Content Personalization User's Guide
Contents
1. If unknown leave blank Purchase Value Owner s Yeu L Spouse Partner Owned Jointly vou L Spouse Partner L Owned Jointly If yes enter details under Mortgage Other Yes No Yes No Debts and Mortgages Associated Debts E No Yearly No Yearly Income from eg rental income Property L Yes Monthly _ Yes a Monthly e eecht Page Advisors Note Indicates importable value Confidential Financial Review Notes Enter additional information below Notes Enter additional information below Entries completed Click here to go to the next step in the questionnaire Financial Planning Questionnaire Appendix 7 Property and Other Assets additional forms continued If unknown leave blank If yes enter details under Debts and Mortgages e g rental income If unknown leave blank If yes enter details under Debts and Mortgages e g rental income Page Property 9 Property 10 Purchase Value Owner s You L Spouse Partner O Owned Jointly Yeu C Spouse Partner Owned Jointly Mortgage Other Yes Ba No Yes U No Associated Debts H Yearly No Yearly No Income from ioc Dwe t Jm e t Jusen Property 11 Property 12 Current Value CE Purchase Value Owner s You O Spouse Partner Owned Jointly You Spouse Partner C Owned Jointly Mortgage Other Yes No2. Yes L No Associated Debts E Yearly L No E Yearly No Income from deeg Cie IE Omen Cres Jusen Advisors Note Indicates importable value Confidential Financial Review Notes Enter additional information below Notes Enter additional information below Entries completed Click here to go to the next step in the questionnaire Financial Planning Questionnaire Appendix 7 Property and Other Assets additional forms continued If unknown leave blank If yes enter details under Debts and Mortgages e g rental income If unknown leave blank If yes enter details under Debts and Mortgages e g rental income Page D Les e Property 13 Property 14 Primary Residence Primary Residence Type of Property Purchase Value Owner s You C Spouse Partner Owned Jointly Yeu L Spouse Partner Owned Jointly Mortgage Other L Yes L No Yes L No Associated Debts C No Ki Yearly L No Yearly Income from Property Yes L Monthly C Yes C Monthly Property 15 Property 16 Type of Property Primary Residence Primary Residence Current Value e 1 Purchase Value Owner s You E Spouse Partner C Owned Jointly You Spouse Partner DW Owned Jointly Mortgage Other R Yes No a Yes No Associated Debts C No C Yearly O No Yearly Income from Property C Yes Monthly Yes Monthly
3. You Spouse Partner Yearly Yearly CD CD C You D Spouse Partner C You C Spouse Partner S CD L ae L Monthly L Monthly 6 jJ s jJ Drawdown 5 Drawdown 6 DW You L Spouse Partner C You Spouse Partner D CON EC Monthly C Monthly CD E Advisors Note Indicates importable value Financial Planning Questionnaire Confidential Financial Review Notes Enter additional information below Notes Enter additional information below Notes Enter additional information below Financial Planning Questionnaire Confidential Financial Review Annuities Please tell us about any existing annuities pension or non pension from which you currently receive income or from which you expect income that is presently deferred Annuity 1 Annuity 2 Enter income before tax Leave blank if lifetime income If unknown leave unselected Enter income before tax Leave blank if lifetime income If unknown leave unselected Page Owner Name of Annuity Type of Annuity Currently receiving income from annuity Income Current or Expected Term Survivorship Owner Name of Annuity Type of Annuity Currently receiving income from annuity Income Current or Expected Term Survivorship You C Spouse Partner Co E L Pension L Yes E No payments are deferred LS L Monthly bi Single Joint Life If Joint Life Survivor
4. Advisors Note Indicates importable value Confidential Financial Review Notes Enter additional information below Notes Enter additional information below Entries completed Click here to go to the next step in the questionnaire Financial Planning Questionnaire Appendix 7 Property and Other Assets additional forms continued If unknown leave blank If yes enter details under Debts and Mortgages e g rental income If unknown leave blank If yes enter details under Debts and Mortgages e g rental income Page T T T T T T Property 17 Property 18 SE cups Primary Residence Purchase Value Owner s You L Spouse Partner Owned Jointly You C Spouse Partner Owned Jointly Mortgage Other L Yes No Yes L No Associated Debts C No L Yearly C No Yearly Income from Property Yes L Monthly Yes L Monthly Property 19 Property 20 Purchase Value Owner s Yeu Spouse Partner Owned Jointly You L Spouse Partner Owned Jointly Mortgage Other Yes L No Yes C No Associated Debts Income from B bos Yearly L No C Yearly E Ce LE Jusen ves menw Advisors Note Indicates importable value Confidential Financial Review Notes Enter additional information below Notes Enter additional information below Entries completed Click here to go to the next step in the ques
