Financial and Retirement Needs
Confidential/Private
FOR ATTENTION
Anton Du Preez
Fanie Du Preez
TODAY'S DATE:
/
/
PRINCIPLE
CLIENT NAME & SURNAME: MR/MRS/MISS
<select>
MR
MRS
MISS
ID NUMBER:
INCOME TAX NUMBER:
SMOKER:
<select>
YES
NO
QUALIFICATION:
<select>
No Matric
Matric
3 Years plus Diploma
3 Years minus Diploma
3 Year Degree
Professional
OCCUPATION:
GROSS ANNUAL INCOME:
R
RETIREMENT FUNDING INCOME:
R
(The portion that
is
used as the calculation for Pension Provident Fund contribution)
NON- RETIREMENT FUNDING INCOME:
R
(The portion
not
used as the calculation for Pension Provident Fund contribution)
EMPLOYED / SELF EMPLOYED:
<select>
EMPLOYED
SELF EMPLOYED
MARRIED:
<select>
YES
NO
TYPE:
<select>
COM. OF PROPERTY
ANC
ACCRUAL
DATE OF MARRIAGE:
/
/
SPOUSE
CLIENT NAME & SURNAME: MR/MRS/MISS:
<select>
MR
MRS
MISS
ID NUMBER:
SMOKER:
<select>
YES
NO
INCOME TAX NUMBER:
QUALIFICATION:
<select>
No Matric
Matric
3 Years plus Diploma
3 Years minus Diploma
3 Year Degree
Professional
OCCUPATION:
GROSS ANNUAL INCOME:
R
RETIREMENT FUNDING INCOME:
R
(Normally your salary)
NON- RETIREMENT FUNDING INCOME:
R
(Normally fringe benefits)
EMPLOYED / SELF EMPLOYED:
<select>
EMPLOYED
SELF EMPLOYED
CONTACT INFO
PRINCIPLE
WORK TEL NUMBER:
CELL:
FAX:
EMAIL:
SPOUSE
:
WORK TEL NUMBER:
CELL:
FAX:
EMAIL:
PHYSICAL ADDRESS:
POSTAL ADDRESS:
CHILDREN
YES / NO:
<select>
YES
NO
IF YES
NAMES:
1)
DATE OF BIRTH:
/
/
2)
DATE OF BIRTH:
/
/
3)
DATE OF BIRTH:
/
/
RISK INFORMATION STARTS HERE
DO YOU HAVE A MEDICALL AID? IF YES, THEN PLEASE PROVIDE NAME AND PRICE.
DO YOU HAVE AN UP TO DATE WILL? IF YES, THEN PLEASE PROVIDE NAME OF EXECUTOR?
IF NOT, THEN WOULD YOU LIKE US TO DRAFT A WILL FOR YOU AT NO COST THROUGH THE MEADOW TRUSTEES?
<select>
YES
NO
YOUR CURRENT DEBT
(Please provide the current outstanding debt amounts and interest rates)
BOND / HOME LOAN DEBT:
R
@PRIME MINUS
%
ANY OTHER PROPERTY DEBT:
R
CAR DEBT AMOUNT/S:
R
@PRIME MINUS
%
ANY OTHER DEBT AMOUNTS:
R
(E.g. student or personal loans)
TOTAL DEBT AMOUNT ADDS UP TO:
R
YOUR WORK/EMPLOYMENT BENEFITS
(Speak to your HR or ask around for your latest info on pension / provident fund)
LIFE COVER AMOUNT
WHAT IS THE LIFE COVER AMOUNT THAT YOUR COMPANY PROVIDENT/PENSION OR GROUP SCHEME WILL PAY OUT TO YOUR FAMILY TODAY?
R
DISABILITY
WHAT IS THE DISABILITY AMOUNT THAT YOUR COMPANY PROVIDENT /PENSION OR GROUP SCHEME HAS IN PLACE FOR YOU TODAY AND IS IT A LUMPSUM OR DISABILITY INCOME PM?
