Parag Nesarikar’s Financial Needs Analysis ( Factfinder Sheet ) Questionnaire

1. Personal Details:

Name: __________________________ DoB: ______________________

2. Contact Details:

Residence: __________________________ Office: ____________________________________________________ ____________________________________________________ __________________________

Phone (R): __________________________ (O): __________________________

Mobile: __________________________ E-mail:__________________________

3. Family Details:

S.No Name Relationship D.O.B Occupation

1 ___________________________________________________________________

2 ___________________________________________________________________

3 ___________________________________________________________________

4 ___________________________________________________________________

5 ___________________________________________________________________

6 ___________________________________________________________________

4. Priorities in Life:

PRIORITY RANKING(Please rank the following from 1 to 6 in order of preference)

Self Protection __________

Family Protection __________

Children’s Education __________

Children’s Marriage __________

Health Care __________

Tax Planning __________

5. Financial Details:

Income (Monthly)

Salary / Business income Rs. _________________Spouse’s salary / Business income Rs. _________________ House rent income Rs. _________________Other income Rs. _________________Total Rs. _________________

Expenses / Liabilities (Monthly ) Housing Rs. _________________Utilities Rs. _________________Loan repayment (EMI’s) Rs. _________________Credit Card debts Rs. _________________Other regular repayments Rs. _________________Total Rs. _________________

Savings / Investments

Equity / Stocks Rs. _________________Bonds Rs. _________________Mutual Funds Rs. _________________PPF / Banks FD / NSC Rs. _________________Other Savings Rs. _________________Total Rs. _________________

What is the normal return you expect on your savings? ______%

Assets

Property Rs._________________Other assets Rs._________________

Loan details

Existing Loan Is the Loan Loan Amount Insured? Completion Date

1. Housing Loan ____________ ____________ ____________2. Vehicle loan ____________ ____________ ____________3. Personal Loan ____________ ____________ ____________ 4. Credit Card ____________ ____________ ____________ 5. Any other loan ____________ ____________ ____________

6. Insurance Details:

Type Sum Assured (Rs.)

Annual Premium (Rs.)

Expiry Beneficiary

Health Insurance(Mediclaim)

N.A.

Personal Accident InsuranceCritical Illness Insurance

N. A.

Term Insurance

Endowment / Whole life PolicyPension Plan

Motor Insurance N. A.

Householder’s Insurance

N. A.

Other Insurances

Approximate Annual Disposable Income: Rs. _________________(Monthly income * 12 Less Monthly Expense * 12 Less Insurance Premium)

7. Current Financial Planning:

Current Allocation of Savings to Priorities

Self Protection __________

Family Protection __________

Children’s Education __________

Children’s Marriage __________

Health Care __________

Tax Planning __________

Total __100%__

8. Financial Goals:

(i) Age you would like to retire at Yrs.____________________

(ii) Annual income you would require at that age Rs. ____________________

(iii) Requirement for your child’s marriage Rs. ____________________

(iv) When do you require this money Yrs.____________________

(v) Requirement for your child’s education Rs. ____________________

(vi) When would you require this money Yrs.____________________

(vii) Any other liability (other than the loans mentioned above) Rs. ____________________

(viii) When would you require this money Year___________________

(ix) Do you have a PF account Yes/No_________________

(x) Your PF balance at retirement Rs. ____________________

Client Signature: ______________________________

Note: Insurance is the subject matter of solicitation

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