Financial Health Check

Would you like one of our Financial Coaches to have a look at your current financial position? Please complete the form below and click ‘submit’ and we’ll get back to you as soon as possible.

Personal Details
Title *
First Name *
Last Name *
Age *
Email *
What is the best time to contact you? *
If other time please specify
Preferred phone *
Postcode *
Dependants
Do you have any children?
If yes how many?
What are their ages?
Income & Expenditure
Your current income
Your spouses income
Business income
Combined rental income
Other regular income
Estimated annual expenditure
ASSETS & LIABILITIES
Principal Residence
Estimated value of main residence
Mortgage value
Monthly repayments
Investments
Property 1
Estimated value
loan balance
Interest rate
Loan type
Monthly repayments
Property 2
Estimated value
loan balance
Lender
Interest rate
Loan type
Monthly repayments
Property 3
Estimated value
loan balance
Lender
Interest rate
Loan type
Monthly repayments
Property 4
Estimated value
loan balance
Lender
Interest rate
Loan type
Monthly repayments
Shares
Estimated value
loan balance
Lender
Interest rate
Loan type
Monthly repayments
Managed Funds
Estimated value
loan balance
Lender
Loan type
Interest rate
Monthly repayments
Term deposits and cash
Other
Estimated value
loan balance
Lender
Interest rate
Loan type
Monthly repayments
Superannuation
Superannuation Provider

Provider 1
Superannuation Value
Superannuation owner
Superannuation Provider 2

If you have a second Superannuation provider please enter their details
Superannuation Provider 2 value
Superannuation Provider 2 owner
Credit Cards
Credit Limits
Total amount owing
Credit cards
Lenders
Interest rate
Monthly repayments
Personal Loans
Loan balance
Lender
Interest rate
Loan type
Monthly repayments
Insurance
Life Insurance
Do you have life insurance? *

If yes please provide cover details below
Provider
Value
Owner
Life Insurance provider 2

If you have a second provider of life insurance please provide their details
Value
Owner
Income Protection Insurance
Do you have income protection insurance? *

If yes please provide cover details below
Provider
Value
Owner
Provider 2

If you have a second provider of income protection insurance please provide details.
Value
Owner
Trauma Insurance
Do you have trauma insurance? *

If yes please provide cover details below
Provider
Value
Owner
Trauma insurance provider 2

If you have a second trauma insurance provider please provide their details.
Value

If you have a second trauma insurance provider please provide their details.
Owner
Wills & Powers of Attorney
Do you have a current will?

If yes please provide cover details below
When was it last updated?
Do you have a power of attorney?

If yes please provide cover details below
Lifestyle Goals
How much money after all your expenses are paid would you need to earn while you are still working - on top of what you earn, so you can put towards living your ideal lifestyle?
What age would you like to stop work?
How much money would you like to earn per annum when you stop working?
Investment Objectives
What is your current savings per month?
What is your desired savings per month?
What short, medium and long term investment objectives do you have (inc. property, shares, and personal items such as holidays, new car, pay off mortgage, etc)?
Other Information
Is there anything else you would like to add that was not previsouly mentioned?
Where did you hear about us?
If employer, association, or other please specify

Financial Health Check

Financial Health Check

Personal Details

Dependants

Income & Expenditure

ASSETS & LIABILITIES

Principal Residence

Investments

Property 1

Property 2

Property 3

Property 4

Shares

Managed Funds

Other

Superannuation

Credit Cards

Personal Loans

Insurance

Wills & Powers of Attorney

Lifestyle Goals

Investment Objectives

Other Information