Confidential Fact Finder

And Financial Needs Analysis

Data Collection Form

Version date 1/7/2011

Client:______________________________________________________

Date completed:______/______/______

Interprac Financial Planning Pty Ltd

ABN: 14 076 093 680 Australian Financial Services Licence 246638

29-33 Palmerston Crescent, South Melbourne 3205 Tel: 1800 700 666 or (03) 9209 9777 Fax: (03) 9209 9770

This Financial Analyser is designed to provide your InterPrac authorised representative with accurate detailed information as to your current personal and financial position. This information is required under the Corporations Law so that your advisor has reasonable grounds for making their recommendations. The information contained within this document will be used solely by your advisor for the purpose of making recommendations and will be treated strictly confidential.

PLANNING OBJECTIVES One of the first things we will need to do is to find out what you are trying to achieve and what is important to you. Planning is all about knowing what you need, developing strategies that are appropriate to you and then doing something about it and this will guarantee that you will increase the chances of making a financial difference. The reason you are here? Please detail here what you would like to achieve. When do you want to retire? Client 1 Client 2 Planned Retirement Age

What income do you want to retire on? Other objectives that may be important to you are listed in the table below. The numbers represent 1: not important, 2: slightly important, 3: important, 4: very important. Use the last column to list the objectives in order of their priority, with 1 being the client’s main priority. Key Objectives Importance Paying off your Mortgage 1 2 3 4 Protecting Assets from the effects of Inflation 1 2 3 4 Developing a Investment Plan Prior to Retirement 1 2 3 4 Planning for Retirement 1 2 3 4 Having an Access to Funds (cash on call) 1 2 3 4 Providing funds for your children’s eduction 1 2 3 4 Providing funding for a major future expense 1 2 3 4 Protecting family/assets in the event of death 1 2 3 4 Tax efficiency 1 2 3 4 Protecting current income in the event of sickness or accident 1 2 3 4 Protecting family/assets in the event of serious illness or trauma 1 2 3 4 Maintaining current standard of living if permanently disabled 1 2 3 4 Maximising Centrelink entitlements 1 2 3 4 Major Future Expenses Please detail here all planned future lump sum expenses over the next 5 years. Item Amount $ Year of Expense Holidays Education New Car/Car Upgrade Home Improvements Gifts Debt Repayment Other (ie wedding/conference, etc) Are you comfortable with the level of investments/saving/ superannuation that you have in place to meet your future retirement lifestyle objectives?

Yes No

Referred by

Company Name

Contact Name

Phone Number

Personal Details Client 1 Client 2 Title Mr Mrs Ms Miss

Mr Mrs Ms Miss Other

Surname

Given Name(s)

Gender Male Female Male Female

Date of Birth | | Age: | | Age:

Marital Status

Health Excellent Good Poor Excellent Good Poor

Smoker Yes No Quit in previous 12 mths Yes No Quit in previous 12 mths

Australian Resident Yes No Yes No No. of Years In Australia Contact Details

Address (Postal)

State Postcode State Postcode

Address (Residential/Other)

State Postcode State Postcode

Home Phone

Work Phone

Mobile

Facsimile

Email

Primary Contact

Employment Details Client 1 Client 2 Employer

Work Status Employed Self Employed

Employed Self Employed Other

Type of structures used Trust Company SMSF Trust Company SMSF

If Other, what status?

Occupation/Position:

Commence with Current Employer: / / / / Cash Flow Client 1 Client 2 Base Income/Salary $ $ Rental Taxable Income $ $ Dividend Income $ $ Other $ $ Tax Free Income $ $ Family Allowance

Centrelink/Veterans Affairs Living Expenses $ Children/Dependents Dependants Dependant 1 Dependant 2 Dependant 3 Name(s)

Gender Male female

Male Female Male Female

Date of Birth | | Age: | | Age: | | Age:

School Year

Working

Adviser Notes

Asset and Liability Statement

Personal Purchase Date

Purchase Price

$

Current Value

$

Outstanding Liability?

$

Lender / Institution

Interest Rate Ownership

(C1/C2/J)*

Family Home

Contents

Motor Vehicle 1

Motor Vehicle 2

Holiday Home

Boat/Caravan

Totals

$

$

$

Adviser Notes

Investment

Purchase Date

Purchase Price

$

Current Value

$

Outstanding Liability?

