Individual Pre-appointment Questionnaire

Section 1 – Contact Information

Client Details:

Title (eg. Ms, Mr, Mrs)(Required)

Surname:(Required)

First Name:(Required)

Middle Name/s:

Also known as/preferred name:

Date of Birth:(Required)

Gender Identity:(Required)

Occupation:(Required)

Contact Number:(Required)

What prompted you to make an appointment?(Required)

Which seminar did you attend?(Required)

Please let us know what prompted you to make an appointment:(Required)

Postal Address:(Required)

List postal address here:(Required)

Section 2 – Relationship

If you have additional Marriages/Divorces, please state the details at the end of the questionnaire

Relationship status:(Required)

Deceased Spouse/Partner Full Name:

Separated Spouse/Partner Full Name:

Spouse/Partner's Full Name:

Date of Registration:

Date of Marriage:

Place of Marriage:

Spouse/Partner Full Name:

Length of Relationship:

Date of Divorce:

Place of Divorce:

Ex Spouse/Partner Full Name:

Spouse/Partner Full Name:

Spouse/Partner's Date of Birth:

Spouse/Partner's Address:

Spouse/Partners Address:

Please add additional information below: (eg. Separated but in a new relationship)

Section 3 – Children

Please include Step Children and/or any Children you are estranged from. Additional Children can be listed at the end of the questionnaire

Do you have Children?(Required)

Child's Full Name:

Date of Birth:

Gender Identity:

Relationship to Child:

Address:

Contact Number:

Email:

Is this child under a disability?

If yes, state disability:

Child 2

Please include Step Children and/or any Children you are estranged from. Additional Children can be listed at the end of the questionnaire

Childs Full Name:

Date of Birth:

Gender Identity:

Relationship to Child:

Address:

Contact Number:

Email:

Is this child under a disability?

If yes, state disability:

Do you have any more children?(Required)

Child 3

Please include Step Children and/or any Children you are estranged from. Additional Children can be listed at the end of the questionnaire

Childs full name:

Date of Birth:

Gender Identity:

Relationship to Child:

Address:

Contact Number:

Email:

Is this child under a disability?

If yes, state disability:

Do you have any more children?(Required)

Section 4 – Household Goods and Personal Contents

Please state any additional contents details at the end of the questionnaire

Brief description of contents:

Eg, General Household Goods or if you have a Special Collection please briefly state

How are these assets owned?

If jointly owned please state with whom

Estimated market value:

Section 5 – Motor Vehicles, Boats, Campervans ect

Please state any additional vehicles at the end of the questionnaire

Do you own a vehicle?(Required)

Description of vehicle:

eg. Subaru Forester 2017

How are these assets owned?

If jointly owned please state with whom:

Do you have money owing against the vehicle?

Estimated market value:

Do you own any other types of vehicles?(Required)

Additional Vehicle:

Please state any additional vehicles at the end of the questionnaire

Description of Vehicle:

eg. Subaru Forester 2017

How are these assets owned?

If jointly owned please state with whom:

Do you have money owing against the vehicle?

Estimated market value:

Do you own any additional vehicles?(Required)

Section 6 – Property Details

Please state any additional properties at the end of the questionnaire

Do you own real estate?(Required)

How is the property held:

Property Type:

How is the property owned?

If jointly owned please state with whom:

If tenants in common please state interest held:

Location of title deeds:

Location of deed:

Estimated value:

Is there a mortgage over this property?

Mortgage Financial Institution:

Mortgage Outstanding:

Do you own more real estate?(Required)

Property Two

Please state the additional property details at the end of the questionnaire

How is the property held:

Property Type:

How is the property owned?

If jointly owned please state with whom:

If tenants in common please state interest held:

Location of title deeds:

Estimated value:

Is there a mortgage over this property?

Mortgage Financial Institution:

Mortgage Outstanding:

Do you own any additional real estate?(Required)

Section 7 – Bank Accounts and Investments

Please state any additional bank accounts and investments at the end of the questionnaire

Do you own a bank or investment account?(Required)

Account 1 – Financial Intuition:

How is this account owned?

If jointly owned please state with whom:

Estimated value:

Do you own a second bank or investment account?(Required)

Account 2 – Financial Intuition:

How is this account owned?

Estimated value:

If jointly owned please state with whom:

Do you own any other bank or investment accounts?(Required)

Section 8 – Shares

Please state any additional shares at the end of the questionnaire

Do you own any shares?(Required)

Share company holdings:

(eg. Woolworths, Telstra)

How are these shares owned?

Estimated value:

If jointly owned please state with whom:

Do you own any additional shares?(Required)

Share company holdings:

(eg. Woolworths, Telstra)

How are these shares owned?

Estimated value:

If jointly owned please state with whom:

Do you own any additional shares?(Required)

Section 9 – Liabilities

Do you have any Liabilities? (Eg. Credit cards)(Required)

Please provide details of liability:

How is the liability held?

If jointly held please state with whom:

Estimated value:

Do you have any other liabilities?(Required)

Section 10 – Superannuation

Do you have superannuation?(Required)

Fund name:

Account type:

Account Balance:

Death Benefit:

If yes please state death benefit cover:

Nomination Type:

Nominated to:

Named Beneficiary Name and Relationship to you:

Do you have any additional superannuation accounts?(Required)

Fund name:

Account type:

Account Balance:

Death Benefit:

If yes please state death benefit cover:

Nomination Type:

Nominated to:

Named Beneficiary Name and Relationship to you:

Do you have any additional superannuation accounts?(Required)

Section 11 – Funeral Arrangements

Do you have any funeral arrangements?(Required)

Pre-paid Funeral:

Pre-arranged funeral:

Funeral Insurance:

Please state the details:

Section 12 – Life Insurance

Do you have Life Insurance?(Required)

Fund Name:

Nomination in place:

If yes, please state who it is nominated to:

Beneficiary Name and Relationship to you:

Insurance cover:

Section 13 – Other Assets:

Do you own any Foreign Assets?(Required)

Do you have an interest in a business?(Required)

Additional Information:

(e.g. additional children, real estate, bank accounts, shares, motor vehicles, superannuation, life insurance, foreign assets, business interests, assets held on trust, interest in a deceased estate or intellectual property rights)

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Individual Pre-appointment Questionnaire

Section 1 – Contact Information

Section 2 – Relationship

Section 3 – Children

Child 2

Child 3

Section 4 – Household Goods and Personal Contents

Section 5 – Motor Vehicles, Boats, Campervans ect

Additional Vehicle:

Section 6 – Property Details

Property Two

Section 7 – Bank Accounts and Investments

Section 8 – Shares

Section 9 – Liabilities

Section 10 – Superannuation

Section 11 – Funeral Arrangements

Section 12 – Life Insurance

Section 13 – Other Assets:

Additional Information:

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