client financial planning fact finder

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Suite 240, 29 Milton Parade Malvern Victoria 3144 Australia Telephone 61+3 9832 0913 Facsimile 61+3 9832 0914 www.maddernfinancial.com.au ABN 83 104 046 657

PORTFOLIO PLANNING

Client Financial Planning Fact Finder

Please note that there may be some questions that do not relate to your circumstances.

Please complete all relevant sections.

CLIENT NAME/S:

DATE:

ADVISER: Dr. Dennis J. Maddern

Confidential Client Information This booklet has been designed to efficiently gather only the information necessary for your Australian Finance Group Financial Planning Representative to best assist you in achieving your financial goals. Please assist your Representative by completing as much as you can. If you are unsure about the nature or details of the information required, feel free to leave any section blank and discuss these further with your Representative during your appointment. Important Notice to Clients The Corporations Law requires that an adviser making investment recommendations must have reasonable grounds for making those recommendations. This means that a planner must conduct an appropriate investigation as to the financial objectives, situation and particular needs of the client. The information requested in this form is necessary to enable recommendations to be made and will be used solely for that purpose. We accept no liability for any advice given on the basis of inaccurate or incomplete information. Maddern Financial Advisers Pty Ltd is a Corporate Authorised Representative AUSTRALIAN FINANCE GROUP FINANCIAL PLANNING PTY LTD ABN 74 099 029 526 Australian Financial Services Licence Number 247105

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Australian Finance Group Financial Planning Privacy

Australian Finance Group Financial Planning is committed to ensuring the confidentiality and security of your personal information. A copy of our privacy policy detailing how we handle your personal information is available on request. Australian Finance Group Financial Planning operates nationally. All offices adhere to the National Privacy Principles and seek to apply consistent privacy practices. Where you seek financial advice from one of our representatives, he or she will provide you with information on the privacy practices of that business. This Privacy Statement outlines how Australian Finance Group Financial Planning and its company offices handle your personal information. You may request access to information held by us about you, your investment portfolio and any other Australian Finance Group Financial Planning services which you may receive by contacting Australian Finance Group Financial Planning on 08 9420 7009. In order to manage and administer our financial planning and advice services, it may be necessary for us to disclose your personal information to certain third parties. Unless you consent to this disclosure we may not be able to provide you with financial planning and advice services. The types of organisations to whom we may disclose your personal information include: • financial institutions for the provision of financial products such as investments, superannuation, life

insurance • your financial adviser for the purpose of managing your investments and financial products • organisations undertaking compliance reviews of our financial advisers or reviews of the accuracy and

completeness of our information • organisations providing mailing services, maintenance of our information technology systems and printing of

our standard documents and correspondence. We will only disclose your personal information to these organisations to enable them to undertake specified management and administration services. Australian Finance Group Financial Planning will not disclose your information for any other purpose unless requested by you. In some cases, it may be necessary to share your personal information with other members of the Australian Finance Group for the provision of certain services such as information technology or for the provision of Australian Finance Group financial services that you have selected. Where you wish to authorise any other parties to act on your behalf, to receive information and/or undertake transactions, please notify us in writing. We may send you further information from time to time about Australian Finance Group Financial Planning. You may elect to stop receiving such information at any time by contacting Australian Finance Group Financial Planning in writing or by phone on 08 9420 7009. You may at any time advise us that you wish to recommence receiving Australian Finance Group Financial Planning information.

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Personal Details Client 1 Client 2 Title

Given Names

Surname

Preferred Name

Gender Male / Female Male / Female

Date of Birth

Private Health Insurance Yes / No Yes / No

Marital Status

Health Good / Average / Poor Good / Average / Poor

Smoker Yes / No Yes / No

Home Address

State Postcode State Postcode

Postal Address

State Postcode State Postcode

Home Phone ( ) ( )

Work Phone ( ) ( )

Mobile Phone

Fax Phone ( ) ( )

Email Address

Employment Details Client 1 Client 2 Employment or Business Status:

Unemployed / Self Employed / Part-time Employed / Retired / Full Time

Employed / Contractor

Unemployed / Self Employed / Part-time Employed / Retired / Full Time

Employed / Contractor

Position/ Occupation:

Qualification:

Primary Duties:

Hours per Week:

Employer / Business Name:

Industry:

Address:

Telephone:

Start Date: / / / /

Are you contemplating leaving your employment?