R
IF IT IS THE USUAL 75% OF GROSS INCOME PM, THEN
WHAT IS THE WAITING PERIOD BEFORE THIS DISABILITY INCOME THAT MIGHT BECOME PAYABLE TO YOU? (NORMALLY IT IS 3–6 MONTHS)
MONTHS
CONFIRM HERE THAT YOU WILL OR WILL NOT RECEIVE AN INCOME FROM YOUR WORK DURING THE ABOVE WAITING PERIOD:
<select>
YES
NO
YOUR RISK WISHES AND NEEDS
UPON DEATH TODAY
CAPITAL AMOUNT
TOTAL DEBT/CAPITAL AMOUNT YOU WISH TO SETTLE UPON DEATH TODAY:
R
HOW MUCH INCOME IN TODAYS VALUE, UPON YOUR DEATH, WOULD YOU LIKE TO PAY TO YOUR SPOUSE AND THE REST OF YOUR FAMILY
R
PM FOR
YEARS (EG. TO AGE 60 OF YOUR SPOUSE)
OR THE CHILDRENS AGE:
YEAR (e.g. 25)
UPON DISABILITY TODAY
WHAT IS YOUR NETT TAKE HOME PAY INTO YOUR BANK ACCOUNT PER MONTH:
R
YOUR INVESTMENT INFORMATION STARTS HERE
COMPANY SAVINGS
DO YOU BELONG TO A PENSION OR PROVIDENT FUND:
<select>
PENSION FUND
PROVIDENT FUND
NOTHING
WHAT IS THE FUND VALUE TODAY:
R
EMPLOYER CONTRIBUTION IS:
R
PM OR A % OF WHAT? R
EMPLOYEE CONTRIBUTION IS:
R
PM OR A % OF WHAT? R
INVESTMENT NEEDS SECTION STARTS HERE
EMERGENCY FUND
<select>
YES
NO
HOW MUCH IS IN YOUR ACCOUNT TODAY?
R
WHAT % RETURN IS IT GROWING P.A?
%
WHAT IS THE PURPOSE OF THIS SAVINGS FOR YOU?
WHEN DO YOU NEED THIS CASH FUND AVAIBLE TO YOU?
DO YOU HAVE AN EMERGENCY FUND FOR UNEXPECTED CAPITAL NEEDS?
<select>
YES
NO
IF SO HOW MUCH CAPITAL DO YOU HAVE AVAILABLE IN CASE OF AN EMERGENCY?
R
EDUCATION
<select>
YES
NO
HOW MANY YEARS LEFT BEFORE YOU NEED THESE SAVINGS TO BE AVAILABLE?
HOW MUCH IN TODAYS VALUE DO YOU REQUIRE AT THE END OF THE ABOVE TERM?
R
PLANNING FOR RETIREMENT
<select>
YES
NO
WITH HOW MUCH INCOME PM BEFORE GROSS TAX IN TODAY'S TERMS WOULD YOU LIKE TO RETIRE WITH?
PM
RETIREMENT AGE FROM:
<select>
55
60
65
70
55 / 60 / 65 / 70
UNTIL WHAT AGE AFTER RETIREMENT WOULD YOU NEED THIS INCOME PAYABLE TO YOU?
OTHER INCOME EARNED PM:
R
(E.g. rental income)
IN GENERAL ABOUT INVESTMENTS
HOW MUCH DO YOU WANT TO INVEST?
R
WILL THIS BE PER MONTH OR A LUMP SUM AMOUNT?
<select>
PER MONTH
LUMP SUM
FOR WHAT PERIOD DO YOU NEED TO INVEST?
ADDITIONAL COMMENTS REGARDING YOUR INVESTMENT NEEDS:
*
SERVICE FROM YOUR FINANCIAL PLANNER / BROKER
WHAT LEVEL OF SERVICE DO YOU NEED FROM YOUR ADVISOR?
*
A MEETING ONCE
OR
TWICE A YEAR:
<select>
ONCE A YEAR
TWICE A YEAR
ADDITIONAL COMMENTS/REMARKS
*
I
HEREBY ACKNOWLEDGE THAT THE INFORMATION SUPPLIED BY ME IS TRUE AND ACCURATE, TO THE BEST OF MY KNOWLEDGE
The above information was supplied by me for attention
Anton du Preez / Fanie Du Preez
*Please ensure you have have made your selection of Financial Planner that should receive this information before you submit. (top of the form)
