FINANCIAL NEEDS ANALYSIS QUESTIONNAIRE
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1 FINANCIAL NEEDS ANALYSIS QUESTIONNAIE Financial planning is about drafting an executable plan, taking into account your personal goals as well as resources (existing provision), to finally have a blueprint of the required steps to be taken in order to realise your goals. It is therefore in your best interest to have an analysis conducted of your financial needs and provisions prior to advice being given as the appropriateness of the advice may hinge on the information at hand. Please take care in providing us with the requested information. PESONAL DETAILS TITLE INITIALS SUNAME MAIDEN SUNAME PEFEED NAME FULL NAMES ID NUMBE TAX NUMBE CLIENT SPOUSE SMOKE STATUS Unmarried Living together Previously Divorced MAITAL STATUS In Community ANC With Accrual WEDDING DATE & PLACE COUNTY SA Other: QUALIFICATION OCCUPATION ANNUAL INCOME EMPLOYE CELLPHONE NUMBE HOME NUMBE FAX NUMBE WOK NUMBE ADESS ETIEMENT AGE ETIEMENT INCOME ADESSES (for the purposes of FICA and future contacts) PHYSICAL ADESS POSTAL ADESS EMPLOYE DEPENDANTS (Who are the people in your life that are affected by the financial decisions you make?) NAME SUNAME ELATION BITH DATE AGE March 12 1
2 FINANCIAL NEEDS ANALYSIS QUESTIONNAIE PESONAL GOALS (AMBITION) Life Goals are what we want to have happen to or in our lives sometime in the future. Once we identify the life goals that are meaningful to us we must then explore those goals in greater detail and plan for them accordingly. A. Personal / Self Priority Level 1. Go back to school to earn a degree or certification 2. Hire a coach (Personal, Career) 3. Begin an exercise program (weight training, yoga, pilates, etc.) 4. Hire a personal trainer 5. Start a weight management program 6. Address an important health issue 7. Attend a personal development event (workshop, retreat, other) 8. Begin a new hobby 9. Develop or master a skill 10. Take art/music/dance classes 11. Learn a new language 12. Other 13. Other B. Family: (Parents, Children, Grandchildren, etc.) 1. Get married 2. Send a family member on a trip 3. Miscellaneous purchase for a family member 4. Assist a family member with a home purchase 5. Fund education expenses for a family member 6. Purchase an automobile for a family member 7. Provide long-term care for a family member 8. Assist a family member with income needs 9. Create a parental pension 10. Fund a child's wedding 11. Fund funeral expenses for family member 12. Create a family business 13. Transfer business to a family member 14. Have a baby 15. Adopt a child 16. Other 17. Other C. Work / Career 1. Change my career path 2. Learn new skills by receiving advanced training or education 3. Start my own business 4. Develop a phased-retirement plan 5. etire from my current job or career 6. Begin an experimental career 7. Take a sabbatical or leave of absence 8. Form a business partnership 9. Acquire or purchase a business 10. Merge my business 11. Expand an existing business 12. Other March 12 2
3 FINANCIAL NEEDS ANALYSIS QUESTIONNAIE D. Leisure / ecreation 1. Go on a trip 2. Purchase a family vacation home 3. Go on a family vacation(s) 4. Purchase a recreation vehicle 5. Purchase a motor home 6. Go away on a hobby-related trip 7. Go on an adventure tour 8. Live in another country 9. Other E. Charitable / Legacy 1. Get involved in a charitable organization 2. Create or fund a scholarship fund 3. Make ongoing contributions to specific charities 4. Go on overseas mission trip 5. Create a foundation 6. Give to a special project 7. Go on a charity related trip 8. Include charities in my estate plan 9. Other Please provide more details on your life goals: e.g. D1 Boat trip to Portuguese islands Nov Mitch Anthony D1 Boat trip to Portuguese islands Nov March 12 3