Do you foresee any substantial change to your income in the next 2-5 years?

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Details of Children/ Dependants 1 2 3 4

Given Names

Surname

Relationship

Gender

School & Grade

Date of Birth

Dependant (Yes / No)

If Yes, until what age?

Special Requirements

Estate Planning Details Client Partner Do you have a current Will? Yes / No Yes / No

Date of Will / Last Reviewed: / / / /

Power of attorney Yes / No Yes / No

Enduring Power of attorney Yes / No Yes / No

Type / Name of Attorney?

Do you have Funeral Plans? Yes / No Yes / No

Do you have any specific intentions regarding your estate distribution?

Financial Concerns How important to you are the following: Please insert the corresponding number. 1 – Not Concerned, 2 – Slightly Concerned, 3 – Concerned, 4 – Very Concerned, 5 – Extremely Concerned

Client 1 Client 2

How concerned are you about having your portfolio keep pace with inflation?

To begin building a constructive investment portfolio?

How concerned are you about tax effective investments and minimise your tax?

To what extent are you concerned about capital stability of your investments?

How concerned are you that cash can be made available to meet emergencies or investment opportunities?

How concerned are you about generating maximum income from your investments?

To what extent are you concerned about maximising the value of your estate and reviewing your Estate Planning?

To review and consolidate superannuation?

To review your insurances (excluding general insurance)?

To receive Social security payments?

To easily manage your investment portfolio?

Other objectives (please list)

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Future Needs, Objectives and Goals E.g. Current income needs, retirement income needs, diversification, tax minimisation, capital growth, investment security, wealth creation, eliminate mortgage etc

Reasons for seeking financial advice

Planned Major Expenses Are you contemplating any lump sum or planned expenditure? $ When?

(eg within 12 months, 1-2 years) Car

Buying a new main residence

House Improvement

Investment property purchase

Holiday Expense

Children’s Education / Wedding

Debt Repayment

Other

What cash reserve do you require for emergencies or unforeseen expenses?

Are you expecting a future lump sum or inheritance?

Retirement Details Client 1 Client 2 Planned Retirement Age:

Retirement Income: $ (today’s dollars) $ (today’s dollars)

After retirement, do you intend to work again either on a full-time or part-time basis?

What capital expenses will you have in retirement? (Please state expense and value)

$ $

$ $

Would you like some assets left to your estate? (Please detail)

$ $

$ $

How much cash would you require for emergencies such as house or car repairs?

$ $

Notes

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Other Professional Advisers Accountant Name:

Company:

Address:

Do we have the authority to contact? Yes / No Phone Contact

Solicitor Name:

Company:

Address:

Do we have the authority to contact? Yes / No Phone Contact

Bank Manager or Other Name:

Company:

Address:

Do we have the authority to contact? Yes / No Phone Contact Tax Structures/ Entities * Partnership Partners and %

Company Name Shareholders and % Company / Partnership / Trust / Super Fund / Other Company / Partnership / Trust / Super Fund / Other Company / Partnership / Trust / Super Fund / Other

Trust (s) Type Trustee Name Beneficiaries

Notes

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Income Details Client 1 Client 2 Salary (Gross) $ $

Rental Income $ $

Bonus / Profit Share $ $

Fringe Benefits $ $

Investment Income $ $

Centrelink / DVA Income $ $

Super / Annuity Income $ $

Deductible Amount (If applicable) $ $

Other Income $ $

Other Income $ $

Total Income $ $

Total Combined $ Notes

Business Expenses (please list and provide details only if applicable)

Is your work area separate from your place of residence? Yes/ No

Centrelink / DVA Details Client 1 Client 2

Eligible for Centrelink /DVA? Yes / No Yes / No

Centrelink Reference Number

Type of benefit(s)

Benefit Amount $ $ Tax free income $ $ “Gifted” assets in last 5 years? Yes / No Yes / No

If so - Value and when / / $ / / $ / / $ / / $ Fortnightly rent paid $ $

Claim Family Tax initiative through Centrelink-DVA/Tax Centrelink-DVA/Tax

Home owner? Yes / No Yes / No

Other support (eg remote area) $ $

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Expenses Details To assist you to calculate your expenses, you may: (a) like to use the following worksheet or (b) go to Total Expenditure

