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1. LJ No Yearly e g rental income Property Yes Monthly Yes Monthly Property 3 Property 4 D 2 Enter additional information below Type of Property Primary Residence Primary Residence ovm D 6 1 If unknown leave blank Purchase Value Owner s L Spouse Partner C Owned Jointly 1 Spouse Partner 1 Owned Jointly If yes enter details under Mortgage Other No Yes No Debts and Mortgages Associated Debts Income from L No D Yearly E No Additional eg rental income Property Yes W Monthly Yes Monthly properties assets Click here for additional forms Advisors Note Indicates importable value Page Debts Financial Planning Questionnaire Please tell us about your debts including mortgages personal loans and outstanding credit card balances Name or Description If other please specify Type of Debt If mortgage T Outstanding Balance T Repayment Amount T Interest Rate T Associated Home Property Name or Description If other please specify Type of Debt If mortgage Page Outstanding Balance Repayment Amount T Interest Rate e Associated Home Property CL 1 Yearly e IT Yes 0 00096 This Only Loan L No Owner s of Debt 1 Spouse Partner Owned Jointly 5 Mortgag
2. Yearly monthly Yearty monthly Yearty monthly Yearty Monny Yearly Monthy Yearly monthly Yearty monthly Yearly monthly Yearty monthly Yearty monthly Yearty Monthly Monty Yearly monthly Yearly monthly Monny Yearly monthly Yearty Page monthly Yearly Financial Planning Questionnaire Wills Estate Plans Confidential Financial Review Please tell us about your current intentions in respect of your estate in the event of your death You Spouse Partner If yes please outline briefly Have you made a will Yes No C No its terms and provisions in the space below Page Advisors Note Not importable Financial Planning Questionnaire Other Information Confidential Financial Review Please use this space to provide any further information that you feel might be relevant to your financial planning needs e g possible future changes in circumstances work or family potential future financial windfalls or planned major expenditure Page 16 Advisors Note Not importable
3. Benefit Paid _ Monthly CHEB COo O Term Remaining COo O GENES C Advisors Note Not currently importable Additional term life cover Click here for additional forms Protection Income Protection Financial Planning Questionnaire Use the following forms if needed to tell us about income protection policies you want to consider in your financial plans Include employee benefits and any personal policies Leave section blank if the policy is an employment benefit Leave section blank if personal policy Page Name of Policy or Insurer Person s Covered Type of Policy Income Protection Policy GENE 1 Personal Policy Income Protection Policy 2 6 L Personal Policy PERSONAL POLICY Premium Amount of Cover Maximum Duration of Benefit Maximum Benefit Age EMPLOYEE BENEFIT Name of Employer Amount of Cover Maximum Duration of Benefit C Employee Benefit Paid _ Monthly CHED RD Paid _ Monthly CHED of sala Paid _ Monthly L Annually Paid _ Monthly Paid Monthly CHEB of salar Paid _ Monthly 4 Annually Advisors Note Not currently importable Confidential Financial Review Notes Enter additional information below Additional income protection Click here for additional forms Expenses Financial Planning Questionnaire Con
4. 7 N Church s Financial Planning Ltd Confidential Questionnaire 2 Holt Barns Frith End Hampshire GU35 0QW Telephone 01420 479463 Fax 01420 476746 www churchsfp co uk About You Financial Planning Questionnaire Confidential Financial Review Please tell us about yourself and your partner C E B uu 9 Forename Enter additional information below Gender Male C Female Male Female Marital Status Married or Civil Partnership Not Married Advisors Note Indicates importable value Address Home Phone Number 27 2 Your Family Financial Planning Questionnaire Confidential Financial Review Please tell us about your children and any other family members and dependants that you would like to include in your financial plans Forename Surname Gender dd mm yyyy Date of Birth Relationship Forename Surname Gender dd mm yyyy _ Date of Birth 5 Relationship Family Member Dependant 1 Family Member Dependant 2 D BHL BB ono Male Female Male C Female Child Child Family Member Dependant 3 Family Member Dependant 4 a M Male Female 1 Male C Female Child Child Advisors Note Indicates importable value Page Employment Enter below details of your employment earnings including salary wages commissions and bonuses Other sources of income such as rental income or royalties should be
