Confidential Fact Finder Financial Needs · PDF fileConfidential Fact Finder and Financial...

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Confidential Fact Finder and Financial Needs Analysis To identify your financial needs and goals Financial Wisdom Limited ABN 70 006 646 108 Australian Financial Services Licensee 231138 Head Office: Level 17, 175 Pitt Street, Sydney NSW 2000 Tel: 1800 024 864 Client: Date Completed: / /

Transcript of Confidential Fact Finder Financial Needs · PDF fileConfidential Fact Finder and Financial...

Page 1: Confidential Fact Finder Financial Needs · PDF fileConfidential Fact Finder and Financial Needs Analysis To identify your financial needs and goals Financial Wisdom Limited ABN 70

Confidential Fact Finderand

Financial Needs AnalysisTo identify your financial needs and goals

Financial Wisdom Limited

ABN 70 006 646 108

Australian Financial Services Licensee 231138

Head Office: Level 17, 175 Pitt Street, Sydney NSW 2000

Tel: 1800 024 864

Client:

Date Completed: / /

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Financial Wisdom Limited and Your Privacy

The privacy of your personal information is important to us:

1. Why are we asking so many questions?

We collect your personal information to ensure that we are able to provide you with the products and services appropriate to your needs.

Financial Planning is the exercise of: -

a. Understanding a client’s financial goals.

b. Gathering all the details of a client’s financial position.

c. Analysing all the issues and options which will form the basis of any recommendations.

d. The adviser providing advice and recommendations, whilst also making all the required disclosures.

e. The client agreeing with the advice to allow the adviser to implement all actions required to achieve the client’s financial goals.

f. The adviser and the client agreeing as to what level of further review and action is required to ensure the advice and recommendations continue to achieve all identified financial goals.

This process seems simple, but it is the result of carefully gathering all the right details in assessing a client’s financial goals.

It is achieved by gathering data through completion of a Fact Finder and Financial Needs Analysis. This document will help identify what is relevant and also helps to prioritise any action required. We aim to ensure that the personal information that we retain about you, is accurate, complete and up to date. If you provide us with incomplete or inaccurate information, we may not be able to provide you with the products or services you are seeking.

The law can also require us to collect personal information eg. The Corporations Act 2001 requires us to identify a person's needs, objectives and financial circumstances to be able to provide financial planning advice; and the Anti Money Laundering and Counter Terrorism Financing Act 2006 ("AML/CTFACT") (Cth) requires us to identify all clients and to conduct identity verification checks.

2. Access

You may (subject to permitted exceptions) access your information by contacting us. We may charge a fee for providing access. Please direct your access requests to Professional Standards, Level 17, 175 Pitt Street, Sydney NSW 2000.

3. We may communicate personal information to: -

• your adviser and external product providers;

• other members of the Commonwealth Bank Group. This enables the Group to have an integrated view of its customers and clients;

• organisations (who are bound by strict confidentiality) to whom we outsource certain functions such as our auditors. In these circumstances, information will only be used for our purposes;

• other professionals such as solicitors, accountants, and stockbrokers when a referral is required;

• third parties when required by law eg. under Court Order; and

• Government departments or agencies such as ASIC or AUSTRAC.

4. Our Privacy Policy

As a member of the Commonwealth Bank Group of companies, Financial Wisdom Limited has adopted the principles set out in the Privacy Act 1988 as part of our continuing commitment to client service and the maintenance to client confidentiality. For further details please refer to the Group’s Privacy Policy which can be located online at www.commbank.com.au

Gathering all the right facts should lead to the right financial solution for you!

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Personal details

* Mandatory fields Client 1 Client 2

Title:

Last Name: *

Given Names: *

Preferred Name

Gender: Male / Female Male / Female

Date of Birth: * / / / /

Age:

Marital Status:

Health: Excellent / Good / Average / Poor Excellent / Good / Average / Poor

Smoker: Yes / No / Quit Yes / No / Quit

If Quit, within 12 months Yes / No Yes / No

Australian resident for tax purposes? Yes / No Yes / No

Period as an Australian tax resident

Worked outside of Australia? Yes / No Yes / No

If yes, state when, where and duration

Contact details

* Mandatory fields Client 1 Client 2

Postal Address:

Home Address: *

Home Phone:

Work Phone:

Mobile:

Fax:

E-mail:

Primary contact: Client 1 / Client 2

Tax structures / entities

Name Type

Company / Partnership / Trust / Super Fund / Other

Company / Partnership / Trust / Super Fund / Other

Company / Partnership / Trust / Super Fund / Other

Children / Dependents

Name DOB Age Gender Support to Age

Income or Austudy

Relationship to Client

/ / $

/ / $

/ / $

Are you planning to grow your family? Yes / No

What health issues need to be considered for dependents?

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Financial planning objectives

What would you expect to achieve from our meeting today?

Your Statement of Advice should take into consideration factors that are considered important to you. To assist us in providing you with suitable and appropriate advice, could you please rate the following objectives in their order of importance to you. Please add any other financial objectives not in this list.

Please rate each item in order of their importance to you by placing a circle around the relevant number. The numbers represent:

1. Not important 2. Slightly important 3. Important 4. Very important

* When you have rated the importance of each objective please prioritise your objectives in the 'Priority' column in alphabetical order with "A" being most desirable, "B" second most and so on.

Your objectives are to: Importance Priority*

Generate more income 1 2 3 4

Invest a lump sum amount 1 2 3 4

Invest funds on an ongoing regular basis 1 2 3 4

Implement a savings plan for your child/ren’s education 1 2 3 4

Invest in tax advantaged investments 1 2 3 4

Invest in socially responsible/ethical/sustainable investments 1 2 3 4

Have your existing investment portfolio reviewed 1 2 3 4

Implement a capital growth / wealth creation investment strategy 1 2 3 4

Invest borrowed funds as part of your capital growth / wealth creation investment strategy

1 2 3 4

Make a contribution to super 1 2 3 4

Make a contribution to super in order to qualify for the spouse super contributions tax offset or the Govt co-contribution

1 2 3 4

Rollover an existing superannuation benefit 1 2 3 4

Consolidate your existing superannuation benefits 1 2 3 4

Have your existing super portfolio reviewed 1 2 3 4

Obtain self managed superannuation fund advice 1 2 3 4

Assess if you are on track to meet your retirement income need 1 2 3 4

Create an income stream to meet your retirement income needs 1 2 3 4

Protect your family and / or assets in the event of death 1 2 3 4

Protect your assets and lifestyle in the event of permanent disability 1 2 3 4

Protect against the costs of serious illness or trauma 1 2 3 4

Protect your income earnings against sickness or accident 1 2 3 4

Qualify for, or maximise social security benefits 1 2 3 4

Undertake a debt reduction strategy 1 2 3 4

Other - 1 2 3 4

Other - 1 2 3 4

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Other objectives (please detail)

Your goal and aspirations

Timeframe Goal / aspiration Anticipated cost ($)

Short term goals - immediate to less than 2 years

Medium term goals - 2 to 5 years

Long term goals -greater than 5 years

Other information

Are there any lifestyle goals (non-financial) that you would like me to be aware of? Yes / No

If yes – provide comment

Income requirements - today and future

What is the level of saving you have achieved in the past (per annum)? $ Annually

What level of after tax income (today’s terms) would you like to achieve in retirement (pa)? $ Annually

Retirement planning

Client 1 Client 2

Planned Retirement Age

Eligible Service Date (ETP) / / / /

Do you think that your current rate of savings will provide you with the retirement lifestyle you desire?