Item Weekly Monthly Item Weekly Monthly

Housing Education Mortgage Repayments School Fees Rent Child Care Council Rates Other Water Rates Personal Electricity Clothing/Footwear Gas Entertainment Telephone Recreation Repairs/Maintenance Hairdresser Furnishings/Appliances Holidays Other Books/Mags/Newspapers Transport Subscriptions Fuel & Oil Other Maintenance & Repairs Gifts Registration & 3rd Party Church Comprehensive Insurance Donations Loan/Lease Repayments Pet/Vet Fees Other Child Support/Maintenance Household Shopping Wealth Creation Food Superannuation Lunches Investment Expenses Alcohol/Cigarettes Property Expenses Other Other Health Preservation Health Benefits/Insurance Life Insurance Chemist Income Protection Medical/Dental/Optical General Insurance (car,

house, etc)

Other Sub Total $ $ Sub Total $ $

TOTAL EXPENDITURE $ $

Adviser Notes (Please detail here any issues relating to the client’s expenses)

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Personal Balance Sheet Physical Assets Current Purchase Centrelink Asset Owner Retain Value ($) Price ($) Value ($) Tested C1 / C2 / J Yes / No Principal Residence N Contents / Personal Property Y Motor Vehicles Y Motor Vehicles Y Holiday Home Y Caravan / Boat / Trailer Y Other Other

Financial Assets Cash and Fixed Interest Current Income pa Maturity Security for Owner Retain Value ($) % Date loan C1 / C2 / J Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No

Financial Assets Direct Property Current Purchase Purchase Rental Rental Security for Owner Retain Value ($) Amount ($) Date Income (pa) Expenses ($) loan C1 / C2 / J Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No Yes / No

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Financial Assets Managed Funds / shares Purchase Ref/Policy Current Retain Price Units Date No. Owner Value Units Income Yes / No Exit Fees?

Liabilities Type Current Finance Interest Principal & Interest Monthly Loan Interest Rate Owner Retain Value ($) Provider Rate or Interest only Repayments Date Deductible C1 / C2 / J Yes / No Home Mortgage Yes / No

Investment Loan 1 Yes / No

Investment Loan 2 Yes / No

Overdraft Yes / No

Credit Cards & Limit Yes / No

Personal Loan Yes / No

Other Yes / No

Other Yes / No

Notes

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Superannuation details (please photocopy superannuation statements)

Fund 1 Fund 2 Fund 3 Fund 4

Product name/ Provider:

Owner

Investment option(s):

Eligible for choice of fund? Yes / No Yes / No Yes / No Yes / No

Entry fee paid Management costs p.a. Exit fee Non-super benefits only applicable to members (eg discounted home loans, credit cards, bank accounts, memberships)

Insurance cover held. Yes / No Yes / No Yes / No Yes / No

Asset to be retained: Yes / No Yes / No Yes / No Yes / No Fund type: Accumulation/

Defined benefit Accumulation/ Defined benefit

Accumulation/ Defined benefit


Member number:

Current value: $ $ $ $ Concessional contributions p.a.: $ $ $ $ Concessional contributions cap applicable

$50,000 / $100,000

$50,000 / $100,000

$50,000 / $100,000

$50,000 / $100,000

Amount of concessional contributions made in the last 12 months2.

$ $ $ $

Available amount of cap remaining this year

$ $ $ $

Non-concessional contributions p.a.: $ $ $ $

Amount of non-concessional contributions made over the last 3 years3.

$ $ $ $

Available amount of non-concessional threshold remaining

$ $ $ $

Eligible service period: / / / / / / / /

Superannuation Components:

Total taxable components: $ $ $ $

Total tax-free components: $ $ $ $

Preserved amount: $ $ $ $

Restricted non-preserved: $ $ $ $

Unrestricted non-preserved: $ $ $ $

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Fund 5 Fund 6 Fund 7 Fund 8

Product name/ Provider:

Owner

Investment option(s):

Eligible for choice of fund? Yes / No Yes / No Yes / No Yes / No

Entry fee paid Management costs p.a. Exit fee Non-super benefits only applicable to members (eg discounted home loans, credit cards, bank accounts, memberships)

Insurance cover held. Yes / No Yes / No Yes / No Yes / No

Asset to be retained: Yes / No Yes / No Yes / No Yes / No Fund type: Accumulation/

Defined benefit Accumulation/ Defined benefit



Member number:

Current value: $ $ $ $ Concessional contributions p.a.: $ $ $ $ Concessional contributions cap applicable

$50,000 / $100,000

$50,000 / $100,000

$50,000 / $100,000

$50,000 / $100,000

Amount of concessional contributions made in the last 12 months2.

