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Initial Consultation Questionnaire
1.
Title
Mr
Mrs
Ms
Miss
Dr
2.
Surname
3.
First Name
4.
Preferred Name
5.
Date of Birth
Date / Time
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
6.
Occupation
7.
Employer
8.
Employment Status
Full-time
Casual
Part-time
Contract/Self-employed
Retired
Unemployed
9.
Salary/Wage/Net Profit (before tax)
10.
Partner Title
Mr
Mrs
Ms
Miss
Dr
11.
Partner Surname
12.
Partner First Name
13.
Partner Preferred Name
14.
Partner Date of Birth
Date / Time
Date
January
February
March
April
May
June
July
August
September
October
November
December
1900
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
Su
Sunday
Mo
Monday
Tu
Tuesday
We
Wednesday
Th
Thursday
Fr
Friday
Sa
Saturday
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
15.
Partner Employer
16.
Partner Occupation
17.
Partner Employment Status
Full-time
Casual
Part-time
Contract/Self-employed
Retired
Unemployed
18.
Partner Salary/Wage/Net Profit (before tax)
19.
Marital Status
Single
Married
De facto
Divorced
Separated
Widowed
*
20.
Residential Address
(Required.)
Address
Address 2
Suburb/Town
State
Postcode
Email Address
Mobile Phone Number
*
21.
Postal Address
Address
Address 2
Suburb/Town
State
Postcode
22.
Combined Estimated Living Expenses (excl. loan commitments)
$30,000 - $35,000 per annum
$35,000 - $40,000 per annum
$40,000 - $45,000 per annum
$45,000 - $50,000 per annum
$50,000 - $55,000 per annum
$55,000 - $60,000 per annum
Above $60,000 per annum
23.
Total Bank Balances including offset accounts
24.
Total Home Loans Owing
25.
Investment Properties Total Value
26.
Investment Loans Owing
27.
Combined Super Fund Balances
28.
Total Number of Super Funds Combined
1
2
3
4
5
29.
Super Fund Names
Super Fund 1
Super Fund 2
Super Fund 3
Super Fund 4
Super Fund 5
30.
Do you have a share portfolio?
Yes - Less than $50,000 in value
Yes - More than $50,000 in value
No
31.
Have you insured your income?
Yes
No
32.
Has your partner insured their income?
Yes
No
33.
Are you paying too much tax?
Yes
No
34.
Is your partner paying too much tax?
Yes
No
35.
Do you salary sacrifice into super?
Yes
No
36.
Does your partner salary sacrifice into super?
Yes
No
37.
Do you salary package benefits at work?
Yes
No
38.
Does your partner salary package benefits at work?
Yes
No
39.
Are you happy with your work-life balance?
Yes
No
40.
Do you have any interests outside of work that you are passionate about?
Yes
No
Details:
41.
Do you know how much income you will need in retirement?
Yes
No
42.
Are you worried about running out of money in retirement?
Yes
No
43.
Are you aware that investing in property can be part of a retirement strategy?
Yes
No
44.
Do you understand Centrelink income and assets testing?
Yes
No
45.
Have you spoken with a Financial Planner before?
Yes
No
*
46.
How did you find us?
(Required.)
Google
Police Credit Union
My friend or relative is a client and referred us
We were referred by another business
Have seen the premises
Other (please specify)
47.
This is the brain dump section - What do you need some help with? What is concerning you? What is on your bucket list? When do you want to retire?
48.
How urgent is the appointment?
I/We have decided to get advice and would like to speak to someone within the month.
I have a time critical issue that is distressing and need urgent assistance.
Any time that suits is fine.