Yes / No Yes / No

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Other special interests eg collectibles, golf, tennis

Client 1 Client 2

Adviser notes

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Estate Planning

Client 1 Client 2

Do you have a Will? Yes / No Yes / No

Does it reflect current wishes? Yes / No Yes / No

Date last reviewed: / / / /

Date prepared: / / / /

Will location:

Executor(s):

Type of Power of Attorney: General / Enduring / Other/ None held General / Enduring / Other/ None held

Granted to:

Do you have any specific estate planning requirements / needs?

If yes, provide details:

Yes / No Yes / No

Professional advisers

Company Name Contact Name Phone Number

Accountant:

Solicitor:

Doctor:

Other:

Employment details

Client 1 Client 2

Employer:

Work status: Employed / Self Employed / Other Employed / Self Employed / Other

If Other, what status?

Occupation / Position:

Number of hours worked weekly

Commenced with current employer: / / / /

Centrelink details

Client 1 Client 2

Eligible for Centrelink / DVA? Yes / No Yes / No

Centrelink Reference Number:

Type of benefit(s):

Benefit amount: $ $

Maintenance payment amount: $ $

Maintenance income amount: $ $

Tax free income: $ $

“Gifted” assets in last 5 years? Yes / No Yes / No

If so – Value and when: / / $ / / $

/ / $ / / $

Personal use assets amount: $ $

Fortnightly rent paid: $ $

Claim Family Tax initiative through: Centrelink-DVA / Tax Centrelink-DVA / Tax

Home owner? Yes / No Yes / No

Other support (eg remote area): $ $

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Income details

Income details Client 1 Client 2

Gross employment income / Operating profit (excluding Superannuation) - from primary occupation

$ $

Bonus / Commission $ $

Other taxable income (eg family trust distributions, rents) $ $

Tax free income $ $

Other non-taxable Centrelink / DVA exempt income ( $ ) $ $

Centrelink / DVA (taxable) ( $ ) $ $

Centrelink / DVA (non taxable) ( $ ) $ $

Income from private companies* (unfranked/franked) ( $ ) $ $

Investment (unfranked) ( $ ) $ $

Investment (franked) ( $ ) $ $

Reportable Fringe Benefits $ $

Pensions $ $

Total $ $

Gross Fringe Benefits from primary occupation (eg car, child education expenses, etc) - from primary occupation:

$ $

Tax deductible expenses $ $

Is your salary / wage subject to risk of downward fluctuation? Yes / No Yes / No

Number of weeks that you could maintain your standard of living without income (disregarding any leave entitlements)?

Unused Sick Leave entitlements? (number of days)

Unused Annual Leave entitlements? (number of days)

Unused Long Service Leave entitlements? (number of days)

Are you likely to change your occupation in the future to one with the potential to provide fewer earnings than your current occupation?

Yes / No Yes / No

* How is the business income distributed? eg dividends, salary, superannuation contributions. Specify if franked.

Adviser notes

Please detail here any issues relating to the client’s income.

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Expenditure details

Item Weekly $ Annual $ Item Weekly $ Annual $

Personal Transport

Food Registration / Licensing

Clothing Insurance

Medical Car Loan / Lease

Gas, Water, and Electricity Petrol and Maintenance

Phone, Post, Internet Sub-total

Furnishings General

Alcohol Superannuation (RSP)

Other Life Insurance

Sub-total Trauma / TPD Insurance

Housing Health Insurance

Rates and Taxes Fares / Taxi

Insurances Credit / Store Cards

Repairs and Maintenance Gifts

Rent / Mortgage Other

Other Other

Sub-total Sub-total

Entertainment Tax Deductible Expenditure

Magazines / CD / Books Income Protection Insurance

Gifts Memberships

Restaurants / Outings Professional Texts

Sports / Membership Other

Holidays Sub-total

Other Dependants

Other Education

Sub-total Child Care

Other

Sub-total

TOTAL

Adviser notes

Please detail here any issues relating to the client’s expenditure

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Existing assets

Lifestyle assets

Description Current Value $ Purchase Amount Purchase Date Asset Tested Y/N Centrelink Value $ Owner Security for Loan? Retain?

Family Home $ $ / / Yes / No $ C1/ C2/ Joint Yes / No Yes / No

Contents $ $ / / Yes / No $ C1/ C2/ Joint Yes / No Yes / No

Motor Vehicle 1 $ $ / / Yes / No $ C1/ C2/ Joint Yes / No Yes / No

Motor Vehicle 2 $ $ / / Yes / No $ C1/ C2/ Joint Yes / No Yes / No

Holiday Home $ $ / / Yes / No $ C1/ C2/ Joint Yes / No Yes / No

Boat / Caravan $ $ / / Yes / No $ C1/ C2/ Joint Yes / No Yes / No

Other $ $ / / Yes / No $ C1/ C2/ Joint Yes / No Yes / No

Other $ $ / / Yes / No $ C1/ C2/ Joint Yes / No Yes / No

Cash / Fixed interest

DescriptionCurrentValue

PurchaseAmount

PurchaseDate

Income% or $ pa

MaturityDate

OwnerSecurity for

Loan?Retain? Reinvest Income?

$ $ / / / / C1/ C2/ Joint Yes / No Yes / No Yes / No

$ $ / / / / C1/ C2/ Joint Yes / No Yes / No Yes / No

$ $ / / / / C1/ C2/ Joint Yes / No Yes / No Yes / No

$ $ / / / / C1/ C2/ Joint Yes / No Yes / No Yes / No

$ $ / / / / C1/ C2/ Joint Yes / No Yes / No Yes / No

$ $ / / / / C1/ C2/ Joint Yes / No Yes / No Yes / No

$ $ / / / / C1/ C2/ Joint Yes / No Yes / No Yes / No

Direct property

Description Current Value Purchase Amount Purchase Date Annual Rent Annual Expenses Owner Security for Loan? Retain?

$ $ / / $ $ C1/ C2/ Joint Yes / No Yes / No

$ $ / / $ $ C1/ C2/ Joint Yes / No Yes / No

$ $ / / $ $ C1/ C2/ Joint Yes / No Yes / No

$ $ / / $ $ C1/ C2/ Joint Yes / No Yes / No

$ $ / / $ $ C1/ C2/ Joint Yes / No Yes / No

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Managed funds / Shares

Description Current ValuePurchaseAmount

Purchase Date Income paCurrent

UnitsOwner

Security forLoan?