$ $ $ $

Available amount of cap remaining this year

$ $ $ $

Non-concessional contributions p.a.: $ $ $ $

Amount of non-concessional contributions made over the last 3 years3.

$ $ $ $

Available amount of non-concessional threshold remaining

$ $ $ $

Eligible service period: / / / / / / / /

Superannuation Components:

Total taxable components: $ $ $ $

Total tax-free components: $ $ $ $

Preserved amount: $ $ $ $

Restricted non-preserved: $ $ $ $

Unrestricted non-preserved: $ $ $ $

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Income Steams details (Annuities, Allocated Pensions, Account Based Pensions) Fund 1 Fund 2 Fund 3 Fund 4

Annuity and Pensions

Product name/Provider

Owner

Type

Asset to be retained Yes / No Yes / No Yes / No Yes / No

Date of purchase / / / / / / / /

Original Investment $ $ $ $ Current Value $ $ $ $ Current Units

Income pa $ $ $ $

Payment frequency

Minimum required payment $ / % $ / % $ / % $ / %

Entry fee paid $ / % $ / % $ / % $ / %

Management costs p.a. $ / % $ / % $ / % $ / %

Exit fee $ / % $ / % $ / % $ / %

Term / maturity date / / / / / / / /

Tax free amount $ $ $ $ Centrelink / DVA Deductible amount

$ $ $ $

Residual capital value $ or %

Reversionary beneficiary

Investor number

Rebate % % % % %

Eligible service period / / / / / / / /

Investment Option(s)

Components

Taxable $ $ $ $

Tax free $ $ $ $ Adviser Notes

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Redundancy Completed years of service

Details

Company Payments Client Partner Superannuation

Payments Client Partner

Unused Annual Leave (Gross or Net) Tax free Component

Unused Long Service Leave (Gross or Net) Taxable Component

Unused Sick Leave (Gross or Net) TOTAL

Redundancy / Early Retirement - Tax free

Redundancy/ Early Retirement - ETP Preserved amount

included in above

Ex Gratia / Golden Handshake Superannuation Pension (pa)

Other Payment Date TOTAL

Notes

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Risk Management / Insurances Do you wish to review your insurances?

Yes / No

Type (eg Life/ Trauma/ TPD/ Income Protection/ Business Expenses Insurance)

Owner C1 / C2 / J

Amount of Cover

Provider / Policy No.

Held within superannuation

Beneficiary

$ Yes / No

$ Yes / No

$ Yes / No

$ Yes / No

$ Yes / No

$ Yes / No

$ Yes / No

$ Yes / No

$ Yes / No

$ Yes / No

$ Yes / No

$ Yes / No

$ Yes / No

Brief summary of work-related activities

Do you have any dangerous hobbies?

(e.g. skydiving)

Have you been to see a doctor for a non-routine check or any medical ailment over the past 18 months. If so, please provide details below:

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Insurance Objectives & Concerns

Protection of family and/or assets in the event of Death or Total and Permanent Disablement

Client 1 Client 2

Liabilities to be paid out (eg Mortgage, Personal Loans) $ $

Children’s Education Expenses $ $

Income to be Replaced $ $

For how long would you want your income replaced? Funeral Expenses $ $

Emergency Fund $ $

Other $ $

Total $ $

Provide against Critical Illness or Major Trauma Client 1 Client 2 Liabilities to be paid out (eg Mortgage, Loans) $ $

Other Expenses (eg Medical, Home Improvements) $ $

Income to be Replaced $ $

Other $ $

Total $ $

Protect Income against Serious Illness or Injury Client 1 Client 2 Amount of Income to be Covered $ $

Waiting Period (How long could you sustain lifestyle without earning income?)

Benefit Period (If you needed to make claim, for how long would you like benefits paid?)

Other

Total $ $ Business Insurance (detail in notes below) Client 1 Client 2 Need for share purchase, partnership insurance Business overheads insurance Do you require Keyperson insurance?

Notes

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Investor Risk Profile Your attitude to risk is probably the most important factor to consider before investing. To achieve higher returns, you will have to be prepared to accept a higher risk of capital loss. This is because the funds and assets that offer high returns are generally more volatile than those producing lower returns. It is what we call ‘risk/return trade off’.