5. Final Salaries additional forms Use the following forms if needed to tell us about any additional final salary schemes you want to consider in your financial plans Enter current or estimated future 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 Advisors Note Not currently importable Page Owner Name of Pension or Employer Active Member If Yes Years of Service If No Are you currently 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 receiving payments Pension Income Expected or Current Retirement Age Survivor Benefits Leave blank if unknown Final Salary 5 a You L Spouse Partner o Yes C No Yes ff Final Salary 7 No payments are deferred C Yearly L Monthly E You Spouse Partner Co LJ ves C No um L Yes as RW No payments are deferred BS Yearly Monthly Final Salary 6 You L Spouse Partner Financial Planning Questionnaire
6. additional forms 33 Appendix 3 Savings and Investments additional forms 34 Appendix 4 Pensions Money Purchases additional forms 38 Appendix 5 Pensions Final Salaries additional forms 39 Appendix 6 Annuities additional forms 40 Appendix 7 Property and Other Assets additional forms 41 Appendix 8 Debts additional forms 45 Appendix 9 Protection Term Life additional forms 47 Appendix 10 Protection Income Protection additional forms 48 Page iii About You Financial Planning Questionnaire Confidential Financial Review Please tell us about yourself and your partner C E B uu Forename Enter additional information below Gender Male C Female Male Female Marital Status R Married or Civil Partnership Not Married Advisors Note Indicates importable value Address Home Phone Number O Co O 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 gt Relationship Family Member Dependant 1 Family Member Dependant 2 D BHL BB ono Male Female L Male L Female Child Child Family Member Dependant 3 F
7. No C L Yes DS e L 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 L No 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 L You C Spouse Partner Co Yes L No L Yes Eu Monthly Notes Enter additional information L No payments are deferred e Final Salary 4 Notes O You Spouse Partner Enter additional information e C Yes No L Yes Sie a Monthly C Lo WW No payments are deferred Additional final salaries Click here for additional forms Drawdowns Please tell us about any existing drawdowns from which you currently receive income Income before tax Income before tax 7 Income before tax Page Owner Name of Drawdown Payment Amount Current Balance Owner Name of Drawdown Payment Amount Current Balance Owner Name of Drawdown Payment Amount Current Balance Drawdown 1 Drawdown 2 You Spouse Partner L
8. Percentage Non Pension Annuity 3 You L Spouse Partner CD L Pension L Yes O No payments are deferred HM o Monthly Single Joint Life If Joint Life Survivor Percentage O Non Pension Advisors Note Not currently importable L You O Spouse Partner CY L Pension L Non Pension Yes L No payments are deferred PM E Monthly Single _ Joint Life If Joint Life Survivor Percentage Annuity 4 L You L Spouse Partner L Pension Non Pension L Yes L No payments are deferred mm L Monthly Single Joint Life If Joint Life Survivor Percentage Notes Enter additional information below Notes Enter additional information below Additional annuities 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 L Yes No L Yes L No ion a state pension Ki Yearly L Yearly Current or Forecast L Monthly C L Monthly Bars Edd L Weekly L Weekly Advisors Note Not currently im
9. 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 Repayment Amount F 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 Yearly CS Yes 0 000 M Only Loan L No Owner s of Debt vou Spouse Partner Owned Jointly CC Mortgage E Yearly D Yes 0 000 Interest Only Loan L No Owner s of Debt vou Spouse Partner C Owned Jointly TC Advisors Note Indicates importable value Mortgage In L Monthly Yes 0 000 Interest Only Loan L No You L Spouse Partner Owned Jointly Co LL Mortgage W Yearly e H Yes 0 000 Interest Only Loan L No You L 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 t
10. Spouse Partner CH Owned Jointly You KH Spouse Partner Owned Jointly Current Balance 1 1 O O Contributions if applicable if applicable pow Entries completed M Years if applicable Years if applicable i Remaining Term Click here to go to the next step in the questionnaire Page Financial Planning Questionnaire Appendix 3 Savings and Investments additional forms continued Confidential Financial Review Savings Investment 17 Savings Investment 18 Type of Investment Notes e of Investmen j SE SE Savings Account Enter additional information below TEN E Bank or Institution Owner s You Spouse Partner L Owned Jointly You Spouse Partner C Owned Jointly tm ume EL gs Contributions if applicable if applicable Years if applicable Years if applicable Remaining Term i SE Advisors Note Indicates importable value Savings Investment 19 Savings Investment 20 Notes EE Savings Account Savings Account Enter additional information below or Savings oe SS Bank or Institution Owner s You Spouse Partner B Owned Jointly You Spouse Partner Owned Jointly tms 00 mm 6 0 dum Contributions if applicable if applicable Entries completed Years if applicable 1 Years if applicable Remaining Term Click here to go to the next step in the questionnaire Financial Planning Questionnaire Appendix 4 P