Retain?Regular

InvestmentReinvestIncome?

$ $ / / $ / % C1 / C2 / J Yes / No Yes / No $ pa Yes / No

$ $ / / $ / % C1 / C2 / J Yes / No Yes / No $ pa Yes / No

$ $ / / $ / % C1 / C2 / J Yes / No Yes / No $ pa Yes / No

$ $ / / $ / % C1 / C2 / J Yes / No Yes / No $ pa Yes / No

$ $ / / $ / % C1 / C2 / J Yes / No Yes / No $ pa Yes / No

$ $ / / $ / % C1 / C2 / J Yes / No Yes / No $ pa Yes / No

$ $ / / $ / % C1 / C2 / J Yes / No Yes / No $ pa Yes / No

$ $ / / $ / % C1 / C2 / J Yes / No Yes / No $ pa Yes / No

$ $ / / $ / % C1 / C2 / J Yes / No Yes / No $ pa Yes / No

Existing liabilities

Type LenderCurrent

DebtInterest

RatePrincipal or

Interest OnlyLoanTerm

MonthlyRepayment

Interest TaxDeductible?

Owner RetainOriginalAmount

OriginalDate ofLoan

Home Mortgage $ % P&I / IO $ Yes / No C1 / C2 / J Yes / No $ / /

Investment Loan $ % P&I / IO $ Yes / No C1 / C2 / J Yes / No $ / /

Personal Loan $ % P&I / IO $ Yes / No C1 / C2 / J Yes / No $ / /

Credit Cards $ % P&I / IO $ Yes / No C1 / C2 / J Yes / No $ / /

Lease / HP $ % P&I / IO $ Yes / No C1 / C2 / J Yes / No $ / /

Reverse Mortgage $ % P&I / IO $ Yes / No C1 / C2 / J Yes / No $ / /

Line of Credit / Home Equity Loan $ % P&I / IO $ Yes / No C1 / C2 / J Yes / No $ / /

Margin Loan $ % P&I / IO $ Yes / No C1 / C2 / J Yes / No $ / /

Other $ % P&I / IO $ Yes / No C1 / C2 / J Yes / No $ / /

Do you expect any changes in your future assets and liabilities? Yes / No

If yes – provide comment

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Superannuation benefits- Client 1 (complete in full or attach copy of latest statement)

Fund 1 Fund 2 Fund 3 Fund 4

Product name / Provider:

Type (eg industry / retail / wholesale)

Investment option(s):

Eligible for choice of fund? Yes / No Yes / No Yes / No Yes / No

Entry fee paid: $ / % $ / % $ / % $ / %

Management costs pa $ / % $ / % $ / % $ / %

Exit fee: $ / % $ / % $ / % $ / %

Non-super benefits only applicable to members (eg discounted home loans, credit cards, bank accounts, memberships)

Insurance cover held? Yes / No Yes / No Yes / No Yes / No

Asset to be retained? Yes / No Yes / No Yes / No Yes / No

Binding nomination made? Yes / No Yes / No Yes / No Yes / No

Year nomination made

Fund type: Accumulation /

Defined benefit

Accumulation /

Defined benefit

Accumulation /

Defined benefit

Accumulation /

Defined benefit

Member number:

Date of commencement: / / / / / / / /

Current value: $ $ $ $

Concessional contributions pa: $ $ $ $

Concessional contributions cap applicable:

$50,000 / $100,000 $50,000 / $100,000 $50,000 / $100,000 $50,000 / $100,000

Amount of concessional contributions made in the last 12 months:

$ $ $ $

Available amount of cap remaining this year:

$ $ $ $

Non-concessional contributions pa: $ $ $ $

Amount of non-concessional contributions made over the last 3 years:

$ $ $ $

Available amount of non-concessional threshold remaining:

$ $ $ $

Eligible service period: / / / / / / / /

Superannuation Components:

Total taxable components: $ $ $ $

Total tax-free components: $ $ $ $

Preserved amount: $ $ $ $

Restricted non-preserved: $ $ $ $

Unrestricted non-preserved: $ $ $ $

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Superannuation benefits- Client 1 (complete in full or attach copy of latest statement)

Fund 1 Fund 2 Fund 3 Fund 4

Product name / Provider:

Type (eg industry / retail / wholesale)

Investment option(s):

Eligible for choice of fund? Yes / No Yes / No Yes / No Yes / No

Entry fee paid: $ / % $ / % $ / % $ / %

Management costs pa $ / % $ / % $ / % $ / %

Exit fee: $ / % $ / % $ / % $ / %

Non-super benefits only applicable to members (eg discounted home loans, credit cards, bank accounts, memberships)

Insurance cover held? Yes / No Yes / No Yes / No Yes / No

Asset to be retained? Yes / No Yes / No Yes / No Yes / No

Binding nomination made? Yes / No Yes / No Yes / No Yes / No

Year nomination made

Fund type: Accumulation /

Defined benefit

Accumulation /

Defined benefit

Accumulation /

Defined benefit

Accumulation /

Defined benefit

Member number:

Date of commencement: / / / / / / / /

Current value: $ $ $ $

Concessional contributions pa: $ $ $ $

Concessional contributions cap applicable:

$50,000 / $100,000 $50,000 / $100,000 $50,000 / $100,000 $50,000 / $100,000

Amount of concessional contributions made in the last 12 months:

$ $ $ $

Available amount of cap remaining this year:

$ $ $ $

Non-concessional contributions pa: $ $ $ $

Amount of non-concessional contributions made over the last 3 years:

$ $ $ $

Available amount of non-concessional threshold remaining:

$ $ $ $

Eligible service period: / / / / / / / /

Superannuation Components:

Total taxable components: $ $ $ $

Total tax-free components: $ $ $ $

Preserved amount: $ $ $ $

Restricted non-preserved: $ $ $ $

Unrestricted non-preserved: $ $ $ $

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Superannuation benefits- Client 2 (complete in full or attach copy of latest statement)

Fund 1 Fund 2 Fund 3 Fund 4

Product name / Provider:

Type (eg industry / retail / wholesale)

Investment option(s):

Eligible for choice of fund? Yes / No Yes / No Yes / No Yes / No

Entry fee paid: $ / % $ / % $ / % $ / %

Management costs pa $ / % $ / % $ / % $ / %

Exit fee: $ / % $ / % $ / % $ / %

Non-super benefits only applicable to members (eg discounted home loans, credit cards, bank accounts, memberships)

Insurance cover held? Yes / No Yes / No Yes / No Yes / No

Asset to be retained? Yes / No Yes / No Yes / No Yes / No

Binding nomination made? Yes / No Yes / No Yes / No Yes / No

Year nomination made:

Fund type: Accumulation /

Defined benefit

Accumulation /

Defined benefit

Accumulation /

Defined benefit

Accumulation /

Defined benefit

Member number:

