of InterviewPlanners Name


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TAX STATUSPersonal Company Trust Super Fund Other:

INVESTMENTS HELD FOR AND ON BEHALF OF (if applicable)Company Trust Super Trust Other:

Entity NameTrustee NamePERSONAL SUMMARY DETAILSClient PartnerTitle Mr Mrs Miss Ms Title Mr Mrs Miss MsGiven Names Given NamesPreferred Name Preferred NameSURNAME SURNAMEDate of Birth Date of BirthPlace of Birth Place of BirthSex Male Female Sex Male FemaleMarital Status

Single

Married

Divorced

Other:

Home Address Postal Address (if applicable)Suburb / Town Suburb / TownState Postcode State PostcodeHome Telephone Work TelephoneFax Mobile

CHILD / DEPENDANT DETAILSName Sex Age Date of Birth Eligible for Indian?

M F Yes NoM F Yes NoM F Yes NoM F Yes No

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HEALTH DETAILSClient PartnerHealth Poor Good Excellent Health Poor Good ExcellentSmoker Yes No Smoker Yes NoPrivate Health Cover Yes No Private Health Cover Yes NoDo you or any member of your family suffer from any physical disability or health condition that may affect

current or future financial planning considerations?

ESTATE PLANNING DETAILSClient Partner

Do you have a current Will? Yes No Yes NoIf Yes:Date Last ReviewedLocation of WillName of ExecutorTelephoneDo you have in place aPower of Attorney (POA)? Yes No Yes NoIf Yes:Type of POA Enduring Enduring

General/Limited General/LimitedMedical Medical

Name of AttorneyOther Other

TelephoneHave you invested in aFuneral Plan? Yes No Yes NoIf Yes:Name of PlanAmount Invested (Rs.)Estate Planning Objectives

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EMPLOYMENT DETAILS

Client Full Time Part Time Casual Unemployed Home Duties Other:Employer Name Work AddressPosition / Title

State Postcode

Employment Start Date Work TelephoneRetirement Age Work FaxPartner Full Time Part Time Casual Unemployed Home Duties Other:Employer Name Work AddressPosition / Title

State PostcodeEmployment Start Date Work TelephoneRetirement Age Work FaxDo you intend to stay with your current employer or are you contemplating leaving?

Do you foresee any substantial change to your income in the next two to five years?

After Retirement, do you intend to work again either on a full time or part time basis?

REFERENCE NUMBER DETAILSClient PartnerTax File No. Tax File No.Authorization Yes No Authorization Yes NoDSS/DVA No. DSS/DVA No.Medicare No. Medicare No.Mobility No. Mobility No.Other OtherPlease note: Tax File Numbers will only be retained and/or used where a written authority has been

obtained from the client.

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CURRENT INCOME AND EXPENSESCurrent AmountWeekly Fortnightly Monthly Annual

Client ( pw) (Rs.pf) (Rs. pm) (Rs. pa)Gross Salary / WagesOther Taxable IncomeOther Non Taxable IncomeCentrelink or DVA - Pension / Allowance(A) TOTAL INCOMEClient 0.00 0.00 0.00 0.00PartnerGross Salary / WagesOther Taxable IncomeOther Non Taxable IncomeCentrelink or DVA - Pension / Allowance(B) TOTAL INCOME - Partner 0.00 0.00 0.00 0.00

Weekly Fortnightly Monthly AnnualCombined (Rs. pw) (Rs.pf) (Rs. pm) (Rs. pa)(C) TOTAL LIVING EXPENSES CombinedTotal IncomeSurplus/(Deficit)(A)+ (B)(C) 0.00 0.00 0.00 0.00

Income TestAssessable ?Yes / No

Y NY NY NY NY N

Y NY NY NY NY N

NOTESPlease detail here any additional information in relation to your income and/or expenses (i.e. salary

packaging, deductible expenses, inheritance etc)

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REGULAR EXPENSES - DETAILSWeekly Fortnightly Monthly Annual

HOUSING (Rs.) (Rs.) (Rs.) (Rs.)RentHome Mortgage RepaymentsCouncil / Shire RatesWater RatesElectricityGas / OilTelephoneHouse & Contents InsuranceHousehold Repairs / MaintenanceFurnishings / Appliances

