Important Notice to Clients:

The information requested in this Client Profile is one of the tools we use to establish a basis for the advice we will provide. It is therefore important for you to complete this document as accurately and fully as possible. Failure to do so could result in advice being provided that is not appropriate to your individual needs, circumstances and objectives.

PERSONAL DETAILS












Health Details




Expected Cover Details







Asset Details

Current Cash and Equivalents.
Please provide details of your current assets

Asset Current Value Offset in event of
Superannuation Balance $ Death or TPD
Cash and savings account $ Death, TPD or Trauma
Investments (Shares, Bonds etc.) $ Death, TPD or Trauma

Assets to be Liquidated
Please provide details of any other assets that may be liquidated if the insured event occurs

Asset Amount Sold event of
Home & Contents $ Death, TPD or Trauma
Investment Property $ Death, TPD or Trauma
Vehicle $ Death, TPD or Trauma

These Assets will offset the amount of insurance you need. In case of your superannuation balance, only Life and TPD insurance needs will be offset.

Liability Details

Home Loan


Other Liabilities
Please specify any liabilities and loans that you would like paid off in the event of death, TPD or Trauma

Liability Current Value Death TPD Trauma
Investment Property Loan $
Investment Loan $
Vehicle Loan $
Credit Cards $
Expenses Details

Please provide details about any ongoing expenses. This includes household, rent, mortgage repayments, education and any other ongoing expenses

Expense Amount Frequency Start Date Duration Death TPD Trauma
$
$
$
$

Other Expenses
Please provide any estimated additional one-time expenses that may occur

Life Insurance

Expense Amount
Funeral Expense $
Specific Expense $
Other Expenses $

TPD Insurance

Expense Amount
House Modification $
Transport Modification $
Medical / Rehabilitation $
Other Expenses $

Trauma Expense

Expense Amount
Recovery $
Medical Expense $
Other Expenses $
Income Details

What is your current Annual income? $
How much is your Partners Income (If its join) $
Investment Income $
How much of this income do you wish to insure? $
Annual superannuation contribution to be insured $



Additional Preferred Income
Please provide details about additional income you/your partner would like ongoing in the event of death, TPD or Trauma

Insured Event Annual Preferred Income Years Covered for
Death $
TPD $
Trauma $
Our Acknowledgment

Information In this form

The information provided in this form Client Profile is complete and accurate to the best of my/our knowledge (except where I/we have indicated that I/we have chosen not to provide the information).

I/We understand and acknowledge that by either not fully or accurately completing the Client Profile, any recommendation or advice given by the adviser in these circumstances may be inappropriate to my/our needs and that I/we risk making a financial commitment to an investment policy that may be inappropriate for the needs identified.

At my request the areas that I require advice on are:

Financial Services Guide

I/We have read and understood the Financial Services Guide version prior to obtaining financial planning services and/or recommendations.

Authority to Adviser

I/We authorise Mr. Amit Sharma of IM Financial Planning to prepare a Statement of Advice.

Statement of Advice Preparation Fee

The fee for the preparation of the Statement of Advice has been set at $ and I/we authorise to proceed on this basis.

Authority for current Adviser

I/We authorise of to contact any of my/our existing advisers whose details I/we have provided.

Information and Privacy Agreement

I/We agree that:

  • 1. Subject to the authorisation of the preparation of a Statement of Advice, I am/we are to receive the following financial planning services from the adviser named in this Client Profile & Lifestyle Questionnaire [“adviser”] and understand that my/our personal information (including any sensitive information such as health information, membership of professional organisations and sexual preferences and practices [“sensitive information”]) is being collected primarily for these purposes:

    · life, trauma insurance and income protection insurance
    · an ongoing review service for my/our investment portfolio or life insurance program.

    Your adviser will only provide you with advice that your adviser is permitted to offer you.

  • 2. I/We also consent to the disclosure of my/our personal information (including my/our sensitive information):
    · to organisations involved in providing my/our adviser with marketing services and to their service providers (for example posting services), so that my/our adviser may offer me/us products and services that might meet my/our financial needs; and
    · to other organisations in connection with the sale or proposed sale of all or part of the adviser’s business and to the use of that personal information by those organisations for those purposes.

  • 3. I/We also consent to the collection of my/our personal information for the purpose of my/our adviser providing the services stated above. This consent also relates to my/our sensitive information.

  • 4. If I/we have provided personal information about an individual (such as a partner, dependant, employer, or accountant) I/we have or will as soon as practicable, provide the individual with a copy of the Privacy Notification Statement (PNS) that was provided to me/us with the Financial Services Guide and made them aware that the PNS applies to their personal information that has been collected for the purpose of my adviser providing me/us with the financial advice I/we have requested.

  • 5. If I/we have provided sensitive information about someone else, I/we have or will obtain the consent of that person to that information being collected by my/our adviser and my/our adviser’s service providers.




*REQUIRED