Fact Finding

Financial Needs Analysis

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Financial Needs Analysis

Let’s Get Started

Give yourself at least 15 minutes to complete this questionnaire.

A quick look over all the questions will help you prepare any documentation or information you do not know off hand.

Estimates are allowable when stating amounts relating to your Assets & Liabilities.

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Financial Needs Analysis

How You Heard About Us

Have Financial Goals?

Short-Term Goals Short-Term Goals Acquire a Business Become a Millionaire Build Emergency Fund Buy a Home Buy a Rental Property Settle Unsecured Debt Financial Security Get Properly Insured Increase Tax Efficiency Pay Off Debt Plan For Fun Refurb Rental Property Renovate My Home Save For a Vacation Save For Education Save For Retirement Save For Wedding Start a Business Start a Side Hustle OTHER GOAL

Medium-Term Goals Medium-Term Goals Acquire a Business Become a Millionaire Build Emergency Fund Buy a Home Buy a Rental Property Setlle Unsecured Debt Financial Security Get Properly Insured Increase Tax Efficiency Pay Off Debt Plan For Fun Refurb Rental Property Renovate My Home Save For a Vacation Save For Education Save For Retirement Save For Wedding Start a Business Start a Side Hustle OTHER GOAL

Long-Term Goals Long-Term Goals Acquire a Business Become a Millionaire Build Emergency Fund Buy a Home Buy a Rental Property Settle Unsecured Debt Financial Security Get Properly Insured Increase Tax Efficiency Pay Off Debt Plan For Fun Refurb Rental Property Renovate My Home Save For a Vacation Save For Education Save For Retirement Save For Wedding Start a Business Start a Side Hustle OTHER GOAL

Title

First Name

Have A Second Name?

Second Name

Have a Third Name?

Third Name

Surname

Gender

Marital Status

Maiden Name

Date of Birth (DDMMCCYY)

Smoker Status

Email Address

Phone Number

Select Your Province

Region - Gauteng

Region - Johannesburg

Region - Pretoria

Region - Vaal Triangle

Region - Kwazulu Natal

Region - Limpopo

Region - Mpumalanga

Region - Free State

Region - North West

Region - Western Cape

Region - Boland

Region - Cape Town

Region - Garden Route

Region - Eastern Cape

Region - Northern Cape

Physical Address

Name of Spouse

Surname of Spouse

Spouse Maiden Name

Spouse Date of Birth (DDMMCCYY)

Have a Child/ren?

How Many Child/ren?

Add Details (Child 1)?

Child 1 - Name

Child 1 - Surname

Child 1 - Gender

Date of Birth (DDMMCCYY)

Add Details (Child 2)?

Child 2 - Name

Child 2 - Surname

Child 2 - Gender

Date of Birth (DDMMCCYY)

Add Details (Child 3)?

Child 3 - Name

Child 3 - Surname

Child 3 - Gender

Date of Birth (DDMMCCYY)

Add Details (Child 4)?

Child 4 - Name

Child 4 - Surname

Child 4 - Gender

Date of Birth (DDMMCCYY)

Add Details (Child 5)?

Child 5 - Name

Child 5 - Surname

Child 5 - Gender

Date of Birth (DDMMCCYY)

Add Details (Child 6)?

Child 6 - Name

Child 6 - Surname

Child 6 - Gender

Date of Birth (DDMMCCYY)

Add Details (Child 7)?

Child 7 - Name

Child 7 - Surname

Child 7 - Gender

Date of Birth (DDMMCCYY)

Add Details (Child 8)?

Child 8 - Name

Child 8 - Surname

Child 8- Gender

Date of Birth (DDMMCCYY)

Add Details (Child 9)?

Child 9 - Name

Child 9 - Surname

Child 9- Gender

Date of Birth (DDMMCCYY)

Add Details (Child 10)?

Child 10 - Name

Child 10 - Surname

Child 10- Gender

Date of Birth (DDMMCCYY)

Job Title

Employment Status

Employer

Highest Qualification

Qualification Complete?

Field of Qualification

Got Benefits at Work?

Corporate Benefits Corporate Benefits Group Life Cover Group Disability Cover Dreaded Disease Cover Income Protection Child Education Cover Funeral Benefit Medical Aid Pension Fund Provident Fund

State Income (p.m.)/(p.a.)?

Income, Monthly (Pretax)

Income, Annual (Pretax)

Device You Are Using Now

Make Screen Horizontal

Add Asset #1

Name of Institution, eg. ABSA, Investec etc.

Name of Asset, eg. "Merc Class", "House in Jhb", Rolex etc

Market Value Asset #1

Add Asset #2

Asset #2 Type

Name of Institution, eg. "FNB", "Coronation" etc.