TRANSPORTRunning Costs / Petrol / FuelRegistration & Third PartyComprehensive InsuranceMaintenance / Services / RepairsLicence Fees / Fines / ParkingPublic Transport / Taxi FaresLoan / Lease Repayments

FOODGroceriesMeatFruit & VegetablesLunchesAlcohol / Cigarettes

HEALTHHealth Benefits / InsuranceChemistMedical / Dental / Optical

EDUCATIONSchool FeesChild CareOther

PERSONALClothing / FootwearEntertainment / Dinning OutSport / Recreation / HobbiesHaircutsGifts / Presents / ChristmasVacations / HolidaysBooks / Magazines / NewspapersSubscriptions / FeesLife InsuranceDisability Insurance

OTHERChild Support / MaintenancePets / Vet Fees

Charities / DonationsMiscellaneous

TOTAL Rs. 0.00 0.00 0.00 0.007


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FIXED ASSETS AND INVESTMENTSInvestment Name / Type Owner Original Amount Loan Current Sell Price Current Reference Retain?

C/P/J/O Date Invested Amount No Units (Rs.) Value or Policy Yes/NoInvested (Rs.) (Rs.) (Rs.) Number

Principal Residence Y NFarm Y NBusiness Interests Y NContents / Personal Property Y NMotor Vehicles Y NInvestment Property Y NUndeveloped Land Y NHoliday Home Y NLife Insurance (surrender value) Y NCredit Cards Y NOther Loans Y NBank Accounts/Term Deposits Y NDirect Shares Y NManaged Investments/Unit Trusts Y NSuperannuation Y NAnnuities/Allocated Pensions Y NOther Assets Y N

Y NY NY NY NY NY NY NY NY N

Owner: C=Client; P=Partner; J=Joint; O=OtherWho do you Bank with? (Bank Account Details)Bank Name Account Number Current Balance Term? Maturity Date

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INSURANCE POLICIESPolicy 1Policy Type Policy OwnerPolicy Number InsuredInsurance Company Sum InsuredRenewal Date Gross PremiumStatus Payment FrequencyDisability Insurance: Monthly Benefit Waiting Period Benefit PeriodLife Insurance: Cash Value As at Maturity Value As atPolicy 2Policy Type Policy OwnerPolicy Number InsuredInsurance Company Sum InsuredRenewal Date Gross PremiumStatus Payment FrequencyDisability Insurance: Monthly Benefit Waiting Period Benefit PeriodLife Insurance: Cash Value As at Maturity Value As atPolicy 3Policy Type Policy OwnerPolicy Number InsuredInsurance Company Sum InsuredRenewal Date Gross PremiumStatus Payment FrequencyDisability Insurance: Monthly Benefit Waiting Period Benefit PeriodLife Insurance: Cash Value As at Maturity Value As at

INSURANCE OBJECTIVES

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INVESTMENT RISK PROFILE1. How much of your income would be spent on servicing current debts eg: credit cards,

rent or mortgage payments: ScoreMore than 30%. 2 0Between 10% to 30%. 4 0Less than 10%. 6 0

2. In the event of an emergency, how much cash savings would you have?:less than 3 months of living expenses. 2 03 to 6 months of living expenses. 4 0Greater than 6 months of living expenses. 6 0

3. Is your current state of employment:nsecure 0

Relatively Stable 4 0g y ecure 0

4. Do you require any income from your investment portfolio?All income earned to be received. 2 0

art a ncome earne to e receve . 0All income earned to be reinvested. 6 0

5. Do you require access to your investment capital:requre t or spen ng. 0

In case of an emergency. 4 0ave no requ rement or access to my nvestment cap ta . 0

6. Would you change to another investment if:Your investment drops in value 2 0The value drops more than 20% during a given year 4 0I would not sell in the short term based on negative returns 6 0

7. Where do you currently invest most of your money?:Mainly cash and term deposits. 2 0Shares, investment, diversified managed funds etc. 4 0Aggressive investments including small company shares or speculative investmentopportunities. 6 0

8. Which statement best describes your investment objectives:A secure safe place for my investments with no loss in capital. 2 0Investments that show steady growth, and have minimal risk to my capital. 4 0An aggressive mix of investments and mostly those with higher risk and the chancefor the highest returns. 6 0

9. What type of return would you expect from your investment?Regular income 2 0Both income and capital growth 4 0

a n y cap ta growt . 010. What is your investment time frame?