4 FINANCIAL NEEDS ANALYSIS QUESTIONNAIE ate your own level of knowledge on a scale from Low to High pertaining to the following relevant products (indicate only the product/subject applicable to you). Product/ Subject 1. Money in the bank (savings) 2. Investments in pure equity 3. Collective investments (Unit trusts) 4. Money market portfolios 5. Bond portfolios 6. Equity portfolios 7. Property portfolios 8. Balanced portfolios 9. Absolute return portfolios 10. Endowment policy 11. etirement annuity 12. Living annuity 13. Preservation fund 14. Long-term insurance policy offering the following benefits: Life cover Disability cover Physical impairment Trauma benefits 15. Short-term insurance policy offering the following benefits: Personal goods motor, household goods etc. Commercial goods office content and equipment etc. 16. Health care benefits Health care medical aid Health care pre-funding Are there any investments you would avoid as a matter of principle? Applicable to you Knowledge If you had all of the money that you would ever need, what would you do differently with your life? What is your current investment strategy? Are you satisfied with this strategy? What are your expectations of me as your financial advisor? How often and how much communication would you like with me as your financial advisor? March 12 4
5 INCOME & EXPENSES FINANCIAL NEEDS ANALYSIS QUESTIONNAIE MONTHLY INCOME SOUCES Client (C) Net Disposable Income (shortfall) Spouse (S) Total Salary (please provide payslip) ental Income Interest Dividends Foreign income Other Other Deductions [on payslip] Pension fund Medical aid UIF Tax Other Expenses (if you have a personal budget, you are welcome to provide the details) Bank charges/costs DSTV Domestic worker Property loan repayment * Groceries Donations Short term insurance Municipal account Vehicle loan repayment * Entertainment cost Fuel Security School fees Other debt repayments (clothing accounts etc.) Telephone accounts Other Other Other Assurance (totals) ** C (policy S (policy number) number) *Please provide a copy of home loan and/or vehicle settlement statement. ** Latest premium details will be provided via the financial services exchange (trading as Astute) if letter of consent was signed. March 12 5
6 FINANCIAL NEEDS ANALYSIS QUESTIONNAIE WILL (Please provide a copy for estate planning purposes) MOST ECENT WILL: Date: Place of safe keeping: Executor: BANK DETAILS (for debit order, income or future payments please provide proof) BANK BANCH ACCOUNT NUMBE ASSETS & LIABILITIES DISCIPTION OWNE Own/Spouse/Trust MAKET VALUE OUTSTANDING (debt) INCOME (monthly) FIXED ASSETS Private property Own/Spouse/Combined Holiday property Own/Spouse/Combined Business property Own/Spouse/Combined Own/Spouse/Combined Own/Spouse/Combined Own/Spouse/Combined MOVING ASSETS Vehicle Own/Spouse/Combined House content Own/Spouse/Combined Own/Spouse/Combined LIQUID ASSETS Shares Own/Spouse/Combined Cash in bank Own/Spouse/Combined Coins Own/Spouse/Combined Own/Spouse/Combined FOEIGN ASSETS Investments Own/Spouse/Combined Property Own/Spouse/Combined Own/Spouse/Combined ASSETS NOT PAT OF JOINT ESTATE Inheritance Own/Spouse/Combined Trust EXPENSES (monthly) Completed by on (Date) / /20 March 12 6
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IFC! Independent Financial Consultants!! Fax To: Independent Financial Consultants Att: Iracema Fonseca Fax to email: (086) 586-4165 Fax land: (021) 593-3135 : (084) 334-4848 (W) (021) 593-3012 From: Subject:
IN THE SUPERIOR COURT OF FLOYD COUNTY, STATE OF GEORGIA
IN THE SUPERIOR COURT OF FLOYD COUNTY, STATE OF GEORGIA _, ) Plaintiff / Petitioner, ) ) CIVIL ACTION FILE v. ) ) No., ) Defendant / Respondent. ) ) DOMESTIC RELATIONS FINANCIAL AFFIDAVIT 1. AFFIANT S
DOMESTIC RELATIONS FINANCIAL AFFIDAVIT
IN THE SUPERIOR COURT OF CLAYTON COUNTY STATE OF GEORGIA vs. Plaintiff,,, Defendant. Civil Action Case Number DOMESTIC RELATIONS FINANCIAL AFFIDAVIT (1) Your Name: Your Age: Spouse s Name: Spouse s Age:
DETERMINATION OF RESIDENCY STATUS (LEAVING CANADA)
Canada Revenue Agency Agence du revenu du Canada NR73 E (12) DETERMINATION OF RESIDENCY STATUS (LEAVING CANADA) NOTE: In this form, the text inserted between square brackets represents the regular print
Home Loan and Secured Line of Credit Variable Interest Rate Fixed Interest Rate: 1 year 2 year 3 year Combination/Split Loan $ $
Date: Loan Application Form Home Loan and Secured Line of Credit Variable Interest Rate Fixed Interest Rate: 1 year 2 year 3 year Combination/Split Loan Investment Loan Principal & Interest Construction
Credit Card Application Form
Credit Card Application Form Are you a Member? Yes No. On approval of this Credit Card you will be required to become a Member of Police Bank. Credit Details Member Number (if you are a current member)