Name of Asset, eg. "BMW 435i", "Speedboat" etc

Market Value Asset #2

Add Asset #3

Asset #3 Type

Name of Institution, eg. "Nedbank". "Liberty" etc

Name of Asset, eg. "Audi S4", "Caravan" etc.

Market Value Asset #3

Add Asset #4

Asset #4 Type

Name of Institution, eg. "Capitec", "Sanlam" etc.

Name of Asset, eg. "Volvo XC60", "Bidvest" etc.

Market Value Asset #4

Add Asset #5

Asset #5 Type

Name of Institution, eg. "Standard Bank", "Momentum" etc.

Name of Asset, eg. "VW Golf TSI", "Holiday House" etc.

Market Value Asset #5

Add Asset #6

Asset #6 Type

Name of Institution, eg. "RMB", "Allan Gray" etc.

Name of Asset #6

Market Value Asset #6

Add Asset #7

Asset #7 Type

Name of Institution, eg. "ABSA", "Stanlib" etc.

Name of Asset #7

Market Value Asset #7

Add Asset #8

Asset #8 Type

Name of Institution, eg. "FNB", "Investec" etc.

Name of Asset #8

Market Value Asset #8

Add Asset #9

Asset #9 Type

Name of Institution, eg. "Nedbank", "Coronation" etc.

Name of Asset #9

Market Value Asset #9

Add Asset #10

Asset #10 Type

Name of Institution, eg. "Nedbank", "Coronation" etc.

Name of Asset #10

Market Value Asset #10

Add Asset #11

Asset #11 Type

Name of Institution, eg. "ABSA", "Coronation" etc.

Name of Asset #11

Market Value Asset #11

Add Asset #12

Asset #12 Type

Name of Institution, eg. "Nedbank", "PPS" etc.

Name of Asset #12

Market Value Asset #12

Add Asset #13

Add Remaining Assets Here

Add Liability #1?

Liability #1 Title

Credit Limit, Liability #1

Market Value, Liability #1

Outstanding Balance, Liability #1

Add Liability #2?

Liability #2 Type

Liability #2 Title

Credit Limit, Liability #2

Market Value, Liability #2

Outstanding Balance, Liability #2

Add Liability #3?

Liability #3 Type

Liability #3 Title

Credit Limit, Liability #3

Market Value, Liability #3

Outstanding Balance, Liability #3

Add Liability #4?

Liability #4 Type

Liability #4 Title

Credit Limit, Liability #4

Market Value, Liability #4

Outstanding Balance, Liability #4

Add Liability #5?

Liability #5 Type

Liability #5 Title

Credit Limit, Liability #5

Market Value, Liability #5

Outstanding Balance, Liability #5

Add Liability #6?

Liability #6 Type

Liability #6 Title

Credit Limit, Liability #6

Market Value, Liability #6

Outstanding Balance, Liability #6

Add Liability #7?

Liability #7 Type

Liability #7 Title

Credit Limit, Liability #7

Market Value, Liability #7

Outstanding Balance, Liability #7

Add Liability #8?

Liability #8 Type

Liability #8 Title

Credit Limit, Liability #8

Market Value, Liability #8

Outstanding Balance, Liability #8

Add Liability #9?

Liability #9 Type

Liability #9 Title

Credit Limit, Liability #9

Market Value, Liability #9

Outstanding Balance, Liability #9

Add Liability #10?

Liability #10 Type

Liability #10 Title

Credit Limit, Liability #10

Market Value, Liability #10

Outstanding Balance, Liability #10

Add Liability #11?

Add Remaining Liabilities Here

Got Insurance? (Excl. Work Benefits)

Life Cover: Existing Insurer Life Cover: Existing Insurer ABSA Life Discovery Life Hollard Life FMI Liberty Metropolitan Momentum Old Mutual PPS (Professional Provident Society) Sanlam OTHER INSURER

Your Insurer/s

Life Cover: Existing Coverage Life Cover: Existing Coverage Life Cover Disability Cover Dreaded Disease Cover Income Protection Retrenchment Protection

Existing Coverage - Life Cover

Existing Coverage - Disability Cover

Existing Coverage - Dreaded Disease

Existing Coverage - Income Protection (pm)

Existing Coverage - Retrenchment Protection (pm)

Got Medical Aid?

Want To Create a Financial Plan?

How Would You Like to Contribute?

Monthly Budget You Are COMFORTABLE With

Once-Off Lump Sum Amount

Do You Have a Will?

Is Your Will Current?

Anything Else We Should Know?

Tell Us More

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