We will recommend investment strategies to match your investments to your risk profile. Investing across the various investment sectors according to your risk profile is called diversification. For example, instead of investing only in property, or only in shares, you might invest a proportion in both, or even include cash or fixed interest to create a balanced portfolio.

This workbook will help us to understand what type of Investor you can afford to be and will enable us to recommend a personal asset allocation tailored to your needs. Please complete questions below by circling the answer that most closely describes you for each question.

Investor Risk Profile Points

1. Which of the following best describes your current stage of life? a. Single with few financial burdens. You are keen to accumulate wealth for the future. Some funds

must be kept available for enjoyment such as cars, clothes, travel and entertainment. 50

b. A couple without children. You may be preparing for the future by establishing a home. This stage of life has a high purchase rate of consumer items. You are probably financially better off now than you may be in the future.

40

c. Young Family. This is the peak home purchasing stage. You have a mortgage and may maintain only small cash balances. Probably dissatisfied with your financial position and the amount of money saved.

30

d. Mature Family. You are in your peak earning years and have got the mortgage under control. Many partners also work and any children are growing up and have either left home or require less supervision. You are starting to think about retirement, although it may be a few years away.

50

e. Preparing for retirement. You probably own your own home and have few financial burdens, however are concerned whether you can afford a comfortable retirement. Interested in travel, recreation and self education.

20

f. Retired. No longer working you must rely on existing funds and investments to maintain your lifestyle. You may be receiving the pension abd are keen to enjoy life and maintain your health.

10

2. In light of current interest rates, what returns do you reasonably expect to achieve from your

investments? a. A return without losing any capital. 10

b. Current inflation rate plus 2-4% 20

c. Current inflation rate plus 5-7% 30

d. Current inflation rate plus 8-12% 40

e. Over 12% 50

3. If you didn’t need your capital for more than 10 years. For how long would be prepared to see your

investment performing poorly before you cashed it in? a. You would cash it in if there were any loss in value. 0

b. Up to 3 months 10

c. Up to 6 months 20

d. Up to 1 year 30

e. Up to 2 years 40

f. More than 2 years 50

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4. How familiar are you with investment markets? a. Very little understanding or interest 10

b. Not very familiar 20

c. Have enough experience to understand the importance of diversification 30

d. Understand that markets may fluctuate and that different market sectors offer different income, growth and taxation characteristics.

40

e. Experience with all investment sectors and understand the various factors which may influence performance.

50

5. The greatest tax savings are generally obtained from more volatile investments.

Which balance would you be most comfortable with? a. Preferable guaranteed returns, before tax savings 10

b. Stable reliable returns, minimal tax savings 20

c. Some variability in returns, some tax savings 30

d. Moderate variability in returns, reasonable tax savings 40

e. Unstable, but potentially higher returns, maximising tax savings. 50

6. What would your reaction be if 6 months after placing your investment you

discovered that your investment has decreased by 20%? a. Horror. Security of your capital is critical and you did not intend to take any risks. 10

b. You would cut your losses and transfer your funds into more secure investments. 20

c. You would be concerned, but would wait to see if the investments improve. 30

d. This was a calculated risk and you would leave the investments in place, expecting performance to improve.

40

e. You would invest more funds to lower your average investment price, expecting future growth. 50

7. Which of the following best describes your purpose for investing.

a. You have an investment horizon longer than 5 years. You understand investment markets and are mainly investing for growth to accumulate long term wealth.

50

b. You are not nearing retirement, have surplus funds to invest and you are aiming to accumulate long term wealth from a balanced portfolio.

40

c. You have a lump sum (for example an inheritance or an eligible termination payment from your employer) and you are uncertain about what secure investment alternatives are available.

30

d. You are nearing retirement and you are investing to ensure you have sufficient funds available to enjoy your retirement.

20

e. You have some specific objectives within the next 5 years for which you want to accumulate sufficient funds.

20

f. You want to provide a regular income and/or totally protect the value of your accumulated capital.

10

8. For how long would you expect most of your money to be invested before you would need to access it?

(Assuming you and/or your adviser has made plans to meet short term financial goals and to handle emergencies.)

a. Less than 2 years 10

b. Between 2 and 3 years 20

c. Between 3 and 5 years 30

d. Between 5 and 7 years 40

e. Longer than 7 years 50

Total Investor Profile Score

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Investor Profile Total PointsCautious: You are a conservative investor. Risk must be very low and you are prepared to accept lower return terms to protect capital. The negative effects of tax and inflation will not concern you, provided your capital is protected.

