FINANCIAL NEEDS ANALYSIS
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1 Triarc (Pty) Ltd EG 2012/011172/07 Phone +27 (0) Fax +27 (0) FINANCIAL NEEDS ANALYSIS Data Capturing Form ο Client First Name Mid Names Surname Date of Birth Male Female Have Will Address Health Status Smoker Other Info: Planned etirement Age or Date Employer Has Pension/Provident Fund Spouse First Name Mid Names Surname Date of Birth Male Female Have Will Marriage We are married Date: Marriage Contract Ante-Nuptial Community Of Property Traditional With Accrual Separation of Property Without Accrual Common Law Accrual Values Initial Value of Assets Client Initial Value of Assets Spouse Health Status Smoker Other Info: Planned etirement Age or Date Employer Has Pension/Provident Fund Triarc (Pty) Ltd EG 2012/011172/07 FSP OG4040 Page 1/6
2 Children Child 1 Child 2 Full Name Date of Birth Sex Male Female Male Female elationship to Client elationship to Spouse Child 3 Child 4 Full Name Date of Birth Sex Male Female Male Female elationship to Client elationship to Spouse Other Dependents Dependent 1 Dependent 2 Full Name Date of Birth Sex Male Female Male Female elationship to Client Health Status Triarc (Pty) Ltd EG 2012/011172/07 FSP OG4040 Page 2/6
3 Assets & Liabilities House (Primary) Address: In Trust Value Purchase Date or Base Cost (1 Oct 2001) Current Market Value Date of Value Bank Latest Loan Value Date of Value Monthly Installment of Current Loan Interest ate % Loan ental Income Owners 1. % Bequests 1. % House (Secondary) Address: ο In Trust Value Purchase Date or Base Cost (1 Oct 2001) Current Market Value Date of Value Bank Latest Loan Value Date of Value Monthly Installment of Current Loan Interest ate % Loan ental Income Owners 1. % Bequests 1. % Triarc (Pty) Ltd EG 2012/011172/07 FSP OG4040 Page 3/6
4 Vehicle 1 Year, Make, Model, eg. No Monthly Installment Years for Down Payment or Current Loan Interest ate % Market Value Date Current Loan Value Date HP Company Owner(s) Bequest(s) Vehicle 2 Year, Make, Model, eg. No Monthly Installment Years for Down Payment or Current Loan Interest ate % Market Value Date Current Loan Value Date HP Company Owner(s) Bequest(s) Other Assets Market Value Base Cost Convert to Cash at death /disability/ retirement? Or Bequeath to Please tick: Please tick: Death Disab etire Spouse Other Triarc (Pty) Ltd EG 2012/011172/07 FSP OG4040 Page 4/6
5 Income And Expenses for (Client) (Capture all expenses with a minus) Frequency monthly quarterly semi-annually annually Pensionable Gross Salary % Growth Non-Pensionable Gross Salary % Growth Household (Food, Clothing, Leisure, DSTV, etc.) Income And Expenses for (Spouse) Frequency monthly quarterly semi-annually annually Pensionable Gross Salary % Growth Non-Pensionable Gross Salary % Growth Household (Food, Clothing, Leisure, DSTV, etc.) Monthly Income and Expenses for Child 1 Child Care (From Date to ) Age Education Current (From Date to ) Age Education Secondary (From Date to ) Age Education University (From Date to ) Age Monthly Income and Expenses for Child 2 Child Care (From Date to ) Age Education Current (From Date to ) Age Education Secondary (From Date to ) Age Education University (From Date to ) Age Monthly Income and Expenses for Child 3 Child Care (From Date to ) Age Education Current (From Date to ) Age Education Secondary (From Date to ) Age Education University (From Date to ) Age Triarc (Pty) Ltd EG 2012/011172/07 FSP OG4040 Page 5/6
6 Monthly Income and Expenses for Child 4 Child Care (From Date to ) Age Education Current (From Date to ) Age Education Secondary (From Date to ) Age Education University (From Date to ) Age Monthly Income and Expenses for Dependent 1 Household (From Date to ) Age Other? (From Date to ) Age Other? (From Date to ) Age Other? (From Date to ) Age Monthly Income and Expenses for Dependent 2 Household (From Date to ) Age Other? (From Date to ) Age Other? (From Date to ) Age Other? (From Date to ) Age Circumstance Dependent Cost Assumptions Description Lump Sum Amount Circumstance Funeral Death Alteration of Building Other? Other? Planning equirements Planning for Death Planning for Disability Planning for Severe Illness etirement Planning Education Planning Investment Planning isk Profile DATED AT ON THIS DAY OF 20 Signature and Name Client. Signature and Name Spouse Triarc (Pty) Ltd EG 2012/011172/07 FSP OG4040 Page 6/6
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