Fact Find - DFG Wealth

About You

Tell us a little about yourself

Name*

Date of Birth*

Marital Status*

Your Partner's Name*

Date of Birth - Partner*

Do you have any Children/Dependents?*

Yes
No

Please provide details*

Please click + Symbol for additional Children/Dependants

Name	Date of Birth

How can we reach you?

Please provide your contact details so we can get in touch when needed.

Phone Number*

Email*

Phone Number - Partner*

Email - Partner*

Home Address*

Is your postal address the same as your home address?*

Yes
No

Postal Address*

What do you do for work?

We'll need these details to help us build your financial plan.

Employment Status*

Employment Details*

Click the + symbol to add a new line for additional employment

Employer	Occupation	Hours per Week (approx)	Annual Wage (approx)

Self-Employment Details*

Click the + symbol to add a new line for additional employment

Name of Business	Type (ie. Company, Sole Trader, Partnership, Trust)	Occupation	Your annual income from business (approx)

How long have you been retired for?*

Do you receive the Government Age Pension?*

Yes
No

How much Age Pension do you currently receive per fortnight?*

Do you receive an allocated pension (from your own super)?

Yes
No

Allocated Pensions Details*

Name of Fund	Monthly Amount

How long have you been unemployed for?*

Do you have a confirmed employment arrangement lined up in the near future?*

Yes
No

Please detail your future Employment Arrangement

Employer	Occupation	Hours per week (Approx)	Annual Wage (Approx)

Do you have any sources of income other than those already mentioned?*

This could include any income from rent, investments, dividends, government allowances or payments, pensions, transition to retirement arrangements or any other ongoing income not already disclosed.

Yes
No

Other sources of income*

Click the + symbol to add a new line for additional incomes

Description	Annual Income Received (Approx.)

Approximately how much are you able to save per month?*

Your Partner's Employment Status*

Employment Details - Partner*

Click the + symbol to add a new line for additional employment

Employer	Occupation	Hours per Week (approx)	Annual Wage (approx)

Self-Employment Details - Partner*

Click the + symbol to add a new line for additional employment

Name of Business	Type (ie. Company, Sole Trader, Partnership, Trust)	Occupation	Your annual income from business (approx)

How long has your partner been retired for?*

Does your partner receive the Government Age Pension?*

Yes
No

How much Age Pension does your partner currently receive per fortnight?*

Does your partner receive an allocated pension (from their super)?

Yes
No

Allocated Pensions Details - Partner*

Name of Fund	Monthly Amount

How long has your partner been unemployed for?*

Does your partner have a confirmed employment arrangement lined up in the near future?*

Yes
No

Please detail your partner's future Employment Arrangement

Employer	Occupation	Hours per week (Approx)	Annual Wage (Approx)

Does your partner have any sources of income other than those already mentioned?*

This could include any income from rent, investments, dividends, government allowances or payments, pensions, transition to retirement arrangements or any other ongoing income not already disclosed.

Yes
No

Other sources of income - Partner*

Description	Annual Income received (Approx)

Approximately how much does your partner save per month?*

Tell us about your Superannuation

Do you have any Superannuation?*

Yes
No

Your Super*

If multiple funds, please click the + symbol to add a new line.

Fund Name	Amount

Does your Partner have any Superannuation?*

Yes
No

Your Partner's Super*

If multiple funds, please click the + symbol to add a new line.

Fund Name	Amount

Your Assets

Tell us about what you (and/or your partner) own.

Do you own your Home?*

Yes
No

How much do you think it's worth?*

Do you intend on buying a home soon?*

Yes, we're currently looking.
Yes, we've put down a deposit!
Not in the near future

Approximately how much are you looking to spend?*

What's the purchase price?*

Please enter a number from 50000 to 100000000.

Do you (or your partner) own any investment properties?*

Yes
No
Not yet. We have purchased, but yet to settle

Investment Property Details*

If multiple properties, please click the + symbol to add a new line. Please include details of any properties purchased, but not yet settled.