11. enter any earnings on Are you a company owner L Yes E No L Yes L No average from company Company Dividends Pensions and Other Benefits If yes enter additional Do you participate in an L Yes No E Yes _ No details in the Money employer sponsored Purchase or Final Salary pension scheme sections of this questionnaire Type of pension scheme C Money Purchase C Final Salary L Money Purchase C Final Salary Does your employer or company offer other Other benefits for Income Protection Redundancy Cover C Income Protection Redundancy Cover benefits that should be consideration in your considered in your financial financial plan g Death in Service Life Assurance C Death in Service Life Assurance lan SS C Death in Service Widow s Pension L Death in Service Widow s Pension Click h ly MAC ici E Stock Purchase Plan E Stock Purchase Plan Entries completed Further details may be Advisors Note Ken SE i noted right Indicates importable value L Other please specify in notes right L Other please specify in notes right Click here to go to the next step in the questionnaire Page Appendix Employment additional forms 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 Mon
12. f R Yes L No L Yes e 0 e Final Salary 8 L No payments are deferred E Yearly 5 Monthly L You k Spouse Partner E Yes No C ves E 1 C Coo L No payments are deferred Yearly D Monthly Confidential Financial Review Notes Enter additional information Notes Enter additional information Entries completed Click here to go to the next step in the questionnaire Appendix 6 Annuities additional forms Use the following forms if needed to tell us about additional annuities you want to consider in your financial plans Enter income before tax Leave blank if lifetime income If unknown leave unselected Enter income before tax Leave blank if lifetime income If unknown leave unselected Page Owner Name of Annuity Type of Annuity Currently receiving income from annuity Income Current or Expected Term Survivorship Owner Name of Annuity Type of Annuity Currently receiving income from annuity Income Current or Expected Term Survivorship Annuity 5 L You O Spouse Partner L Pension L Yes L No payments are deferred GD D Monthly BR Single Joint Life If Joint Life Survivor Percentage L Non Pension Advisors Note Not currently importable Annuity 7 L You B Spouse Partner 7 L Pension Yes No payments are deferred EE B Monthl
13. gs Contributions if applicable if applicable Years if applicable Years if applicable Remaining Term id Ir SE Advisors Note Indicates importable value Savings Investment 1 1 Savings Investment 12 Type of Investment Notes YRS Pin ng Savings Account Savings Account mm or Savings 9 H Enter additional information below SS emm Bank or Institution Owner s You Spouse Partner L Owned Jointly You Spouse Partner Owned Jointly tms me D Contributions if applicable if applicable E Ti Entries completed Years IT a Icabie b Remaining Term s Sn ee Click here to go to the next step in the questionnaire Page Financial Planning Questionnaire Appendix 3 Savings and Investments additional forms continued Confidential Financial Review Savings Investment 13 Savings Investment 14 Notes Type of Investment Savings Account Savings Account Enter additional information below or Savings Bank or Institution Owner s You Spouse Partner E Owned Jointly You L Spouse Partner L Owned Jointly Current Balance t 1 fe jJ Contributions if applicable if applicable Years if applicable Years if applicable Advisors Note Indicates importable value Savings Investment 15 Savings Investment 16 Notes LP EE GUEST Savings Account Savings Account Enter additional information below or Savings Bank or Institution Owner s LI You
14. here to go to the next step in L Other please specify in notes right the questionnaire Appendix 2 Other Income additional forms Financial Planning Questionnaire Confidential Financial Review Use the following forms if needed to tell us details of any other income sources apart from employment pensions and annuities Other income sources might include rental income or royalties for example Page e Other Income 5 Annual Income 1 1 1 1 Is this income taxable L Yes L No C Expected duration Earner Recipient You L Spouse Partner Other Income 7 Other Income Source l Annual Income 1 Is this income taxable Yes No Expected duration Earner Recipient You Spouse Partner Advisors Note Indicates importable value Other Income 6 SE ves L No S a You Spouse Partner Other Income 8 sz L Yes C No CD L You L Spouse Partner Notes Enter additional information below Notes Enter additional information below Entries completed Click here to go to the next step in the questionnaire Page Type of Investment or Savings Name of Account Bank or Institution Owner s Current Balance Regular Contributions Remaining Term Savings Investment 5 Savings Account O You Spouse Partner Owned Jointly vou Spouse Partner L Owned Jointly if applicable EE Year