Date of commencement: / / / / / / / /

Current value: $ $ $ $

Concessional contributions pa: $ $ $ $

Concessional contributions cap applicable:

$50,000 / $100,000 $50,000 / $100,000 $50,000 / $100,000 $50,000 / $100,000

Amount of concessional contributions made in the last 12 months:

$ $ $ $

Available amount of cap remaining this year:

$ $ $ $

Non-concessional contributions pa: $ $ $ $

Amount of non-concessional contributions made over the last 3 years:

$ $ $ $

Available amount of non-concessional threshold remaining:

$ $ $ $

Eligible service period: / / / / / / / /

Superannuation Components:

Total taxable components: $ $ $ $

Total tax-free components: $ $ $ $

Preserved amount: $ $ $ $

Restricted non-preserved: $ $ $ $

Unrestricted non-preserved: $ $ $ $

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Immediate and Allocated Annuities, Super and Allocated Pensions and Account Based Pensions (Income streams which commenced after 1/7/07). Complete in full or attach copy of latest statement

Fund 1 Fund 2 Fund 3 Fund 4

Annuity and Pensions

Product name / Provider:

Owner:

Type:

Asset to be retained? Yes / No Yes / No Yes / No Yes / No

Date of purchase: / / / / / / / /

Original investment: $ $ $ $

Current value: $ $ $ $

Current units:

Income pa: $ $ $ $

Payment frequency:

Minimum required payment: $ / % $ / % $ / % $ / %

Entry fee paid: $ / % $ / % $ / % $ / %

Management costs pa: $ / % $ / % $ / % $ / %

Exit fee: $ / % $ / % $ / % $ / %

Term / maturity date: / / / / / / / /

Tax free amount: $ $ $ $

Centrelink / DVA Deductible amount:

$ $ $ $

Residual capital value $ or %

Reversionary beneficiary:

Investor number:

Offset %: % % % %

Eligible service period: / / / / / / / /

Investment Option(s):

Components:

Taxable: $ $ $ $

Tax-free: $ $ $ $

Additional information for Immediate and Allocated Annuities, Superannuation and Allocated Pensions commenced prior to 1/7/07 which are being rolled over

Unused undeducted purchase price

Pre 1 July 1983

Is it a pre-94 pension? Yes / No Yes / No Yes / No Yes / No

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Employment termination payments if leaving employment

Client 1 Client 2

Is this a transitional termination payment? (ie employment contract in place @ 10/5/06) Yes / No Yes / No

Client 1 Client 2 Client 1 Client 2

Company Payment: Superannuation Payments:

Lump Sum

Unused Long Service Leave (net/gross)

$ $ Total taxable component $ $

Unused Annual Leave (net/gross)

$ $ Total tax-free component $ $

Redundancy / Early Retirement – Tax Free

$ $

Redundancy / Early Retirement – ETP

$ $ TOTAL $ $

Ex gratia / Golden Handshake $ $ Preserved amount $ $

Other $ $ Superannuation Pension (pa)

$ $

TOTAL $ $ Payment Date $ $

Adviser notes

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Insurance

General insurance

Do you already have this type of insurance in place? (if yes please provide details below) Yes / No

Do you wish to review this? Yes / No

Do you understand the importance of protecting your assets? Yes / No

Do you wish me to proceed with an insurance protection recommendation? Yes / No

Policy 1 Policy 2 Policy 3 Policy 4

Policy owner:

Company:

Policy number:

Policy type:

Policy status:

Renewal date: / / / / / / / /

Commencement date: / / / / / / / /

Sum insured: $ $ $ $

Market value: $ $ $ $

Replacement value: $ $ $ $

Annual premium: $ $ $ $

Payment frequency:

Indexed to CPI? Yes / No Yes / No Yes / No Yes / No

Retain Policy? Yes / No Yes / No Yes / No Yes / No

Health insurance

Client 1 Client 2

Do you have health insurance? Yes / No Yes / No

Insurer:

Type of cover:

Level of cover:

Premium: $ $

Start date of cover:

Retain policy?

Claiming offset against premiums? Yes / No Yes / No

Adviser notes

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Life / Trauma / TPD / Whole of Life / Endowment Insurance

Do you already have this type of insurance in place? (if yes please provide details below) Yes / No

Do you wish to review this? Yes / No

Do you understand the importance of protecting your assets? Yes / No

Do you wish me to proceed with an insurance protection recommendation? Yes / No

Policy 1 Policy 2 Policy 3 Policy 4

Policy owner:

Life insured:

Insurance company:

Policy number:

Policy type:

Terminal withdrawal value: $ $ $ $

Date commenced: / / / / / / / /

Renewal date: / / / / / / / /

Level of cover: $ $ $ $

Level of TPD: (Trauma policies only)

$ $ $ $

Level of Trauma: (Trauma policies only)

$ $ $ $

Add Death cover: $ $ $ $

Premium: $ $ $ $

Payment frequency:

Payment type: Level / Stepped Level / Stepped Level / Stepped Level / Stepped

Indexed to CPI? Yes / No Yes / No Yes / No Yes / No

Policy status:

Superannuation policy? Yes / No Yes / No Yes / No Yes / No

Continuation option? Yes / No Yes / No Yes / No Yes / No

Retain policy? Yes / No Yes / No Yes / No Yes / No

Exclusions / Loadings

Adviser notes

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Income Protection and Business Insurance

Do you already have this type of insurance in place? (if yes please provide details below) Yes / No

Do you wish to review this? Yes / No

Do you understand the importance of protecting your income? Yes / No

Do you wish me to proceed with an insurance protection recommendation? Yes / No

Policy 1 Policy 2 Policy 3 Policy 4

Policy owner:

Life insured:

Insurance company:

Policy number:

Policy name:

Policy type ie Standard / Plus:

Date commenced: / / / / / / / /

Policy status:

Renewal date: / / / / / / / /

Monthly benefit: $ $ $ $

Indexed to CPI? Yes / No Yes / No Yes / No Yes / No

Annual premium: $ $ $ $

Payment frequency:

Payment type: Level / Stepped Level / Stepped Level / Stepped Level / Stepped

Benefit period

Waiting period

Indemnity / Agreed value

Superannuation policy? Yes / No Yes / No Yes / No Yes / No

Continuation option? Yes / No Yes / No Yes / No Yes / No

Retain policy? Yes / No Yes / No Yes / No Yes / No

Exclusions / Loadings

Adviser notes

For example: is the client aware of any reason or impediment to them obtaining life or disability cover from an insurer, or have they had an application for personal insurance cover rejected by an insurer?

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Risk Profile Questionnaire

The following questions are designed to determine your risk profile taking into account your financial needs, circumstances and

objectives. This is an important process in assisting to identify an appropriate investment strategy and make recommendations thatsuit your specific requirements.

How to complete this section:

Please read each question carefully and write down the number that matches your preferred response in one of the boxes at the end

of each question. When you have answered all the questions please add up your score/s in the Final Score box on the next pageand then write in your Risk Profile.