0 - 100

Judicious: You are a cautious investor seeking better than basic returns, but risk must be low. Typically an older investor seeking to protect the wealth that you have accumulated, you may be prepared to consider less aggressive growth investments.

101 - 180

Prudent: You are a prudent investor who wants a balanced portfolio to work towards medium to long term financial goals. You require an investment strategy that will cope with the effects of tax and inflation. Calculated risks will be acceptable to you to achieve good returns.

181 - 260

Assertive: You are an assertive investor, probably earning sufficient income to invest most funds for capital growth. Prepared to accept higher volatility and moderate risks, your primary concern is to accumulate assets over the medium to long term. You require a balanced portfolio, but more aggressive elements may be included.

261 - 350

Aggressive: You are an aggressive investor prepared to compromise portfolio balance to pursue potentially greater long term returns. Your investment choices are diverse, but carry with them a higher level of risk. Security of capital is secondary to the potential for wealth accumulation.

351 - 400

Asset Class (Income/Growth) Cautious (70/30)

Judicious (50/50)

Prudent (30/70)

Assertive (15/85)

Aggressive(0/100)

Cash (income) 10.00% 15.00% 5.00% 0.00%

Australian Fixed Interest (income) 20.00% 27.50% 12.50% 7.50% 0.00%

International Fixed Interest (income) 20.00% 27.50% 12.50% 7.50% 0.00%

Australian Shares (growth) 21.00% 12.50% 30.00% 37.50% 50.00%

International Shares (growth) 21.00% 12.50% 30.00% 37.50% 50.00%

Property (growth) 8.00% 5.00% 10.00% 10.00% 0.00%

Total 100% 100% 100% 100% 100%

Time Frames What is the time horizon for your investment decisions? (ie Will funds be needed within the following time periods?) Less than 2 years $ Between 2-5 years $ Longer than 5 years $ More than 5 years $ Comments:

I/We confirm that I/We have read through the Personal Risk Profile Questionnaire and I/We are comfortable with the above Personal Risk Profile selection. I/We have discussed the potential risks fully with our Adviser and I/We fully accept the consequences of my/our decision.

Client Signature Client 2 Signature

Print Name Print Name

Date / /

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Client(s) Acknowledgement I/We acknowledge that:

the information contained in the Personal Information Collection Booklet is an accurate and complete record of the information I/we provided to the Planner;

Authorise the collection, use and disclosure of my/our personal information for the purpose of the provision of financial planning and advice services and for the management and administration of my/our investment portfolio and financial products as outlined in the “Australian Finance Group Financial Planning Privacy Statement”. I/we understand that unless I/we consent to the collection, use and disclosure identified in the Privacy Statement, Australian Finance Group Financial Planning may not be able to deliver the relevant financial planning and advice services or manage my/our investment portfolio;

I/we permit this document to be passed in confidence to any member of AFG Financial Planning Pty Ltd or any of its related companies;

I/we have received and have read and understood the Financial Services Guide provided by my adviser before any advisory services were provided;

Should I/we not proceed within 60 days with the implementation of the financial plan, I/we understand that the information provided must be reviewed;

I/We understand that a fee of $_____________is payable for services provided; Our Adviser has provided information on the Privacy Policy Statement.

Please tick the appropriate response(s) below:

I/We have provided full financial information.

I/We have provided limited financial information. I/We have read and understood the warnings noted above under “Important Information for the Client(s)”.

Important Information for the Client(s) If incomplete or limited financial information has been provided:

a) I, as your Planner, will not be able to undertake a full needs analysis of your individual investment objectives, financial situation and particular needs;

b) There is a possibility that any recommendation given to you may not be fully appropriate to your individual objectives and needs, especially those which I, as the Planner, do not know; and

c) You as the client must carefully assess the appropriateness of the recommendations to your own individual investment objectives, financial situation and particular needs before acting on them.

d) You as the client (s) understand that the adviser may not be able to make such recommendations accurately. Client 1 Client 2 Signature

Date

Adviser’s Declaration

Adviser’s Acknowledgement (Compulsory): Adviser Dr Dennis J. Maddern I declare that the information contained in the Personal Information Collection Booklet is an accurate and complete record of the information obtained from the client(s); FSG Part 1 Version 7 and Part 2 Version 5.3 have been provided before any advisory services were provided Yes No Privacy Policy Statement provided Yes No

