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Phone :

02 8021 5805

Address :

202/40 Yeo St, Neutral Bay NSW 2089, Australia

Email :

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Client Discovery

WELCOME TO Secured Wealth

Client Discovery

NEW CLIENT - PERSONAL INFORMATION
Personal Details
DEPENDANTS
ESTATE PLANNING
MEDICAL HISTORY
INCOME/EXPENDITURE ANALYSIS
ASSETS
LIABILITIES

NEW CLIENT - PERSONAL INFORMATION

How many people are applying together?

One

Two

Your email address

Please Note : Your personal information will never be shared without your prior permission, please refer to our Financial Services Guide for more information. All information contained within our website is of a general nature and does not take into consideration your personal circumstances.

Personal Details

All clients need to complete this section

Owner 1

Owner 2

Are you fluent in English?

Yes

Are you fluent in English?

Yes

Do you require the assistance of an interpreter?

Yes

Do you require the assistance of an interpreter?

Yes

First Person

Second Person

Legal Name

Prefix First Last

Legal Name

Prefix First Last

Preferred Name

(if applicable)

Preferred Name

(if applicable)

Marital status

Date of Birth

Retirement Age

(if unsure choose age 65)

Retirement Age

(if unsure choose age 65)

Have same address

Yes

Address

Street Address City State / Province / Region Postal Code Country

Address

Street Address City State / Province / Region Postal Code Country

Phone

Occupation

Qualifications

Breakdown of occupation duties

(administration, manual, travel ,office based, on site etc)

Breakdown of occupation duties

(administration, manual, travel ,office based, on site etc)

Employment status

Full-Time

Part-Time

Self-employed

Unemployed

Homemaker

Retired

Employment status

Full-Time

Part-Time

Self-employed

Unemployed

Homemaker

Retired

Employer Name

Start date

Date

If self-employed, what is the business structure?

Sole Trader

Company

Partnership

If self-employed, what is the business structure?

Sole Trader

Company

Partnership

Partnership Split (%)

Smoking status

Yes

Smoking status

Yes

Accrued sick leave (days)

Accrued annual leave (days)

Accrued long service leave (days)

Hours worked per week

DEPENDANTS

Do you have any dependants?

Yes

Name

DOB

Relationship

What age would you expect dependancy to cease?

(commonly 18 or 21)

Name

DOB

Relationship

What age would you expect dependency to cease?

(commonly 18 or 21)

Name

DOB

Relationship

What age would you expect dependancy to cease?

(commonly 18 or 21)

Name

DOB

Relationship

What age would you expect dependancy to cease?

(commonly 18 or 21)

Name

DOB

Relationship

What age would you expect dependancy to cease?

(commonly 18 or 21)

Name

DOB

Relationship

What age would you expect dependancy to cease?

(commonly 18 or 21)

Name

DOB

Relationship

What age would you expect dependancy to cease?

(commonly 18 or 21)

Name

DOB

Relationship

What age would you expect dependancy to cease?

(commonly 18 or 21)

Name

DOB

Relationship

What age would you expect dependancy to cease?

(commonly 18 or 21)

Name

DOB

Relationship

What age would you expect dependancy to cease?

(commonly 18 or 21)

Name

DOB

Relationship

What age would you expect dependancy to cease?

(commonly 18 or 21)

Add more

ESTATE PLANNING

Owners

Will

Do you have a Will?

Yes

Do you have a Will?

Yes

What is the date of your Will?

DD slash MM slash YYYY

What is the date of your Will?

DD slash MM slash YYYY

Is your Will current?

Yes

Is your Will current?

Yes

Do you have an Power of Attorney?

Superannuation

Which super fund(s) do you hold? please list all

Have you made nominations on death?

Yes

Unsure

Have you made nominations on death?

Yes

Unsure

If yes, please provide nomination details?

If yes, please provide nomination details ?

Have you ever been declared bankrupt?

Yes

Have you ever been declared bankrupt?

Yes

MEDICAL HISTORY

Owners

Medical History

What is your height?

What is your weight?

Do you have any known medical conditions?

Yes

Do you have any known medical conditions?

Yes

Have you had any previous operations?

Yes

Have you had any previous operations?

Yes

Are you currently taking any medications?

Yes

Are you currently taking any medications?

Yes

Do you suffer from back/neck pain?

Yes

Do you suffer from back/neck pain?

Yes

Do you suffer from Anxiety or Depression?

Yes

Do you suffer from Anxiety or Depression?

Yes

If yes to any of the above please provide the details here:

(Your response should include the diagnosis, the date symptoms started, date they resolved (if it has), what treatment you received and any ongoing complications)

Family History

Has anyone in your Immediate family had the following? (Brother, Sister, Parents only):

Cancer

Yes

Cancer

Yes

Heart attacks

Yes

Heart attacks

Yes

Stroke

Yes

Stroke

Yes

Motor Neuron/MS

Yes

Motor Neuron/MS

Yes

Please provide who it affected, what age they were diagnosed and any other relevant information

INCOME/EXPENDITURE ANALYSIS

Owners

Income

Salary and Wages (including super)

Other

Income Type i.e. Bonus, Retal/Investment

Other

Income Type i.e. Bonus, Retal/Investment

Other

Income Type i.e. Bonus, Retal/Investment

Other

Income Type i.e. Bonus, Retal/Investment

Other

Income Type i.e. Bonus, Retal/Investment

Other

Income Type i.e. Bonus, Retal/Investment

Other

Income Type i.e. Bonus, Retal/Investment

Other

Income Type i.e. Bonus, Retal/Investment

Other

Income Type i.e. Bonus, Retal/Investment

Other

Income Type i.e. Bonus, Retal/Investment

Other

Income Type i.e. Bonus, Retal/Investment

Add more

Total combined income (before tax)

Expenses

Frequency

Weekly

Fortnightly

Monthly

Yearly

Living expenses

Rent/home mortgage

Other