The box at the end of each question you are to complete depends on your circumstances and the advice you are seeking. Pleasenote the following:

• Score Client 1 box only if you are an individual seeking advice.• Score Client 1 and Client 2 boxes if you are a couple and you have separate funds to invest and have different risk profile

views.

• Score Joint box if you are a couple and investing jointly.

Question 1 (Your liquidity requirements, ie having access to your funds)

Apart from short term and anticipated liquidity needs, how long do you envisage before requiring access to most ofyour funds?

1. 1 year or less.

2. 2 to less than 3 years.

3. 3 to less than 5 years.

4. 5 years plus.

Score Client 1: Client 2: Joint:

Question 2 (Your investment experience)

How familiar are you with investment markets?

1. No experience at all.

2. Not familiar but am willing to consider investment alternatives.

3. I understand that the markets fluctuate and different market sectors have different income, growth and taxation characteristics. Irecognise the importance of diversification.

4. Experienced with all investment sectors and understand the various factors which may influence performance.

Score Client 1: Client 2: Joint:

Question 3 (Your attitude to risk)

Which of the following best describes your attitude to the volatility of returns?

1. I prefer lower capital growth in order to avoid volatile returns.

2. I aim to achieve steady capital growth and will accept some volatility of returns.

3. I am prepared to take on higher volatility for the opportunity of greater returns.

4. I am interested in aggressive growth strategies, including borrowing for investment purposes, and understand the possibility ofnegative returns.

Score Client 1: Client 2: Joint:

Question 4 (Your investment objectives)

What do you want your investments to achieve?

1. Security of capital with minimal opportunity for capital growth.

2. Generate an income stream with less emphasis on growth.

3. Achieve steady capital growth with less emphasis on income.

4. High capital growth and minimal income.

Score Client 1: Client 2: Joint:

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Question 5 (Your concerns about inflation)

How concerned are you that the value of your capital and the purchasing power of your investment income should keep pace with or exceed the rate of inflation?

1. Not concerned.

2. Slightly concerned.

3. Moderately concerned.

4. Highly concerned.

5. Extremely concerned.

Score Client 1: Client 2: Joint:

Question 6 (Your concerns about taxation)

Are you prepared to invest in tax-advantaged investments that may fluctuate in value, in order to minimise your income tax?

1. No - I do not want to purchase any investments that may lead to capital fluctuations.

2. Maybe - I would prefer stable, reliable capital value and returns with some tax savings, if possible.

3. Yes - I can accept some fluctuation in capital value from time to time in exchange for some tax advantages.

4. Definitely - my main objective is to minimise income tax and I am prepared to accept capital fluctuation to achieve this.

Score Client 1: Client 2: Joint:

Question 7 (Your investment preference)

Which one of the following best describes your attitude to choosing an investment?

2. I prefer investments that do not have any capital fluctuation associated with them.

4. I prefer to diversify with a mix of investments, which have an emphasis on low capital fluctuation. I can accept having a small proportion of the portfolio invested in assets which have a higher degree of short term fluctuations in order to potentially achieve a slightly higher return over the longer term. I understand that these types of investments can produce a negative return in atleast 1 year in every 8 years.

6. I prefer to have a spread of investments in a balanced portfolio. I understand that this type of portfolio can produce a negative investment return in at least 1 year in every 6 years.

8. I prefer to diversify my investments with an emphasis on more investments, which have potentially higher returns, but still having a small amount of stable investments. I understand that these types of investments can produce a negative return in at least 1 year in every 5 years.

10. I prefer to select investments that have a higher degree of capital fluctuation so that I can earn higher returns over the long term. I understand that this higher volatility means that a negative return can occur in at least 1 year in every 4 years.

Score Client 1: Client 2: Joint:

Final Score Client 1: Client 2: Joint:

Add up the score for each question and write it into the appropriate box

Risk Profile Client 1: Client 2: Joint:

Refer to next page and write the Risk Profile into the appropriate box that matches your final score

Adviser notes

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Client risk profiles

Defensive (8 to 11)

Your investment style would suggest that you do not wish to take any investment risk. Your main priority isthe safeguarding of your investment capital, and you are prepared to sacrifice higher returns for peace of mind. Generally, the most appropriate strategy for someone with a Defensive approach to investing is to invest 90% in income and 10% in growth assets. With your investment style it is important that you understand the likelihood of and are prepared to accept negative returns approximately 1 year in every 20 years. A defensive approach is also appropriate when the term of the investment is between 1 to 2 years.

Conservative (12 to 17)

Your investment style would suggest that you are prepared to accept a small amount of risk; however, your priority remains the preservation of your capital over the medium to long term. Generally, the most appropriate strategy for someone with a Conservative approach to investing is to invest 70% in income and 30% in growth assets. With your investment style it is important that you understand the likelihood of and are prepared to accept negative returns approximately 1 year in every 8 years. A conservative approach is also appropriate when the term of the investment is between 2 to 3 years.

Moderate (18 to 25)

Your investment style would suggest that you have some understanding of the investment markets and their behavior, and are prepared to take short term risk in order to gain longer term capital growth. Generally, the most appropriate strategy for someone with a Moderate approach to investing is to invest 40% in income and 60% in growth assets. With your investment style it is important that you understand the likelihood of and are prepared to accept negative returns approximately 1 year in every 6 years. A moderate approach is also used when the term of the investment is between 3 to 4 years.

Growth (26 to 31)

Your investment style would suggest that you are seeking a greater growth component in your investment portfolio, and although you remain cautious towards taking extreme levels of risk, your general understanding of the investment market enables you to feel comfortable with short term risk. Your priority is consistent capital growth with some income to smooth volatility in your returns. Generally, the most appropriate strategy for someone with a Growth approach to investing is to invest 20% in income and 80% in growth assets. With your investment style it is important that you understand the likelihood of and are prepared to accept negative returns approximately 1 year in every 5 years. A growth approach is also used when the term of the investment is between 4 to 5 years.

Aggressive (32 to 35)

Your investment style would suggest that you are most interested in maximising the value of your investments through long term capital growth, although you do not wish to make unbalanced investment decisions. You are prepared to sacrifice short-term safety in order to maximise long term capital growth. Generally, the most appropriate strategy for someone with an Aggressive approach to investing is to invest 100% in growth assets. With your investment style it is important that you understand the likelihood of and are prepared to accept negative returns approximately 1 year in every 4 years. An aggressive approach is also used when the term of the investment is between 5 to 7 years.

High Alpha (32 to 35)

A sub class of the Aggressive investment style is “High Alpha”. The High Alpha investment strategy may be appropriate for someone with an Aggressive approach to investing. While the High Alpha investment strategy is also to invest 100% in growth assets, the investment portfolio typically has a higher exposure toAustralian Shares than an Aggressive investment strategy. The High Alpha investment strategy is more volatile than an Aggressive style of investment portfolio. It is important that you understand that a High Alpha style portfolio is likely to have a negative return approximately 1 year in every 3 years, and is appropriate for a term of investment of more than 7 years.