Adviser's Signature: Date:

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OPTION TO QUOTE TAX FILE NUMBER Most investment and superannuation application forms request the applicant to provide their Tax File Number (TFN). As you will be receiving ongoing service from MFA Financial Advisers/ AFG Financial Planning we offer you the option of authorising MFA Financial Advisers/ AFG Financial Planning to hold your TFN, and/or details of your exemption status, in our records. The collection, use and disclosure of TFNs are strictly controlled by taxation and superannuation laws and the Privacy Act. As an authorised representative of Australian Finance Group Financial Planning P/L, Dr. Dennis J. Maddern is authorised to collect TFN’s under the Income Tax Assessment Act 1997. You are not required to provide us with your TFN and it is not an offence if you choose not to do so. If you do not provide us with your TFN and you wish to quote your TFN on investment and/or superannuation application forms, you will need to bring your TFN with you when calling at our office to complete these documents. IMPORTANT INFORMATION Investment Bodies Investment bodies are authorised to collect TFN’s under the Income Tax Assessment Act 1997. It is not an offence if you choose not to provide your TFN to an investment body. However, if you do not quote your TFN, or exemption status, tax will be deducted from your income distributions at the highest marginal rate. Some persons/entities are exempted from the TFN quotation arrangement, if the exemption status is notified to the investment body:

• Persons receiving any part of an age, service, widow pension or other types of qualifying pension/benefit. (Please state type of pension/ benefit received)

• Children under the age of 16, where the investment is NOT public company share/s and the income will be less than $420 pa. (Please state age)

• Entities not requires to lodge income tax returns. (Please state reason not required to lodge return)

• Non-residents (Please state country of residence)

Superannuation Bodies and Approved Deposit Funds Superannuation Bodies and Approved Deposit Funds are authorised to collect TFN’s under the Superannuation Industry (Supervision) Act 1993. It is not offence if you choose not to provide your TFN, however, if you do not provide your TFN: • you may pay more tax on your superannuation benefit than you have to (you will get a refund at the end of the

financial year income tax assessment); and • a surcharge of up to 15% may be payable on contributions made by for you (the charge may not be payable if

you provide your TFN and if some circumstances the surcharge may be reclaimed through the Australian Taxation Office); and

• it may be more difficult to find your superannuation benefits if you change address without notifying your fund, or to amalgamate any multiple superannuation accounts.

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YOUR ELECTION Please tick ONE of the boxes below to indicate your choice of the options available. If you tick boxes 2 or 3, please record your TFN, and/or exemption status, at the bottom of this page. 1. I instruct MFA Financial Advisers/ AFG Financial Planning NOT to hold my Tax File Number in their

records. 2. I instruct MFA Financial Advisers/ AFG Financial Planning, to hold my Tax File Number in their records. I

authorise MFA Financial Advisers/ AFG Financial Planning or other recipients approved by MFA Financial Advisers/ AFG Financial Planning, to disclose my TFN only to me

3. I instruct MFA Financial Advisers/ AFG Financial Planning, to hold my Tax File Number in their records. I

authorise MFA Financial Advisers/ AFG Financial Planning, or other recipients approved by MFA Financial Advisers/ AFG Financial Planning, to disclose my TFN, or exemption status, to me, the Australian Taxation Office and investment bodies:

Note: MFA Financial Advisers/ AFG Financial Planning is not permitted to disclose your TFN to superannuation bodies; Approved Deposit Funds or assistance agencies. I acknowledge that:

• I have read and understood the information above: and • this authority will remain in force until cancelled by me in writing. If signing under Power of Attorney, I hereby certify that I have not received notice of revocation of that Power. Full name of individual/entity Address Signature Signature My Tax File Number is: My exemption status is (if applicable):

Company Seal (If applicable)

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ADVISER NOTES:

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NOTES (Continuted):