One to four years 2 0Five to ten years 4 0More than ten years 6 0

Total Profile Score 0

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INVESTMENT PROFILE AND ASSET ALLOCATIONWhat is your preferred investment approach?

CONSERVATIVE (20 to 25) MODERATELY CONSERVATIVE (25 to 35)Long term and secure income stream Stable income streamModest growth on the capital invested Minimal growth on the capital investedMedium to long-term capital security Preservation of capital investedMODERATE (35 to 45) MODERATELY AGGRESSIVE (45 to 55)Moderate growth on the capital invested High level of growth on the capital investedModerate income stream Modest level income streamModerate level of capital volatility High volatility of the capital investedAGGRESSIVE (55 to 60)High level of growth on the capital investedIncome is incidentalHigh level of volatility

ASSET CLASS Consevative Conservative Moderate Moderate to Aggressive Agreedto Moderate Agressive

Cash 20% 20% 10% 7% 3%Fixed Interest 55% 35% 25% 13% 7%Indian Shares 15% 30% 40% 42% 48%International Shares 5% 10% 20% 23% 27%Property 5% 5% 5% 15% 15%TOTAL 100% 100% 100% 100% 100%

Investment ApproachConservative (20 to 25)An investor with a conservative approach to investing is generally seeking to preserve capital and as a

trade-off is usually prepared to accept lower investment returns. The main emphasis is on defensive

assets such as cash and government bonds. A conservative portfolio is typically suited to an investor who

prefers reliable returns or who has a short-term investment horizon. In the short to medium term (2-3

years) there should be limited exposure to growth assets such as shares and property. A conservative

investor with a longer term investment approach should consider increased exposure to growth assets,however, this will cause capital values to fluctuate over the short-term. A typical investment portfolio for a

conservative investor will contain 75% in income assets and 25% in growth (3 years or more) or 90%

income and 10% growth (less than 3 years). Conservative to Moderate (25 to 35)An investor with a conservative to moderate approach to investing is generally seeking the preservation of

their capital over the medium to long term but is prepared to accept a small amount of risk for the potential of

modest growth. A conservative to moderate investor would be able to tolerate small fluctuations in their

capital value over the short-term. This profile is suitable for investors seeking a diversified portfolio with an

emphasis on domestic fixed interest securities. A typical investment portfolio for a conservative to moderate

investor will contain 55% in income assets and 45% in growth. An appropriate investment time horizon would

be a minimum of 3-4 years.

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Moderate (35 to 45)An investor with a moderate approach to investing is usually seeking a diversified investment portfolio with

exposure to a broad range of investment sectors. Investments will include a diversified mix of cash, Indian

and international fixed interest, direct property and Indian and international shares. Investors will need to

accept some short-term fluctuations in their capital value in return for future growth. A moderate portfolio is

typically suited to an investor who either seeks to diversify risk with reasonable returns or who has a

medium-term investment horizon (minimum of 3 to 4 years). A typical investment portfolio for a moderate

investor will contain 35% in income assets and 65% in growth.

Moderate to Aggressive (45 to 55)An investor with a moderate to aggressive approach towards investing is generally seeking consistent

capital growth and only modest levels of income from capital invested. This investor remains cautious

towards taking extreme levels of risk however, their general understanding of investment markets enables

this investor to feel comfortable with short-term risk. This investor takes a long-term view seeking exposure

to a diversified portfolio with a emphasis on growth assets. A typical investment portfolio for a moderate tp

aggressive investor will contain 20% in income assets and 80% in growth. An appropriate investment time

horizon would be a minimum of 5 years.Aggressive (55 to 60)An investor with an aggressive approach to investing is comfortable accepting high volatility in their capital

value, with the risk of short to medium-term periods of negative returns. They are generally willing to tradehigher risk for greater long-term returns and typically will have a longer investment horizon. The investment

portfolio will consist of a larger proportion of shares and property with little or no fixed-interest or defensiveasset exposure. It is typically suited to an investor seeking long-term capital growth and who is comfortable

with short-term fluctuations in their capital value. A typical investment portfolio will contain 10% in income

assets and 90% in growth.FINANCIAL CONCERNS & PRIORITIESHow concerned are you about the following? Very Low Low Medium High Very HighLevel of investment risk I am prepared to

accept (refer risk profile also)Safety and security of our Capital

(Rise and fall of Capital value)That our investments keep pace withInflation and the cost of livingLevel of liquidity and flexibility required