$

Lender / Institution

Interest Rate / Return

Repayment Amount

$

Rental / Other Income

$

Ownership (C1/C2/J)*

Bank Account 1

Bank Account 2

Term Deposits

Investment Property Rental $

Investment Property Rental $

Shares

Shares

Managed Funds

Managed Funds

Superannuation

Superannuation

Jewellery/Art etc

Assets gifted in previous 5 years

Other

TOTAL $ $ $

$ $

Other

Liabilities Current Balance

Interest % p.a.

Term Years

Re- Payment

Loan Type (IO or P&I)

Ownership (C1/C2/J)*

Personal Loan Lenders

C/Card Limit $ Lender

Estate Planning Client 1 Client 2 Do you have a will? Yes No Yes No Original Date | | | | Review Date | | | | Executor(s)

Power of Attorney (Granted) Yes No Yes No Type General Enduring Other General Enduring Other Granted to:

Adviser Notes

Insurance Term, TPD, Trauma & Whole of Life/Endowment Including group care, continuation options and Insurance available through superannuation. Do you wish to review this? Yes No Policy 1 Policy 2 Policy 3 Policy 4 Life Insured Policy Owner Insurance Company Insured Amount $ $ $ $ What does it cost you Is Policy through Superannuation Yes No Yes No Yes No Yes No

Income Protection and Business Insurance Policy 1 Policy 2 Policy 3 Life Insured Policy Owner Insurance Company Monthly Benefit $ $ $ Premium Paid $ $ $ General Insurance Do you have insurance on the following assets? Type Yes No Family Home Holiday Home Personal Contents Motor Vehicles Investment Properties Other Adviser Notes:

Do you understand the importance of protecting your assets? Yes No Do you wish me to proceed with an insurance protection recommendation? Yes No

CONSERVATIVE MODERATELY CONSERVATIVE BALANCED GROWTH HIGH GROWTH

Investment Objective

To provide income from cash and similar

securities without risking capital

To provide a relatively stable investment by

investing primarily in cash and fixed interest with a

moderate exposure to growth assets

Provides a balanced return of income and growth by investing equally in cash, fixed interest,

shares and property

Provides a potentially higher overall return by investing predominantly in shares and property with a smaller exposure to cash and fixed interest

To provide higher long term returns predominantly through capital growth in shares and property.

Suitability

Ideally suited for short term investments or for investors that do

not want to risk capital loss, and are prepared

to accept a lower return.

Suited to investors who need income, or are risk

averse. There is an increased risk of capital loss compared to cash

investments.

Suited to investors who are seeking moderately higher

returns over the medium to long term and are prepared to accept

some short term volatility.

Suited to long term investors who are seeking higher returns through capital growth. Investors should be prepared for volatility in returns from year to

year

Suited to long term investors who are prepared to accept higher risk in pursuit of higher returns. Investors

should be prepared for the possibility of capital loss from time

to time.

Potential Short Term Volatility Very Low Low Medium Medium-High High

Potential Long Term Return Very Low Low Medium Medium-High High

Minimum Investment Term No minimum 1 – 3 years 3 – 5 years 5 – 7 years 7 years +

Typical Asset Allocation Cash Fixed Interest Aust. Shares Int. Shares Property

0% – 100% 0% – 100%

0% 0% 0%

0% – 70% 0% – 70% 0% – 30% 0% – 30% 0% – 30%

0% – 50% 0% – 50% 0% – 50% 0% – 50% 0% – 50%

0% – 30% 0% – 30% 0% – 70% 0% – 70% 0% – 70%

0% – 5% 0% – 10% 0% – 100% 0% – 100% 0% – 100%

Your Risk Profile has been determined as_______________________. Is it more important for you to reach your financial planning objectives rather than staying within your current risk profile? [ ] YES [ ] NO If Yes please provide reasons

SCOPE OF ADVICE

As a qualified Financial Planner, I can assist you to achieve your financial goals by providing advice and recommendations on a broad range of topics. However you may only be interested in obtaining limited advice. To assist us in determining the scope of the advice you are seeking, please select from the following list of services. Note that by limiting the scope of advice, you risk receiving advice that may not appropriate to your overall personal circumstances and needs.