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Dr. Dennis J. Maddern Suite 240, 29 Milton Parade B.Sc. M.A. PhD SIA (Aff) AFPA Malvern Victoria 3144 Australia Sub Authorised Representative Telephone: (03) 9832 0913 Maddern Financial Advisers Pty Ltd Facsimile: (03) 9832 0914 Date: _________________________ Company: ______________________________________ Fax: ______________________________________ Phone: ______________________________________ Dear Sir/Madam, I have appointed as my financial planners, Maddern Financial Advisers P/L and I hereby authorise and request you to provide Dr Dennis Maddern or Carla Ralph or any other representatives with any information they may request from you concerning my health or my business, personal, financial, banking, investment, insurance, superannuation or other arrangements. This is not a request to change existing agency arrangements. Membership Number: ______________________________ D.O.B: ______________________________ Address: ___________________________________________________ ___________________________________________________ Thank you. Yours faithfully, Signature: ___________________________ Name: ____________________________

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Client Identification Form

Client Name

Existing Client Yes No

Document 1 Document 2

Description

Description

Date of Birth Date of Birth _ _ /_ _ /____

Document Category Primary Photographic

Primary Non Photographic

Secondary Photographic




Place of Residence

Place of Residence

Date of Issue Date of Issue _ _ /_ _ /2 __

Place of Issue Place of Issue

Expiry Date Expiry Date _ _ /_ _ /2 __

Points Points

Document Number Document Number

Copy Retained on File Yes Attached Copy Retained on File Yes Attached Document 3 Document 4

Description

Description

Date of Birth _ _ /_ _ /____ Date of Birth _ _ /_ _ /____







Place of Residence

Place of Residence

Date of Issue _ _ /_ _ /2 __ Date of Issue _ _ /_ _ /2 __

Place of Issue Place of Issue

Expiry Date _ _ /_ _ /2 __ Expiry Date _ _ /_ _ /2 __

Points Points

Document Number Document Number

Copy Retained on File Yes Attached Copy Retained on File Yes Attached

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Document Type Category Points Birth Certificate Primary Non Photographic 70 Passport Primary Photographic 70 Driver’s License (Australian) Primary Photographic 40 Driver’s License (Overseas) Primary Photographic 25 Credit Card Secondary 25 Debit Card Secondary 25 Medicare Card Secondary 25 Council Rates Secondary 25 Telephone Bill Secondary 25 Utility Bill Secondary 25 Health Insurance Card Secondary 25 Citizenship Certificate Primary Non Photographic 70 Commonwealth Benefit Entitlement Card Primary Non Photographic 40 Public Employee ID Card Primary Non Photographic 40 Tertiary Student ID Card Primary Non Photographic 40 Credit Reference Association of Australia Secondary 35 Current/Previous Employer Secondary 35 Land Titles Office Records Secondary 35 Mortgage Security Documents Secondary 35 Rating Authority Document Secondary 35 Security Document Held by the Dealer Secondary 35 Financial Record Secondary 25 Record from Education Institution Secondary 25 Record Held Under Law Secondary 25 Records of Professional/Association Membership Secondary 25 Verification from Electoral Roll Secondary 25 Verification from Landlord Secondary 25 White Pages Secondary 25

EXAMPLE A – ACCEPTABLE PRIMARY ID DOCUMENTS (OBTAIN ONE OF THE FOLLOWING) Australian State / Territory driver’s licence containing a photograph of the person Australian passport (a passport that has expired within the preceding 2 years is acceptable) Card issued under a State or Territory for the purpose of proving a person’s age containing a photograph of the person Foreign passport or similar travel document containing a photograph and the signature of the person *

EXAMPLE B - ACCEPTABLE SECONDARY ID DOCUMENTS (OBTAIN ONE OF THE FOLLOWING) Birth certificate Australian citizenship certificate Pension card issued by Centrelink Health card issued by Centrelink National identity card issued by a foreign government containing a photograph of the person in whose name the card was issued *

AND (OBTAIN ONE OF THE FOLLOWING) A document issued by the Commonwealth or a State or Territory within the preceding 12 months that records the provision of financial benefits to the individual and which and contains the individuals name and residential address

A document issued by the Australian Taxation Office within the preceding 12 months that records a debt payable by the individual to the Commonwealth (or by the Commonwealth to the individual), which contains the individuals name and residential address

A document issued by a local government body or utilities provider within the preceding 3 months which records the provision of services to that address or to that person (the document must contain the individuals name and residential address)

Foreign driver's licence that contains a photograph of the person in whose name it issued and the individuals date of birth *

If under the age of 18, a notice that: o was issued to the customer by a school principal within the preceding 3 months; and o contains the customers name and residential address; and o records the period of time that the customer attended at that school