15. 4 Co E C E Personal Policy Paid _ Monthly INH GENES C Jr C Paid _ Monthly of sala Paid _ Monthly ii Annually L Annually E Annually Confidential Financial Review Notes Enter additional information below Entries completed Click here to go to the next step in the questionnaire
16. Monthly L Yearly L Monthly L Yearly L Monthly RB Yearly Monthly L Yearly E Monthly L Yearly E Monthly L Yearly Li Monthly L Yearly C Monthly Yearly Monthly Yearly L Monthly L Yearly L Monthly L Yearly C Monthly L Yearly Monthly L Yearly Monthly L Yearly Monthly L Yearly L Monthly Yearly L Monthly C Yearly E Monthly L Yearly FA Monthly Yearly Financial Planning Questionnaire Confidential Financial Review Expenses Household Expense Worksheet continued Advisors Note G Indicates importable value Expense Amount monthly Yearty Monty Yearty monthly Yearty monthly Yearty Monthy Yearty Monthy Yearty monthly Yearty monthly Yearty monthty Yearly monthly Yearty monthly Yearty monthly Yearty monthiy Yearly Monthy Yearly monthly _ Yearty monthly Yearly monthly Yearty monthly Yearty monthly Yearty monthly Yearly monthly Yearly monthiy Yearly monthly Yeany monthiy gesch monthly Yearty Pagel di monthly gesch Financial Planning Questionnaire Ex
17. Tom Farrell Financial Mediation Tom Farrell e 43 Eagle Street financial mediation London WCIR 4AT direct 0207 112 0237 clarity from complexity office 0207 404 4711 fax 0207 405 1904 email help tomfarrell co uk web www tomfarrell co uk FINANCIAL INFORMATION FORM This digital form is designed to capture all your relevant financial information for import into our cash flow modelling system It may also serve along with any required supporting documentation as a Financial Information Form for Mediation Please complete this digital form as fully as possible There may be sections that do not apply to you Please leave these sections blank You can complete the form in stages returning to it when time allows Please make sure that you save the form at the end of each session Once you have completed the form in as much detail as you can please return it to me digitally by attaching it to an email to the following address help tomfarrell co uk If you run into any difficulty in completing this form please do not hesitate to contact me e Tom Farrell is a Mediator amp Financial Neutral e ee FAMILY MEDIATORS Tom Farrell also offers regulated financial advice through Merlin Financial Consultants Limited who are specialist ASSOCIATION Authorised and Regulated by the Financial Conduct Authority Financial Planning Questionnaire Confidential Financial Review Financial Planning Questionnaire Confidentia
18. You EI Spouse Partner Advisors Note Indicates importable value Additional incomes Click here for additional forms Page Anticipated Windfalls Financial Planning Questionnaire Confidential Financial Review Enter here details of any anticipated proceeds from windfall events such as gifts inheritances or even a lottery win Windfall 1 Windfall 2 Gifts Amount m 3 Gambling winnings When do you expect to Var ED or at Age ans ED or at Age receive this windfall E Windfall 3 Windfall 4 Gifts Amount Gambling winnings When do you expect to Year i or at Age Year ED or at Age receive this windfall AY EN E Bo OL GPeXZLZ Advisors Note Not currently importable Page Financial Planning Questionnaire Savings and Investments RE 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 OEICs and Life Funds Savings Investment 1 Savings Investment 2 or Savings Savings Account Enter additional information below Bank or Institution Owner s You Spouse Partner L Owned Jointly You Spouse Partner Owned Jointly Current Balance 1 1 1 1 E SSS O Contributions if applicable if applicable Years if applicable Y if licable Remaining Term H EXC oi Advisors Note Indicates im
19. age Name of Insurer or Policy Name of Person s Covered Type of Policy Term Policy 3 CH Personal Policy Term Policy 4 Notes S Enter additional information below Personal Policy PERSONAL POLICY Amount of Cover Premium EMPLOYEE BENEFIT Name of Employer Amount of Cover Term Remaining L Employee Benefit Paid _ Monthly CHEB as GENES C Advisors Note Not currently importable C Employee Benefit Paid _ Monthly Entries completed Click here to go to the next step in the questionnaire Financial Planning Questionnaire Appendix 10 Protection Income Protection additional forms Use the following forms if needed to tell us about additional income protection policies you want to consider in your financial plans 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 Employee Benefit 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 Income Protection Policy 3 Co D L Personal Policy Paid _ Monthly Gs Cie Paid _ Monthly e of sala Paid __ Monthly L Annually Advisors Note Not currently importable 5 Employee Benefit Income Protection Policy
20. amily Member Dependant 4 a M L Male RW Female Male L Female Child Child Advisors Note Indicates importable value Page Your Family continued Use the following forms if needed to tell us about additional family members you want to consider in your financial plans dd mm yyyy dd mm yyyy Page T T T T amp e Family Member Dependant 5 Family Member Dependant 6 a TR C Gender a Male D Female L Male L Female Dai of ic WEE Relationship Child Child _ __ EE iO Gender C Male Female Male L Female SE WE CR Relationship D CD Advisors Note Indicates importable value Financial Planning Questionnaire Confidential Financial Review Notes Enter additional information below Notes Enter additional information below 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 impo