(Access to money)Our need for IncomeOur need for Capital GrowthOur desire to minimise taxationSimplicity of our investments and ease

of managementOur desire to maintain our Income if ill,

injured or disabledThe level of funds available in my

Estate if I die

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Client PartnerWhat is your investment time frame (in years) for your Non-Superannuation Investments?What is your investment time frame (in years) for your Superannuation Investments? What weekly income do you anticipate you will require in retirement (in todays rupees)? How much do you want to have in cash reserves (immediately available money) at any time?

KEY OBJECTIVES AND SCOPE OF ADVICELegislation requires that the advisor must know the clientbefore making any recommendations. However,

there is provision that in certain circumstances an advisor may supply limited advice. If you are seeking

limited advice of a particular nature you must make this known at the time of the interview and you shouldrecognise that the recommendations will only relate to that limited advice being sought. I / We require only

limited advice in the areas specified below.A full and Comprehensive Analysis of our Financial Concerns, Needs and ObjectivesORLimited Advice addressing the following priorities:Investment and Wealth Accumulation:Develop a Savings and Investment PlanProviding funds for our Childrens educationEstablish and appropriate investment portfolio based on your risk profileReduce the amount of taxation you payInsurance:Protect your family in the event of deathProtect your current income in the event of sickness or accident Protect your family in the event of serious illness or traumaMaintain your current standard of living if permanently disabledSuperannuation and Retirement:Assess whether you have sufficient funds to retire onEstablish/Increase contributions to superannuation account/fundConsolidate your superannuation funds into one easy to manage accountAdvice on Redundancy Payment

Commence a regular retirement IncomeMaximise your Centrelink entitlementsDebt:Consolidate and/or Reduce your Mortgage, Credit card and/or other personal debts Other:

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INVESTMENT STRATEGY NOTES

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CLIENT STATEMENT / AUTHORISATIONI / We hereby declare that the information set out in this form is true and correct to the best of my / our

knowledge. I / We are not aware of any other information and have not disclosed to the person to whom this

form is given any other information which would be relevant to the making of a recommendation by an

investment advisor. I / We give permission for this information to be used for the preparation of my financial

plan and I / we understand that the investment recommendations will be based solely on the information

supplied in this form.PRIVACY CONSENTI / We further declare that we have read and understood the XYZ Privacy statement about my/our privacy

and accept that the collection, use and disclosure of my personal or sensitive information is necessary. I /

We understand that XYZ will not be able to provide me / us with its services without this consent.Yes No

TAX FILE NUMBER AUTHORISATIONI / We give permission for my / our tax file number(s), as provided above, to be retained on file by our

adviser and forwarded to financial institutions as requested or as necessary *. Yes No

* (If No, tax file number must be removed from all records and files)

Signed Date

Signed Date

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GENERAL NOTES

THE FINANCIAL PLANNING PROCESSThe Financial Planning standard board of India Limited (FPSB) has provided the following definition of

financial planning: Financial Planning is the process of providing advice and assistance to a client for the

purposes of achieving the clients financial goals.The FPSB defines the six steps of the financial planning process as follows: 1. The collection and analysis of all relevant personal and financial data.

2. The identification of financial problems.

3. The identification of financial goals and objectives.

4. The provision of a written report with recommendations.

5. The co-ordination and implementation of recommendations.6. The provision or periodic reviews and plan updates.

Thank you for completing this questionnaire. All of the above information will be held in the strictest of

confidence and a written report containing our recommendations will be prepared for your consideration.

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RELEASE OF INFORMATIONTHIRD PARTIES

Date

To:I / We give permission for my / our personal information to be forwarded to the following individuals and / or

Institutions for the following purposes only:Name of Individual Capacity of Individual Personal Information to be Released/Company /Company

Signed DateName

Signed DateName

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