NEEDS ANALYSIS QUESTIONNAIRE
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1 NEEDS ANALYSIS QUESTIONNAIRE 1. Personal details r full name Surname First name(s) s full name Surname First name(s) Address Postal Residential Telephone number (H) Telephone number (W) Fax Cellphone address Identity number / Date of birth Tax number 2. Employment details Occupation Current employer Gross salary (p.m.) Qualification level 1
2 Desired retirement age Percentage of working hours spent on: Travelling % Administration % Supervision % Manual Labour % 3. Marital status ANC ANC + ACCRUAL IN COP SINGLE DIVORCED WIDOWED COMMON LAW OTHER 4. Children FULL NAMES DATE OF BIRTH Education do you wish to provide for your children s education through to their tertiary education years? Will this amount be required on death and disability of the main provider? 5. Health Information Smoking Status Health Rating (Perfect/Average/Poor) Ever been declined cover or had cover offered at restricted rates? Ever been hospitalised or treated for significant illness or injury? Prescribed medication (Yes/No) 2
3 Do you participate in any hazardous sports? Medical Scheme : Membership number: 6. Banking details LOCAL OFFSHORE Bank: Branch: Branch code: Account number: Account type: 7. Property, household effects, vehicles, boats, jewellery, etc. ASSET DESCRIPTION OWNER MARKET VALUE INCOME FROM ASSET OUTSTANDING LIABILITY 8. Business interests ASSET TYPE MARKET VALUE OUTSTANDING LIABILITY 3
4 9. Approved investments Pension & provident funds, retirement annuities, preservation funds and living annuities TYPE OF FUND CONTRIBUTION CURRENT VALUE 10. Discretionary investments Endowments and other insurance ASSET INSTITUTION DESCRIPTION ACCOUNT NO ENTRY DATE MATURITY DATE MATURITY VALUE Structured/linked products, unit trusts, shares, cash etc. ASSET DESCRIPT N INSTITUTION ENTRY DATE NO OF SHARES CURRENT VALUE LIABILITY CONTRIBUT N 4
5 11. Offshore investments ASSET DESCRIPTION INSTITUTION NO OF SHARES CURRENT VALUE INCOME 12. Risk cover If not to be detailed on the Assurance / Investment Portfolio Analysis TYPE OF COVER INSTITUTION CONTRIBUTIONS VALUE OF COVER 13. Personal cash flow Salary (you) Salary (your spouse) Rental income Other investment income Self-employed business profit Pension income Other income: GROSS (ANNUALLY) PENSIONABLE (ANNUALLY) Please detail other income: 5
6 14. Questions on current and future lifestyle 1. What are your lifestyle or financial goals? What are their time periods and approximate costs in present values? e.g. Education Travel 2. Do you own or are you buying a home? Estimated value? Amount owing on home? Interest rate on home loan? 3. Do you intend to move in the foreseeable future? If yes, what year? What is the anticipated value of your new home? 4. Are you planning any major capital purchases? E.g. new car, boat etc. If so, when and how much will it cost? 5. What are your current lifestyle costs per year? Completing the attached budget will help you to estimate your current lifestyle costs. 6. Do you expect to inherit any money or property? If yes, how much and when? Use today s Rands. 7. If not retired, at what age do you plan to retire? If retired, please indicate here. 6
7 8. In retirement, how much income do/will you need? (use today s Rands, excluding tax) For non-retirees, to maintain our current standard of living, two thirds pre-retirement income is widely accepted. 9. Will you want to give your children any financial assistance? If so, when and how much? (in today s R s) 10. Are there any specific issues you would like to discuss during the meeting? BUDGET Budgeted Actual 1 Income 2 Fixed compulsory expenditure 3 Variable compulsory expenditure 4 Discretionary expenditure 5 Provision for annual one-off expenses SURPLUS / DEFICIT SECTION 1 - Income Budgeted Actual Salary - self Salary - spouse Other income - self Other income - spouse SECTION 2 - Fixed expenditure Budgeted Actual Bond HP agreements MV loan 7
8 Short-term insurance Life cover Unit trusts Medical aid Domestic wages Property levies Security company Personal loans Education costs Provision for future education costs Savings for emergency fund Savings for annual payments SECTION 3 - Variable expenditure Budgeted Actual Municipal services Telephone Household expenses Food Bank charges Electricity Water SECTION 4 - Discretionary expenditure Budgeted Actual Clothing Short holidays Entertainment Parking Car maintenance Fuel costs Hobbies & Sport Liquor Magazine/newspaper subscriptions SECTION 5 - Prov. For annual expenses Budgeted Actual Deposit on house Gifts Deposit on car Taxes Clothes Home improvements Holiday TV license 8
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