21. ancial plans Critical Illness Policy Critical Illness Policy 2 Enter additional information below SG mea CD Df Premium Annually Annually Term Is cover offered together a Yes No Yes L No with a Term Life policy Advisors Note Not currently importable Notes Enter additional information Page Page Protection Long Term Care Use the following forms if needed to tell us about long term care cover you want to consider in your financial plans Long Term Care Policy Long Term Care Policy 2 s a E aoe Amount of Cover L Annually E Annually Yano Lifetime Van Lifetime Maximum Coverage Period Benefits Benefits sl Gam e Premium Annually Annually Advisors Note Not currently importable Notes Enter additional information Financial Planning Questionnaire Confidential Financial Review Notes Enter additional information below Expenses Financial Planning Questionnaire Confidential 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 L Yearly L Monthly L Yearly EY Monthly Yearly L Monthly D Yearly Monthly L Yearly
22. ensions Money Purchases additional forms Confidential Financial Review Use the following forms if needed to tell us about any additional money purchases you want to consider in your financial plans Money Purchase 5 Money Purchase 6 Purchase o a E Purchase Personal Pension Bec Enter additional information below Owner You Spouse Partner L You C Spouse Partner Employer Account Balance Retirement Age ER If applicable pint ipi diss 3 i i na Khi t i amount before tax or as Your Contributions of salary annual contribution amount or of salary annual contribution amount or of salary H A 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 7 Money Purchase 8 Notes Decor dd Personal Pension Personal Pension Enter additional information below Owner L You Spouse Partner You Spouse Partner Employer Account Balance Retirement Age ER If applicable amount before tax or as Your Contributions of salary annual contribution amount or of salary annual contribution amount or of salary Enter either as an annual Contributions Click here to go to the next step in amount or as of salary annual contribution amount or of salary annual contribution amount or of salary the questionnaire Page Advisors Note Indicates importable value Appendix 5 Pensions
23. ent income Work part time either temporarily or in late career Advice on redundancy or changing careers Start a new business Invest an inheritance a gift or other windfalls Review your existing investments Liquidity Keep funds accessible on short notice Information on government benefits and entitlements Plan for a future child or children and related expenses such as child care Save for a future wedding or other major celebrations Purchase a future home Fund the renovation of your home Buy a holiday home or other property Downsizing selling a home property business or other assets Education Fund the education of your children grandchildren other dependants Education Fund your own education or a return to university Plan for other major expenditures for example the purchase of a new car or boat Managing debt Credit cards loans mortgages Insurance protection for assets income critical illness or long term health care Provide an inheritance for your dependants omes CO ores Od i A owes Od owes 77 ows ooo O Low Si N High 3 4 5 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 Yes C No its t
24. erm 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 Ei Personal Policy DS Employee Benefit Paid L_ Monthly CHEB Term Policy 2 WEE a Enter additional information below CuE Ei Personal Policy L Employee Benefit Paid _ Monthly CHEB COo O Term Remaining COo O GENES Advisors Note Not currently importable Additional term life cover Click here for additional forms Page Protection Whole Life Use the following forms if needed to tell us about the whole life policies you want to consider in your financial plans Whole Life Name of Insurer or Policy Co Person s Covered E ED Premium RE Annually Amount of Cover 1 1 1 1j Whole Life 3 Name of Insurer or Policy O sn HN Premium L Annually de C Advisors Note Not currently importable Whole Life 2 E ie L Annually Whole Life 4 CD i L Annually Financial Planning Questionnaire Confidential Financial Review Notes Enter additional information below Notes Enter add
