Initial Consultation Questionnaire Question Title * 1. Title Mr Mrs Ms Miss Dr Question Title * 2. Surname Question Title * 3. First Name Question Title * 4. Preferred Name Question Title * 5. Date of Birth Date / Time Date Question Title * 6. Occupation Question Title * 7. Employer Question Title * 8. Employment Status Full-time Casual Part-time Contract/Self-employed Retired Unemployed Question Title * 9. Salary/Wage/Net Profit (before tax) Question Title * 10. Partner Title Mr Mrs Ms Miss Dr Question Title * 11. Partner Surname Question Title * 12. Partner First Name Question Title * 13. Partner Preferred Name Question Title * 14. Partner Date of Birth Date / Time Date Question Title * 15. Partner Employer Question Title * 16. Partner Occupation Question Title * 17. Partner Employment Status Full-time Casual Part-time Contract/Self-employed Retired Unemployed Question Title * 18. Partner Salary/Wage/Net Profit (before tax) Question Title * 19. Marital Status Single Married De facto Divorced Separated Widowed Question Title * 20. Residential Address Address Address 2 Suburb/Town State Postcode Email Address Mobile Phone Number * Question Title * 21. Postal Address Address Address 2 Suburb/Town State Postcode Question Title * 22. Combined Estimated Living Expenses (excl. loan commitments) $30,000 - $35,000 per annum $35,000 - $40,000 per annum $40,000 - $45,000 per annum $45,000 - $50,000 per annum $50,000 - $55,000 per annum $55,000 - $60,000 per annum Above $60,000 per annum Question Title * 23. Total Bank Balances including offset accounts Question Title * 24. Total Home Loans Owing Question Title * 25. Investment Properties Total Value Question Title * 26. Investment Loans Owing Question Title * 27. Combined Super Fund Balances Question Title * 28. Total Number of Super Funds Combined 1 2 3 4 5 Question Title * 29. Super Fund Names Super Fund 1 Super Fund 2 Super Fund 3 Super Fund 4 Super Fund 5 Question Title * 30. Do you have a share portfolio? Yes - Less than $50,000 in value Yes - More than $50,000 in value No Question Title * 31. Have you insured your income? Yes No Question Title * 32. Has your partner insured their income? Yes No Question Title * 33. Are you paying too much tax? Yes No Question Title * 34. Is your partner paying too much tax? Yes No Question Title * 35. Do you salary sacrifice into super? Yes No Question Title * 36. Does your partner salary sacrifice into super? Yes No Question Title * 37. Do you salary package benefits at work? Yes No Question Title * 38. Does your partner salary package benefits at work? Yes No Question Title * 39. Are you happy with your work-life balance? Yes No Question Title * 40. Do you have any interests outside of work that you are passionate about? Yes No Details: Question Title * 41. Do you know how much income you will need in retirement? Yes No Question Title * 42. Are you worried about running out of money in retirement? Yes No Question Title * 43. Are you aware that investing in property can be part of a retirement strategy? Yes No Question Title * 44. Do you understand Centrelink income and assets testing? Yes No Question Title * 45. Have you spoken with a Financial Planner before? Yes No Question Title * 46. How did you find us? Google Police Credit Union My friend or relative is a client and referred us We were referred by another business Have seen the premises Other (please specify) Question Title * 47. This is the brain dump section - What do you need some help with? What is concerning you? What is on your bucket list? When do you want to retire? Question Title * 48. How urgent is the appointment? I/We have decided to get advice and would like to speak to someone within the month. I have a time critical issue that is distressing and need urgent assistance. Any time that suits is fine. Done and Send