Address	Estimated Value	Monthly Rent	Owner (ie. You, Partner, Joint)

Do you (or your partner) own any Investments other than Property or Super?*

Yes
No

Investments*

Please click the + symbol to add a new line for each Investment. These can include (but not limited to) Savings, Shares, Managed Funds, Equity in a Business or anything else you consider an investment for future benefit.

Description of Investment	Estimated Value

Please list any personal or other assets*

Please click the + symbol to add a new line for each Asset. These can include (but not limited to) Vehicles, Home Contents, Cash, Jewellry etc.

Description of Asset	Estimated Value

Your Liabilities

Tell us a bit about what you (and/or your partner) owe to the bank or any other lenders.

Do you (or your partner) have any Liabilities?*

Any loans you may have including Mortgages, Car loans, HECS-HELP, tax debts, personal loans, money owed to friends or family etc.

Yes
No

Liabilities*

If multiple debts, please click the + symbol to add a new line.

Lender	Type (ie. Home Loan, Car Loan, Credit Card)	Amount Owing	Facility Limit	Repayment Amount	Repayment Frequency (ie. Monthly, Weekly)

Personal Insurance & Estate Planning

Please tell us what you have in place to protect yourself, your wealth and your family.

Do you have any of the following Insurance Cover?*

Life Insurance
Total & Permanent Disability Insurance (TPD)
Income Protection
Trauma (Critical Illness) Insurance
Health Insurance
None of the Above

Life Insurance Details*

Click the + symbol if more than one policy

Insurer	Amount Insured	Monthly Premium (Cost)

TPD Insurance Details*

Click the + symbol if more than one policy

Insurer	Amount Insured	Monthly Premium (Cost)

Income Protection Details*

If you have more than one income protection policy please list the most comprehensive one here and give details of any other in the comments section below.

Insurer	Monthly Amount Insured	Monthly Premium (Cost)

What's the waiting period for your Income Protection?*

What's the Benefit Period for your Income Protection?*

Trauma Insurance Details*

Click the + symbol if more than one policy

Insurer	Amount Insured	Monthly Premium (Cost)

Health Insurance Details*

Insurer	Monthly Premium

Are any of your insurance premiums paid for through Super?*

Yes
No

Which of your insurance premiums are paid through Super?*

Select All
LIfe
TPD
Income Protection

Does your partner have any of the following Insurance Cover?*

Life Insurance
Total & Permanent Disability Insurance (TPD)
Income Protection
Trauma (Critical Illness) Insurance
Health Insurance (own policy)
Health Insurance (covered under joint policy)
None of the Above

Life Insurance Details - Partner*

Click the + symbol if more than one policy

Insurer	Amount Insured	Monthly Premium (Cost)

TPD Insurance Details - Partner*

Click the + symbol if more than one policy

Insurer	Amount Insured	Monthly Premium (Cost)

Income Protection Details - Partner*

If you have more than one income protection policy please list the most comprehensive one here and give details of any other in the comments section below.

Insurer	Monthly Amount Insured	Monthly Premium (Cost)

What's the waiting period for your Partner's Income Protection?*

What's the Benefit Period for your Partner's Income Protection?*

Trauma Insurance Details - Partner*

Click the + symbol if more than one policy

Insurer	Amount Insured	Monthly Premium (Cost)

Health Insurance Details - Partner*

Insurer	Monthly Premium

Are any of your partner's insurance premiums paid for through Super?*

Yes
No

Which of your partner's insurance premiums are paid through Super?

Select All
Life
TPD
Income Protection

Do you have a Will?*

Yes
No

Is your Will up to date?*

Yes
No

Your Goals & Objectives

In order to help you as much as we can, please tell us a little about why you'd like to work with us.

Areas You Would like to Discuss*

Please select all options that you are interested in.

Please Describe...*

Please details any specific goals you may have.

If applicable, In your own words, please tell us any specific goals you might have. These may include goals such as: "make sure I have enough money in retirement," "Get Income Protection to protect myself and family," or "Gain piece of mind that I'm doing everything I can to ensure financial security." Don't despair if you can't think of any, as we can help you formulate some goals to aim for.

And Finally...

Please tell us any other relevant information that may not have fit into any of the previous sections...

Comments

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