25. erms 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 28 Advisors Note Not importable Financial Planning Questionnaire Other Information continued Confidential Financial Review Page 29 Advisors Note Not importable Financial Planning Questionnaire Other Information continued Confidential Financial Review Page 30 Advisors Note Not importable Financial Planning Questionnaire Appendix Employment additional forms Confidential Financia Review Use the following forms if needed to enter additional details of your employment earnings including salary wages commissions and bonuses Other sources of income such as rental income or royalties should be entered separately in Other Income Employment 3 Employment 4 Earner Recipient L You Spouse Partner You Spouse Partner Notes Occupation or Employer before taxes Gross Annual Salary and commissions Bonuses Commissions any benefits received in kind Benefits in Kind Self Employed or Company Owner Are you self employed L Yes L No Yes Ba No If yes
26. ey 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 Page noted right Employment 5 L You Spouse Partner ST Self Employed or Company Owner _ Yes No Yes No Pensions and Other Benefits Yes No Earner Recipient Occupation or Employer Gross Annual Salary Other Earnings Bonuses Commissions Are you self employed Are you a company owner Company Dividends Do you participate in an employer sponsored pension scheme Type of pension scheme Money Purchase Final Salary Other benefits for consideration in your financial plan EI Income Protection Redundancy Cover L Death in Service Life Assurance L Death in Service Widow s Pension C Stock Purchase Plan L Other please specify in notes right Advisors Note Indicates importable value Financial Planning Questionnaire Confidential Financial Review Employment 6 Notes Enter additional information below C You L Spouse Partner TT e Yes No ves Ei No ji ves C No Money Purchase Final Salary Income Protection Redundancy Cover L Death in Service Life Assurance C Death in Service Widow s Pension __ Stock Purchase Plan Entries completed Click
27. itional information below Page Name of Insurer or Policy Person s Covered Guaranteed Sum Assured Current Endowment Sum Assured Plus Bonuses Maturity Date Premium Name of Insurer or Policy Person s Covered Guaranteed Sum Assured Current Endowment Sum Assured Plus Bonuses Maturity Date Premium Protection Endowments E EE SS D C anc Paid _ Monthly L Annually mem CD C Advisors Note Not currently importable Paid _ Monthly L Annually Use the following forms if needed to tell us about endowments you want to consider in your financial plans Co C E E CR Paid E Monthly a Annually a fC fo Ga aa a a a CR Paid Monthly L Annually Financial Planning Questionnaire Confidential Financial Review Notes Enter additional information below Notes Enter additional information below Page Protection Family Income Benefits Use the following forms if needed to tell us about the family income benefits you want to consider in your financial plans Family Income Benefit Family Income Benefit 2 Term Remaining GE mm Premium C Annually L Annually Family Income Benefit 3 Family Income Benefit 4 Term Remaining E e Gm Er Premium Annually Annually Advisors Note Not currently importable Financial Planning Questionnaire Confidential Financial Review Notes Enter additional informatio
28. l Financial Review Table of Contents Dnm ome 1 Tour Fani a a a a nong i ng ng g ninh RERARERIRERARERIRERARERIRERIRERIRERIRERIRER s ago AR ER TR KRAMER RR c yn RR RR RR Raga 2 lg ET A Taxes or Rebates Due from Last Year seen 4 IS le e un En EEN 5 Other INCOME eA eere MR ease cdc ee adeccuceadecsevendacdeudedccdaededcndaed sbsadesesonacseddendsses seecscadsnncncavsend 6 Anticipated Ae UE H Savings and Investments HH eene TT ng ng T0 1 E00 nnns 8 Pensions Money Purchases ss 9 Pensions Final Salaries seen 10 pc OC 11 ill E 12 State PENSIONS sss 555295359555955555925595355535355555353555553555953EEgdgggdlggudgggiggudggd100040041080400410004001084400420g4801du 13 Property and Other Assets NN NENNEN NENNEN ENNEN NN deeederedeet 14 RI 15 Protection Term Life HS H kh 16 Protection Whole Life ss 17 Protection Endowments siennes 18 Protection Family Income Benefits 1 111K EEh 19 Protectiori lncom PTOLECEIOfTz vccc16 20011tcssssstsstsssbsstixsb sxtsxsb sstxstixsbixgbixsbsksbdksbsksbdssbdssbdk di KU 20 Protection EEGEN 21 Protection Long Term TE issue A E E 22 IS e 23 Goals and Priorities sise 26 Mills ELE 27 Other Informations 28 Appendix 1 Employment additional forms 31 Page ii Financial Planning Questionnaire Confidential Financial Review Appendix 2 Other Income
29. n below Notes Enter additional information below 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 CF L Personal Policy Income Protection Policy 2 RER TESTS Fo 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 e Paid _ Monthly CHED e of sala Paid _ Monthly 4 L Annually F4 Employee Benefit Paid _ Monthly d een Paid _ Monthly CHEB Jes of salar Paid _ Monthly 4 Ki Annually Advisors Note Not currently importable Confidential Financial Review Notes Enter additional information below Additional income protection Click here for additional forms Financial Planning Questionnaire Protection Critical Illness ea Confidential Financial Review Use the following forms if needed to tell us about critical illness cover you want to consider in your fin