COMPLETE FINANCIAL PLAN

Considers your overall financial position including your short, medium and long term goals and will cover each of the individual areas listed below (where relevant). The end result will be a comprehensive financial plan that will include the analysis, recommendations and projections of anticipated outcomes.

SUPERANNUATION

Covers a broad range of areas including rollovers, personal super, master trusts, employer super and self managed super funds. The advice will consider your existing arrangements and will make recommendations to maximise your superannuation savings. I will also consider your retirement goals and in conjunction with your existing position, project them forward to your intended retirement date and beyond.

INSURANCE

This service reviews your existing level of insurance in light of your current and anticipated needs. Recommendations will be made on the structure, ownership, type and levels of cover that will best suit your personal situation and needs.

WEALTH CREATION &

PERSONAL SAVINGS

Considers how best to structure your existing investments and savings capacity to maximise your wealth. Strategies may include gearing, direct shares, property trusts, managed funds, cash management trusts and tax effective investments.

ESTATE PLANNING

Is the process of ensuring that in the event of your death, your estate is distributed in accordance with your wishes. This will involve consideration of asset protection strategies, the needs of current and future beneficiaries, taxation, testamentary trusts, existing assets and superannuation.

LIMITED ADVICE

Please specify details below.

Thoughts turn into Words… …Words turn into Actions…

……Actions turn into Results

Are YOU READY to Make it Happen…

1. Do you believe you need to do something to help you achieve your goals? Yes [ ] No [ ]

2. Can you see how you can get started with the strategies presented? Yes [ ] No [ ]

3. Do you agree that you have the capacity to implement the strategies presented? Yes [ ] No [ ]

4. Do you believe you can make a financial difference if the strategies are implemented? Yes [ ] No [ ]

5. Do you believe you will get value for money if the strategies are implemented? Yes [ ] No [ ]

6. What would it mean to you to achieve your financial objectives? Not much [ ] A great deal [ ]

7. Are you prepared to spend a bit of time with us to help make this happen? Yes [ ] No [ ]

8. Why wouldn’t you take action to implement the strategies presented?

PLAN PREPARATION FEE The process of developing a financial plan can take many hours. In this regard we charge a plan fee to cover that time plus any disbursement costs. In the event you decide to sign an authority to proceed and implement our recommendations, the fees will be payable within our trading terms The estimated fee for your plan including disbursements will be $_______________. I will give you an invoice on presentation of the plan which will be payable within 14 days. CLIENT DECLARATION Disclaimer: I/we confirm that the information contained in this document is accurate and complete and understand that it is to be used for the purpose of providing financial advice. 1. Name of Client Agreed Risk Profile Signature of Client Date 2. Name of Client Agreed Risk Profile Signature of Client Date

Client 1 Sign Here

Client 2 Sign Here

OFFICE USE ONLY Adviser Planning Notes Priority Strategies Priority Need 1

Possible Strategies to consider

Priority Need 2

Possible Strategies to consider

Priority Need 3

Possible Strategies to consider

Priority Need 4

Possible Strategies to consider

Possible Strategies: 1. Develop defined financial and personal objectives 2. Evaluate cash flow and equity capabilities 3. Evaluate goals to given risk profile choosen 4. Develop a mortgage reduction plan 5. Develop a funding plan– home loan/investment loans / SMSF loan /

margin loan

6. Develop a multi property acquisition strategy 7. Develop a high dividend yielding share portfolio 8. Develop a regular gearing plan 9. Develop a warrant plan 10. Develop an annual tax planning strategy 11. Develop a prepayment plan 12. Develop salary packaging super 13. Develop salary packaging cars 14. Identify appropriate structures; Hybrid / Discretionary / Unit Trust / SMSF 15. Set up a SMSF: Family Fund / CR SMSF Fund 16. Develop a syndicate with other SMSF’s 17. Consolidate superannuation strategy 18. Develop Spouse superannuation splitting strategy 19. Develop co and spouse contributions strategies for super 20. Develop a Transition to retirement strategy 21. Risk management life, income, trauma and facilities 22. Estate Planning 23. Develop regular review process 24. Develop a retirement plan allocated / life / term / market linked pension

strategies (rollovers, un-deducted contributions)

25. Develop DSS strategies Annual Compliance Service Fee: $..................