Adviser notes

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Asset classes

The asset allocation for each risk profile is as follows:

Strategic asset allocation

Asset class Defensive(90/10)

Conservative(70/30)

Moderate(40/60)

Growth(20/80)

Aggressive(0/100)

High Alpha(0/100)

Income

Cash 30% 30% 5% 5% 0% 0%

Fixed Interest 60% 40% 35% 15% 0% 0%Growth

Australian Shares 5% 15% 30% 40% 50% 55%

International Shares 3% 10% 20% 25% 40% 40%Income and Growth

Property/Infrastructure 2% 5% 10% 15% 10% 5%Total 100% 100% 100% 100% 100% 100%

Reconciling a client's needs and objectives with their financial knowledge and investment experience is a fundamental aspect ofgood financial planning. An assessment of a client's tolerance to investment risk is a key aspect of portfolio construction and iscritical to determining appropriate asset allocation, recommended investment classes and expected returns.

Each investment risk profile is supported by flexible asset allocation guidelines designed to match a client's experience and theirtolerance of investment risk with their expectations for investment returns. Given that client circumstances differ, and that portfoliovalues vary over time, an acceptable portfolio recommendation must remain within 5 points of the published benchmark for eachasset class. For example, if the target asset allocation for Australian shares is 30%, the recommended allocation should be between25% and 35%. In addition, any recommended portfolio must also remain within 5 points of the strategic asset allocationbenchmark (ie the growth: income ratio).

Minor variations will occur from time to time and, if appropriately managed, will generally have an immaterial effect on the long termperformance of an investment portfolio. Significant variations from these benchmarks may also occur for a variety of reasonsbut any significant variations will be addressed by the adviser in the Statement of Advice or other documentation.

Risk profile

Spectrum of Return / Risk (For illustrative purposes)

If your adviser identifies that you appear to be unable to reach your stated Financial Goals because they conflictwith your Risk Tolerance, do you want to make “Reaching your Financial Planning Objectives” the priority?

Yes / No

If yes, provide details:

Return

5

32 to 35points

4

26 to 31points

3

18 to 25points

2

11 to 17points

1

8 to 11points

HigherReturn

MediumReturn

LowerReturn

Aggressive

Growth

Moderate

Conservative

Defensive

Risk

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Asset Class Annual Returns - 20 years to 31 December 2007 The best and worst performing asset classes each year have been bolded.

Year Cash Australian Fixed

Interest

Australian Property

Securities

Australian Shares

InternationalShares

Moderate Fund*

Consumer Price Index

1988 12.88% 9.39% 16.06% 17.88% 4.68% 11.84% 7.60%

1989 18.43% 14.89% 2.35% 17.40% 26.77% 16.94% 7.83%

1990 16.13% 19.01% 8.70% -17.52% -14.59% 0.16% 6.85%

1991 11.20% 24.75% 20.08% 34.24% 20.63% 25.63% 1.51%

1992 6.92% 10.41% 3.21% -2.31% 5.22% 4.66% 0.28%

1993 5.39% 16.32% 30.73% 45.36% 24.82% 27.63% 1.95%

1994 5.36% -4.66% -7.09% -8.67% -7.62% -6.20% 2.55%

1995 8.03% 18.63% 14.28% 20.19% 26.66% 19.74% 5.05%

1996 7.57% 11.87% 14.24% 14.60% 6.71% 11.68% 1.52%

1997 5.63% 12.23% 21.91% 12.23% 42.19% 18.86% -0.25%

1998 5.14% 9.54% 18.44% 11.63% 32.82% 15.49% 1.58%

1999 5.01% -1.22% -4.68% 16.10% 17.57% 7.70% 1.80%

2000 6.27% 12.08% 19.71% 4.80% 2.49% 8.45% 5.80%

2001 5.24% 5.45% 14.60% 10.49% -9.65% 4.85% 3.12%

2002 4.77% 8.81% 11.76% -8.64% -27.13% -3.52% 3.03%

2003 4.90% 3.05% 8.80% 14.96% -0.29% 6.62% 2.37%

2004 5.62% 6.96% 32.01% 27.92% 10.43% 16.38% 2.59%

2005 5.73% 5.79% 12.50% 22.45% 17.39% 13.78% 2.80%

2006 6.04% 3.16% 34.03% 24.51% 12.02% 14.57% 3.25%

2007 6.73% 3.46% -8.41% 16.21% -2.14% 5.14% 2.96%

Annualised return

7.58% 9.27% 12.54% 12.72% 8.11% 10.68% 3.19%

Growth^ $43,152 $58,925 $106,214 $109,733 $47,587 $76,047 $18,725

*ASSET ALLOCATION: Cash 5%; FI 35%; Prop 10%; Au Eq 30%; Int Eq 20% ^ Value as at 31 Dec 2007 of $10,000 invested on 1 Jan 1988

ASSET CLASS BENCHMARKS:

Cash: UBS Bank 0+ Years

Australian Fixed Interest: UBS Composite 0+ Years

Australian Property Securities: S&P / ASX 200 Property Trusts Accum Index

Australian Shares: S&P / ASX 300 Accumulation Index

Global Shares: MSCI World Ex Aust Acc Ind Gross Div A$

Indices used are consistent with common market practice and where possible we have chosen an index that runs for thefull period December 1987 to present.

With regards to the Australian shares and property the leading indices in each of these sectors changed in 2000 from ASX to ASX / S&P. This change is reflected in the performance for the year 2000 and onwards.

The indices for cash and fixed interest funds changed in 1988 and 1989 respectively as the UBS indices do not cover theperiod 1980 to the respective date.

The MSCI World A$ Net index was chosen above other MSCI indices as this index is available for the entire period required.

The Moderate portfolio is a weighted annual return of Cash (5%), Fixed Interest (35%), Property Securities (10%), InternationalShares (20%) and Australian Shares (30%). Annualised returns over the period 1/1/1988 to 31/12/2007 were generated from the yearly returns above, including the annualised return for the Moderate portfolio. Past performance is no guarantee of future returns.

Adviser notes

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Scope of advice

Has full advice been requested by the client? Yes / No

If the client has requested that advice be restricted to specific personal securities / insurance recommendations, or a defined range of products, specify the limitations requested below:

Did the client refuse to supply any personal information, or supplied only limited personal information? Yes / No

If YES, the following warning must be provided to the client, and confirmed in the written recommendation.

“As you have declined to provide full personal information, I have not been able to fully assess your financial needs, circumstances and objectives in making my recommendation. As a result, the recommendation may not be appropriate to your particular financialsituation. Therefore, you should carefully assess how appropriate the recommendation is in light of your financial situation.”

Adviser and client declarations

Client Declaration

I / We:

• Acknowledge that all the information provided to my / our adviser in this document is true, current and correct.

• Acknowledge having received a copy of the Financial Services Guide.