5. Cs and Life Funds Savings Investment 1 Savings Investment 2 or Savings Savings Account Enter additional information below Bank or Institution Owner s Spouse Partner Owned Jointly Spouse Partner Owned Jointly Current Balance t 1 1 1 1 E SSS O Contributions if applicable if applicable Years if applicable Y if licable Remaining Term H Dopa Advisors Note Indicates importable value Savings Investment 3 Savings Investment 4 Type of Investment Notes e of Investmen j BE Savings Savings Savings Account Enter additional information below Bank or Institution gt Owner s You Spouse Partner 1 Owned Jointly Spouse Partner Owned Jointly Current Balance 7 1 O ones Additional savings and Page Click here for additional forms Financial Planning Questionnaire Confidential Financial Review Please tell us about your pension arrangements Enter here details of money purchase schemes personal pensions including stakeholder and self invested Pensions Money Purchases personal pensions Note Do not include any pensions from which you are already drawing an income These should be entered separately in the Drawdowns and Annuities sections of this questionnaire Defined benefit schemes final salaries should also be entered separately under Final Salaries Money Purchase 1 Money Purchase 2 Notes
6. Money Purchase Final Salary Income Protection Redundancy Cover Death in Service Life Assurance Death Service Widow s Pension Stock Purchase Plan Other please specify in notes right Financial Planning Questionnaire Confidential Financial Review Notes Enter additional information below Additional employment income Click here for additional forms Retirement Please tell us about your retirement plans At what age do you expect to retire or are you already retired Spouse Partner Are you already retired Yes No Yes No s Please enter any related If not what is your planned retirement age details right Advisors Note Indicates importable value Taxes or Rebates Due from Last Year Do you have any taxes due or are you expecting rebates from the previous tax year You Spouse Partner ves No ves No Do you have taxes due or rebates expected from the previous tax year Advisors Note Not currently importable Page Financial Planning Questionnaire Confidential Financial Review Notes Enter additional information below Notes Enter additional information below Financial Planning Questionnaire Savings and Investments cds Confidential Financial Review Please provide information about your savings and investments Entries may include stock market and other long term investments ISAs individual stocks and shares unit trusts OEI
7. Purchase Personal Pension Enter additional information below Owner You Spouse Partner a You a Spouse Partner Employer Account Balance Retirement Age i 2 If applicable 2 pa t id amount before tax as Your Contributions of salary annual contribution amount or of salary annual contribution amount of salary J Mei Rn dd 7 deii fe Me Enter either as an annual Contributions amount or as of salary annual contribution amount or of salary annual contribution amount or of salary Money Purchase 3 Money Purchase 4 t ersonal Fension 2 Purchase SISSTIH TENSION Enter additional information below 9 Owner You Spouse Partner E You Spouse Partner Employer Account Balance Retirement Age um If applicable amount before tax or as gt Your Contributions of salary annual contribution amount or of salary annual contribution amount of salary Enter either as an annual Contributions 9 Additional money purchases amount or as of salary annual contribution amount of salary annual contribution amount of salary Click here for additional forms Page Advisors Note Indicates importable value Pensions Final Salaries Financial Planning Questionnaire Confidential Financial Review Please tell us about your pension arrangements Enter here details of final salaries defined benefit schemes Enter current or estimated fut
8. e E Yearly D Yes 0 000 Interest Only Loan No Owner s of Debt Spouse Partner C Owned Jointly TC Advisors Note Indicates importable value Mortgage L Monthly Yes 0 000 Interest Only Loan No You L Spouse Partner Owned Jointly Co LL Mortgage 1 Yearly Yes 0 000 Interest Only Loan 1 1 You 1 Spouse Partner Owned Jointly Confidential Financial Review Notes Enter additional information below Notes Enter additional information below Additional debts Click here for additional forms Protection Term Life Financial Planning Questionnaire Confidential Financial Review Please tell us details of arrangements designed to protect you and or your family in the event of death or long term incapacity Include employee benefits and any personal policies Leave section blank if the policy is an employment benefit Leave section blank if personal policy Usually a multiple or percentage of salary Leave blank if term is duration of employment Page Name of Insurer or Policy Name of Person s Covered Type of Policy PERSONAL POLICY Amount of Cover Premium EMPLOYEE BENEFIT Name of Employer Amount of Cover Term Policy Personal Policy C Employee Benefit Paid Monthly CHEB Term Policy 2 Enter additional information below 62 Personal Policy 1 Employee