30. n your financial plan L Death in Service Life Assurance B Death in Service Widow s Pension L Stock Purchase Plan Other please specify in notes right Advisors Note Indicates importable value Employment 2 You L Spouse Partner CO E C C Yes No Yes No Yes L No Money Purchase Final Salary O Income Protection Redundancy Cover L Death in Service Life Assurance L Death in Service Widow s Pension Stock Purchase Plan DI 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 Financial Planning Questionnaire Other Income ee et Confidential Financial Review Tell us details of any other income sources apart from employment pensions and annuities Other income sources might include rental income or royalties for example Other Income 1 Other Income 2 Other Income Source Enter additional information below Is this income taxable L Yes L No L Yes O No Expected duration Earner Recipient You Spouse Partner You C Spouse Partner Other Income 3 Other Income 4 Other Income Source Enter additional information below Is this income taxable L Yes L No C Yes L No mm Expected duration Earner Recipient C You Spouse Partner
31. nterest Rate Associated Home Property Name or Description Type of Debt Outstanding Balance Repayment Amount Interest Rate Owner s of Debt You L Spouse Partner B Owned Jointly Coo Advisors Note Indicates importable value Associated Home Property Cups E E Yearly L Monthly Yes 0 000 Interest Only Loan C No C Owner s of Debt Yeu Spouse Partner Owned Jointly 6 0 s 0 L Yearly L Monthly Yes 0 000 Interest Only Loan L No CD GCLLLLLLI Financial Planning Questionnaire E 1j CS L Yearly m Monthly Yes 0 000 Interest Only Loan O No _ You Spouse Partner a Owned Jointly WE Baa 0 000 Interest Only Loan L No a You L Spouse Partner L Owned Jointly CD Confidential Financial Review Notes Enter additional information below Notes Enter additional information below Entries completed Click here to go to the next step in the questionnaire Appendix 9 Protection Term Life additional forms Financial Planning Questionnaire Confidential Financial Review Use the following forms if needed to tell us about additional term life policies you want to consider in your financial plans 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 P
32. of salary annual contribution amount or of salary annual contribution amount or of salary Money Purchase 3 Money Purchase 4 t ersonal Fension Purchase SNA PERSON Enter additional information below Owner L You Spouse Partner E You Spouse Partner Employer Account Balance Retirement Age C um If applicable amount before tax or as Your Contributions of salary annual contribution amount or of salary annual contribution amount or of salary Enter either as an annual Contributions Additional money purchases amount or as of salary annual contribution amount or of salary annual contribution amount or 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 future 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 You Spouse Partner BR Yes L No L L Yes EE Monthly Final Salary 3 You Spouse Partner e ves
33. penses Confidential Financial Review Household Expense Worksheet continued Advisors Note Indicates importable value Expense Amount KE Monthly L Yearly E Monthly L Yearly E Monthly L Yearly C Monthly Yearly L Monthly Yearly L Monthly L Yearly L Monthly Yearly E Monthly L Yearly L Monthly Yearly L Monthly Yearly L Monthly Yearly L Monthly L Yearly L Monthly Yearly L Monthly Yearly Monthly L Yearly Monthly L Yearly L Monthly E Yearly C Monthly Yearly Monthly L Yearly Monthly L Yearly Monthly L Yearly Monthly L Yearly L Monthly L Yearly CH Monthly Yearly C Monthly Yearly Page Financial Planning Questionnaire Confidential Financial Review Goals and Priorities Please indicate how relevant the following goals and life events are to you Check the appropriate box next to each question 1 being of little relevance or low priority 5 being very relevant or of high priority Advisors Note Not importable Page How relevant are the following objectives and life events to you Basic financial coaching budgeting saving and investing Plan for future retirement Financial advice related to changes in marital status marriage or divorce Manage present retirem
34. portable 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 Do oe Name or Description Enter additional information below ov GD If unknown leave blank Purchase Value T Owner s You L Spouse Partner C Owned Jointly You Spouse Partner E Owned Jointly If yes enter details under Mortgage Other L Yes C No L Yes C No Debts and Mortgages Associated Debts Income from L No E Yearly LJ No Yearly e g rental income Property Li Yes 1 Monthly Yes 1 C Monthly Property 3 Property 4 D A PERTRA Enter additional information below D Type of Property Primary Residence Primary Residence ovm D 6 1 If unknown leave blank Purchase Value Owner s You L Spouse Partner C Owned Jointly You Li Spouse Partner D Owned Jointly If yes enter details under Mortgage Other Yes No Yes L No Debts and Mortgages Associated Debts Income from 8 No D Yearly L No Yearly Additional e g rental income Property Yes W Monthly Yes E Monthly properties assets Click here for additional forms Advisors Note Indicates importable value Page Debts Financial Planning