• Confirm that my / our adviser has explained that a detailed breakdown of all fees and / or Fee for Service related with the placement of my investments will be included in the Statement of Advice prepared for me / us.

• Have read and understood the statements about my / our privacy. I / We consent to the uses described and the disclosures set out on page 2 of this document.

• Wish to proceed with the preparation and presentation of a Statement of Advice based on the above, at a fee of $ payable to Financial Wisdom Limited. I / We understand that this fee is non-refundable.

• Acknowledge that any fees to be incurred for establishment and ongoing service in relation to regular reviews of my / our portfolio will be agreed to after I / we have signed the 'Your agreement to proceed' section within the Statement of Advice.

/ / / /

Client 1 signature Date Client 2 signature Date

Adviser Declaration

I declare that:

• The information contained in this financial analysis is an accurate and complete record of the information provided by the client(s).

• The client(s) was / were given a copy of the Financial Services Guide before any investment advisory service was provided.

• The preparation of your Statement of Advice will be based on the above information and any other documented correspondence entered into.

/ /

Adviser's signature Date

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Insurance analysis (to be completed by your Adviser)

Death Client 1 $ Client 2 $

Lump sum needs

Clear debts

Funeral costs

Emergency funds (3 to 4 months of normal income)

Capital needs

Miscellaneous costs and expenses

Sub Total = A

Gross income needs Client 1 $ Client 2 $ Client 1 $ Client 2 $

Annual income amount required

1Lump sum amount calculated.

2

Income required 3

Child care / education

Other income 1

Other income 2

Other income 3

Other income 4

Sub Total = B

Existing provisions Client 1 $ Client 2 $

Financial assets (eg shares, managed funds, superannuation, business assets)

Lifestyle assets

Existing level of insurance cover

Sub Total = C

Summary Client 1 $ Client 2 $

A Lump sum needs

B Gross income needs

D Cover required before Existing provisions

= ( A + B )

C Less Existing provisions

E Cover required to be purchased

= ( D – C )

Year Lump sum

factor

1 1.000

2 1.963

3 2.889

4 3.781

5 4.640

6 5.466

7 6.262

8 7.028

9 7.765

10 8.475

11 9.158

12 9.816

13 10.449

14 11.058

15 11.645

16 12.210

17 12.753

18 13.276

19 13.780

20 14.265

21 14.732

22 15.181

23 15.613

24 16.030

25 16.430

26 16.816

27 17.188

28 17.545

29 17.889

30 18.220

31 18.539

32 18.846

33 19.142

34 19.426

35 19.700

36 19.963

37 20.217

38 20.461

39 20.696

40 20.923

41 21.141

42 21.350

43 21.552

44 21.746

45 21.934

46 22.114

47 22.287

48 22.454

49 22.614

50 22.769

Notes:

1. The annual income amount required to meet each of these identified expenses in the event of TPD of Client 1 or Client 2.

2. The purpose of this section is to determine the amount of capital required to fund these specific future income needs. Separate calculations may be required for Client 1 and Client 2 depending on the amount and timeframe required.

3. This figure represents the ongoing cost of living that will need to be provided to the surviving partner.

To calculate the capital amount required to fund each of the income needs, you need to multiply the gross annual income amount by the factor corresponding to the number of years the income is required (refer to table on this page).

Eg: education costs of $10,000 for 10 years would require a capital value of $84,750 (ie 10,000 x 8.475)

Assumption: earning rate = 7%

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Insurance analysis (to be completed by your Adviser)

TPD Client 1 $ Client 2 $

Lump sum needs

Clear debts

Emergency funds (3 to 4 months of normal income)

Capital needs Miscellaneous costs and expenses

Sub Total = A

Gross income needs Client 1 $ Client 2 $ Client 1 $ Client 2 $

Annual income amount required

1Lump sum amount calculated.

2

Income required 3

Child care / education

Other income 1

Other income 2

Other income 3

Other income 4

Sub Total = B

Existing provisions Client 1 $ Client 2 $

Financial assets (eg shares, managed funds, business assets)

Lifestyle assets

Existing level of insurance cover

Other assets

Sub Total = C

Summary Client 1 $ Client 2 $

A Lump sum needs

B Gross income needs

D Cover required before Existing provisions

= ( A + B )

C Less Existing provisions

E Cover required to be purchased

= ( D – C )

Year Lump sum

factor

1 1.000

2 1.963

3 2.889

4 3.781

5 4.640

6 5.466

7 6.262

8 7.028

9 7.765

10 8.475

11 9.158

12 9.816

13 10.449

14 11.058

15 11.645

16 12.210

17 12.753

18 13.276

19 13.780

20 14.265

21 14.732

22 15.181

23 15.613

24 16.030

25 16.430

26 16.816

27 17.188

28 17.545

29 17.889

30 18.220

31 18.539

32 18.846

33 19.142

34 19.426

35 19.700

36 19.963

37 20.217

38 20.461

39 20.696

40 20.923

41 21.141

42 21.350

43 21.552

44 21.746

45 21.934

46 22.114

47 22.287

48 22.454

49 22.614

50 22.769

Notes:

1. The annual income amount required to meet each of these identified expenses in the event of TPD of Client 1 or Client 2.

2. The purpose of this section is to determine the amount of capital required to fund these specific future income needs. Separate calculations may be required for Client 1 and Client 2 depending on the amount and timeframe required.

3. This figure represents the ongoing cost of living that will need to be provided to the surviving partner.

To calculate the capital amount required to fund each of the income needs, you need to multiply the gross annual income amount by the factor corresponding to the number of years the income is required (refer to table on this page).

Eg: education costs of $10,000 for 10 years would require a capital value of $84,750 (ie 10,000 x 8.475)

Assumption: earning rate = 7%

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Insurance analysis (to be completed by your Adviser)

Trauma Client 1 $ Client 2 $

Lump sum needs

Clear debts

Emergency funds (3 to 4 months of normal income)

Capital needs Miscellaneous costs and expenses

Sub Total = A

Gross income needs Client 1 $ Client 2 $ Client 1 $ Client 2 $

Annual income amount required

1Lump sum amount calculated.

2

Income required 3

Child care / education

Other income 1

Other income 2

Other income 3

Other income 4

Sub Total = B

Existing provisions Client 1 $ Client 2 $

Financial assets (eg shares, managed funds, business assets)

Lifestyle assets

Existing level of insurance cover

Other assets

Sub Total = C

Summary Client 1 $ Client 2 $

A Lump sum needs

B Gross income needs

D Cover required before Existing provisions

= ( A + B )

C Less Existing provisions

E Cover required to be purchased

= ( D – C )

Year Lump sum

factor

1 1.000

2 1.963

3 2.889

4 3.781

5 4.640

6 5.466

7 6.262

8 7.028

9 7.765

10 8.475

11 9.158

12 9.816

13 10.449

14 11.058

15 11.645

16 12.210

17 12.753

18 13.276

19 13.780

20 14.265

21 14.732

22 15.181

23 15.613

24 16.030

25 16.430

26 16.816

27 17.188

28 17.545

29 17.889

30 18.220

31 18.539

32 18.846

33 19.142

34 19.426

35 19.700

36 19.963

37 20.217

38 20.461

39 20.696

40 20.923

41 21.141

42 21.350

43 21.552

44 21.746

45 21.934

46 22.114

47 22.287

48 22.454

49 22.614

50 22.769

Notes:

1. The annual income amount required to meet each of these identified expenses in the event of TPD of Client 1 or Client 2.

