Name
Date of Birth

Spouse Name
Date of Birth
Email

Telephone (Preferred Contact)

Client Occupation & Salary

Spouse Occupation & Salary

Home Value

Home Address

Home Mortgage

Details of loan
(eg: interest rate, fixed/variable,
principal & interest vs interest only

Investment Property Value

Investment Property Address

Investment Property Mortgage

Details of loan
(eg: interest rate, fixed/variable,
principal & interest vs interest only

Investments (Managed Funds, Shares etc)

Superannuation Fund & Balance

Life Insurance

Yes

No

Amount insured $

Income Protection Insurance

Yes

No

Amount insured $
*comments
T: 02 4227 5511 F: 02 4229 8723 A: 15 Victoria Street, Wollongong NSW 2500
P: PO Box 5429, Wollongong NSW 2520 Email: info@investmentandplanning.com.au