35. portable value Savings Investment 3 Savings Investment 4 Type of Investment Notes e of Investmen j e Savings EECH Savings Account Enter additional information below Bank or Institution Owner s You Spouse Partner L Owned Jointly You Spouse Partner Owned Jointly Current Balance 1 1 1 O os 24x00 SON Ha 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 Purchase Personal Pension Enter additional information below Owner You O Spouse Partner a You a Spouse Partner Employer Account Balance Retirement Age i If applicable ee i i pa t e Sai amount before tax or as Your Contributions of salary annual contribution amount or of salary annual contribution amount or of salary A ide as Mei Rn dd i deii fe Me Enter either as an annual Contributions amount or as
36. rtable Page Financial Planning Questionnaire Confidential Financial Review Notes Enter additional information below Notes Enter additional information below 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 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 E You Spouse Partner C CS Self Employed or Company Owner Yes L No Yes No Pensions and Other Benefits ves L No 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 C Money Purchase Final Salary Other benefits for L Income Protection Redundancy Cover consideration i
37. s if applicable Advisors Note Indicates importable value Type of Investment or Savings Name of Account Bank or Institution Owner s Current Balance Regular Contributions Remaining Term Savings Investment 7 Savings Account L O You Spouse Partner Owned Jointly vou Spouse Partner Owned Jointly as if applicable 1 Years if applicable Appendix 3 Savings and Investments additional forms Savings Investment 6 Use the following forms if needed to tell us about additional savings and investments you want to consider in your financial plans a Years if applicable Savings Investment 8 Per year if applicable CE ED Years if applicable Per year if applicable Financial Planning Questionnaire Confidential Financial Review Notes Enter additional information below Notes Enter additional information below Entries completed Click here to go to the next step in the questionnaire Page Financial Planning Questionnaire Appendix 3 Savings and Investments additional forms continued Confidential Financia Review Savings Investment 9 Savings Investment 10 Notes SP G otinvesiment Savings Account Savings Account Enter additional information below or Savings Sa D S Bank or Institution gt Owner s You Spouse Partner L Owned Jointly You Spouse Partner Owned Jointly amas ume E
38. tionnaire If other please specify Type of Debt Mortgage If mortgage Home Property Financial Planning Questionnaire Appendix 8 Debts additional forms Confidential Financial Review Use the following forms if needed to tell us about additional debts you want to consider in your financial plans Debt 5 Debt 6 Description Notes Enter additional information below Balance 1 g Yearly Yearly Amount E Monthly W Monthly o Yes Yes Interest Rate 0 000 Interest Only Loan E No 0 000 Interest Only Loan a No Owner s of Debt you L Spouse Partner Owned Jointly You L Spouse Partner Owned Jointly Debt 7 Debt 8 Description Notes Enter additional information below M If other please specify Type of Debt ortgage Mortgage If mortgage Home Property Page T Balance Yearl Yearl Amount C Monthly m Monthly Yes Yes Interest Rate 0 000 Interest Only Loan No 0 00096 Interest Only Loan C No Owner s of Debt vou Spouse Partner Owned Jointly You L Spouse Partner Owned Jointly Entries completed Click here to go to the next step in the questionnaire Advisors Note Indicates importable value Appendix 8 Debts additional forms continued If other please specify If mortgage If other please specify If mortgage Page Name or Description Type of Debt Outstanding Balance Repayment Amount
39. y Single _ Joint Life If Joint Life Survivor Percentage O Non Pension Annuity 6 L You L Spouse Partner C E L Pension L Yes E No payments are deferred CD L Monthly Il Single Joint Life If Joint Life Survivor Percentage L Non Pension Annuity 8 E You L Spouse Partner BE o Pension L Non Pension F Yes D No payments are deferred ss m Monthly Single Joint Life If Joint Life Survivor Percentage Financial Planning Questionnaire Confidential Financial Review Notes Enter additional information below Notes Enter additional information below Entries completed Click here to go to the next step in the questionnaire Financial Planning Questionnaire Appendix 7 Property and Other Assets additional forms Use the following forms if needed to tell us about additional properties and other assets you want to consider in your financial plans Property 5 Property 6 If unknown leave blank Purchase Value T T Owner s You L Spouse Partner Owned Jointly Yeu Spouse Partner Owned Jointly If yes enter details under Mortgage Other DW Yes L No E Yes L No Debts and Mortgages Associated Debts L No Yearly No Yearly Income from e g rental income Property L Yes C Monthly C Yes E Monthly Property 7 Property 8 Type of Property Primary Residence Primary Residence Current Value CR
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