2. The purpose of this section is to determine the amount of capital required to fund these specific future income needs. Separate calculations may be required for Client 1 and Client 2 depending on the amount and timeframe required.

3. This figure represents the ongoing cost of living that will need to be provided to the surviving partner.

To calculate the capital amount required to fund each of the income needs, you need to multiply the gross annual income amount by the factor corresponding to the number of years the income is required (refer to table on this page).

Eg: education costs of $10,000 for 10 years would require a capital value of $84,750 (ie 10,000 x 8.475)

Assumption: earning rate = 7%

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Insurance analysis (to be completed by your Adviser)

Income Protection Client 1 $ Client 2 $

AAnnual income from main occupation (less all business expenses if applicable and super, but before tax)

B Maximum allowable annual benefit = A * 0.75

C Super continuance amount (per annum)

D Proposed cover (per month) = ( B + C ) / 12

E Existing cover (monthly benefit)

F Recommended monthly benefit = D - E

Business expense insurance cover

Business expenses insurance cover required (per annum)

Refer to worksheet below if required to calculate business expenses$

Estimated Client 1 share of business overheads expenses %

Estimated Client 2 share of business overheads expenses %

Estimated Other share of business overheads expenses %

Item Annual $ Item Annual $

Rent and Lease Costs Taxes and Interest

Premises Rent / Lease Payments Property Rates and Taxes

Lease Costs of Equipment and Vehicles Mortgage Interest Payments

Sub Total Sub Total

Insurance Fees

Business Insurance Premiums Accounting / Audit Fees

General Insurance Premiums Professional Fees

Work Cover Insurance Premiums Subscriptions

Sub Total Sub Total

Utilities Maintenance and Depreciation

Telephone Cleaning

Electricity Depreciation of Equipment

Gas Sub Total

Water

Heating

Sub Total

Non-Income Producing Staff Other

Salaries Other Expenses

Superannuation Contributions Sub Total

Sub Total

TOTAL I $

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Adviser use only

Referral source Contact name Phone number Benefit payable to

referrer $ / %

Fund Manager Existing client Advertising Where did the client hear about the Licensee / Adviser?

Seminar Direct Mail Other

Strategy considerations

Topic Notes

Liquidity requirements

Income requirements

Time horizon

Diversification

Capital Growth

Superannuation

Retirement Incomes

Centrelink / DVA

Taxation

Insurance

Other strategies

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Identification form for individual and sole traders

GUIDE TO COMPLETING THIS FORM

o Complete all applicable sections of this form in BLOCK LETTERS. Provision of this information is required by law. The individual’s identity must be verified before the product / service can be provided.

o Complete one form for each individual.

o Contact Professional Standards if the individual is unable to provide either the Primary or SecondaryID documents.

SECTION 1: PERSONAL DETAILS

Surname Date of Birth dd/mm/yyyy

Full Given Name(s)

Residential Address (PO Box is not acceptable)

Street

Suburb State Postcode Country

COMPLETE THIS PART IF INDIVIDUAL IS A SOLE TRADER

Full Business Name (if any) ABN (if any)

Principal Place of Business (if any) (PO Box is not acceptable)

Street

Suburb State Postcode Country

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SECTION 2: IDENTIFICATION PROCEDURE

o Verify the individual’s full name; and EITHER their date of birth or residential address.

o Complete EITHER Part A or Part B. (Note: Part B should only be completed if the individual does not own adocument from Part A.)

PART A – ACCEPTABLE PRIMARY ID DOCUMENTS

Tick

Select ONE valid option from this section only

Australian State / Territory driver’s licence containing a photograph of the person

Australian passport (a passport that has expired within the preceding 2 years is acceptable)

Card issued under a State or Territory for the purpose of proving a person’s age containing a photograph of the person

Foreign passport or similar travel document containing a photograph and the signature of the person *

PART B – ACCEPTABLE SECONDARY ID DOCUMENTS

Tick

Select ONE valid option from this section

Australian birth certificate

Australian citizenship certificate

Pension card issued by Centrelink

Health card issued by Centrelink

National identity card issued by a foreign government containing a photograph of the person in whose name the card wasissued *

Tick

AND ONE valid option from this section

A document issued by the Commonwealth or a State or Territory within the preceding 12 months that records the provisionof financial benefits and contains the individuals name and residential address

A document issued by the Australian Taxation Office within the preceding 12 months which contains the individuals nameand residential address

A document issued by a local government body or utilities provider within the preceding 3 months which records theprovision of services to that address or to that person (the document must contain the individuals name and residentialaddress)

Foreign driver's licence that contains a photograph of the person in whose name it issued and the individuals date of birth *

If under the age of 18, a notice that:

o was issued to the customer by a school principal within the preceding 3 months; and

o contains the customers name and residential address; and

o records the period of time that the customer attended at that school

* Documents that are written in a language that is not English, must be accompanied by an English translation prepared by an

accredited translator.

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ID RECORD Document 1 Document 2

Verified From Original Certified Copy Original Certified Copy

Copy of ID Document (copy must be legible)

Attached

(go to Section 3)

Alternative Agreed

(complete ID Document Details below)

Attached

(go to Section 3)

Alternative Agreed

(complete ID Document Details below)

ID DOCUMENT DETAILS

Document 1 Document 2

Document Issuer

Issued Date

Expiry Date

Document Number

English Translation N/A Attached N/A Attached

SECTION 3: FINANCIAL PLANNER DETAILS – identification and verification conducted by:

Date Verified (dd/mm/yyyy)

Financial Planner’s Name Phone No.

AFS Licensee Name Financial Wisdom Limited AFSL No. 231138

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Client authorisation

(for Financial Adviser to request additional information from other Institutions)

To whom it may concern

I, whose date of birth is / /

I, whose date of birth is / /

Of (insert full address )

Request that all relevant information on my investments, insurances, superannuation, bank accounts or other financial information be released to _____________________________

Authorised Representative of Financial Wisdom Limited on request.

Financial Wisdom Limited is an Australian Financial Services Licensee whose Australian Financial Services License number is 231138, whose ABN is 70 006 646 108 and address is Level 17, 175 Pitt Street, Sydney, NSW, 2000

Please also accept a photocopy or facsimile copy of this letter as authority, as the original will stay on file at _______________________

Yours faithfully,

Client 1 Signature Client 2 Signature

/ / / /

Date Date

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Notes

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Notes

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Notes

12206/FW111/0708