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.




YOUR PERSONAL INFORMATION

The tables below outline your personal information:

Client 1 Client 2
Date of Birth
Age
Retirement Age
Occupation
Marital Status
Health
Smoker
Private Health Insurance
DEPENDENTS

Dependent name Relationship Date of birth

EMPLOYMENT

First Name Occupation Employment Status Name of Employer Notes
ESTATE PLANNING DETAILS

Who Have will Will location Date prepared Last review date
Client 1
Client 2

GOALS AND OBJECTIVES

Who Description Time frame

Personal advice should ensure that a customer’s objectives are specific, measurable and prioritized. ASIC guidance advises that the reasons or objectives that prompted the customer to seek advice should be clear and recorded in the customer’s own words. The Statement of Advice should clearly explain why the customer is seeking advice and the outcomes the customer wants to achieve.

Consider the asking the client how the client wishes for those goals or objectives to be funded.


FINANCIAL INFORMATION

EMPLOYMENT

First Name Occupation Employment Status Name of Employer
Client 1
Client 2
CASH FLOW POSITION

Income Owner Annual
TOTAL
Expenses Owner Annual expenses
TOTAL
Asset & Liabilities

Lifestyle Assets Owner Existing amount
TOTAL
None Superannuation Assets % Owner Existing amount
TOTAL
Loans Deductible Owner Current amount
TOTAL
Superannuation Accumulation Assets Owner Existing amount
TOTAL
EXISTING INSURANCE DETAILS

Insurace Client 1 Client 2
Death Cover
TPD
Trauma Cover
Income Protection/Salary
Continuance/ Temporary
Disability
In which fund(s) is this insurance cover held?

Our Acknowledgments

Information in this form

The information provided in this form (Client Profile & Lifestyle Questionnaire Sections A and any supplementary pages) 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 & Lifestyle Questionnaire Sections A and B and any supplementary pages, 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.


Financial Services Guide

I/We have read and understood the Financial Services Guide version 2020 prior to obtaining financial planning services and/or recommendations.

Authority to Adviser

I/We authorise AMIT SHARMA of La Verne Advisers Pty Ltd 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 AMIT SHARMA of La Verne Advisers Pty Ltd to proceed on this basis.

Authority for current Adviser

I/We authorise AMIT SHARMA of La Verne Advisers Pty Ltd 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 & Life Style Questionnaire [“adviser”] and understand that my/our personal information (including any sensitive information such as health information, membership of professional organisation and sexual preferences and practices [“sensitive information”]) is being collected primarily for these purposes:

  • Retirement planning
  • Estate planning
  • Superannuation
  • Investment planning
  • Budgeting
  • Managed investment schemes
  • Life, TPD, Trauma insurance and Income Protection insurance
  • Gearing
  • Direct equities
  • Installment warrants
  • Banking including credit and debit products
  • Arranging for the acquisition and disposal of all relevant products of the type described above; and
  • 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 organizations 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 organizations 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 organizations 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, dependent, 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








AMIT SHARMA
*REQUIRED