9. entered separately in the next section Other Income Please enter annual salary before taxes Average annual bonuses and commissions Average annual value of any benefits received in kind If yes enter any earnings on average from company dividends If yes enter additional details in the Money Purchase or Final Salary sections of this questionnaire Does your employer or company offer other benefits that should be considered in your financial plan Click any that apply Further details may be noted right Page Employment 1 1 You 1 Spouse Partner Eo AAAI Self Employed or Company Owner Yes Yes No Pensions and Other Benefits ves No gt Earner Recipient Occupation or Employer Gross Annual Salary Other Earnings Bonuses Commissions Are you self employed Are you a company owner Do you participate in an employer sponsored pension scheme Type of pension scheme Money Purchase Final Salary Other benefits for Income Protection Redundancy Cover consideration in your financial plan Death in Service Life Assurance B Death in Service Widow s Pension Stock Purchase Plan Other please specify notes right Advisors Note Indicates importable value Employment 2 L Spouse Partner 7 C C Yes No Yes No
10. fidential Financial Review Please enter either a your total household expenses monthly or yearly or b itemise them in the following worksheets 9 b Household Expense Worksheet Page a Total Household Expenses Expense Amount Advisors Note Indicates importable value Monthly Yearly 1 Monthly Yearly Monthly Yearly C Monthly C Yearly Monthly Yearly Monthly L Yearly C Monthly Yearly C Monthly C Yearly Monthly Yearly Monthly Yearly a Monthly Yearly 1 Monthly Yearly C Monthly Yearly Monthly Yearly C Monthly Yearly C Monthly Yearly C Monthly Yearly Monthly Yearly Monthly Yearly Monthly Yearly Monthly Yearly 1 Monthly C Yearly Monthly Yearly Li Monthly Yearly Financial Planning Questionnaire Confidential Financial Review Expenses Household Expense Worksheet continued Advisors Note G Indicates importable value Expense Amount monthly Yearty monthly Yearty monthly Yearty monthly Yearty Monthy Yearty monthly Yearty monthly Yearty monthly Yearty monthty
11. thly C Lo 1 No payments are deferred Additional final salaries Click here for additional forms State Pensions Financial Planning Questionnaire Confidential Financial Review Please tell us about the State Pension benefits you are currently receiving If you are not presently receiving benefits but have your benefit forecast from the Pension Service enter your estimated future pension benefit The Pension Service provides an online pension forecast application which can be accessed on the Directgov website You Spouse Partner Are you currently receiving Yes No Yes No ion a state pension Yearly Yearly Current or Forecast O Monthly 1 Monthly Bernd Edd Weekly Weekly Advisors Note Not currently importable Notes Enter additional information Page Property and Other Assets Financial Planning Questionnaire Confidential Financial Review Please tell us about any properties you own including real property businesses and other assets such as vehicles boats jewellery and collectibles Property 1 Property 2 H2 300 1S9 9 Name or Description Enter additional information below ov GD t If unknown leave blank Purchase Value T Owner s You Spouse Partner C Owned Jointly You Spouse Partner Owned Jointly If yes enter details under Mortgage Other 1 Yes No C No Debts and Mortgages Associated Debts Income from L No
12. ure pension income before tax If presently active member or if pension is deferred Survivor benefits might include Death in Service Widow s Pension Death in Deferment Benefits Enter current or estimated future pension income before tax If presently active member or if pension is deferred Page Final Salary 1 1 You Spouse Partner 2 Yes No C Yes Monthly Final Salary 3 You Spouse Partner Co LL ves C 1 Yes Monthly C Advisors Note Not currently importable Owner Name of Pension or Employer Active Member If Yes Years of Service If No Are you currently 1 payments are deferred receiving payments Pension Income Expected or Current Retirement Age Survivor Benefits Leave blank if unknown Owner Name of Pension or Employer Active Member If Yes Years of Service If No Are you currently C No payments are deferred receiving payments Pension Income Expected or Current Retirement Age Survivor Benefits Leave blank if unknown Final Salary 2 E You Spouse Partner 7 Yes No 1 Yes E Monthly C Notes Enter additional information No payments are deferred COo Final Salary 4 Notes O You Spouse Partner Enter additional information 2 Yes L No ME E Yes a Mon
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