SERVICES REQUESTED

    The purpose of this questionnaire is to clarify your financial needs and to assist us to advise you in relation to certain financial products; including life assurance, serious illness cover, savings, investments and pensions. However, if you wish to focus on certain financial products, please tick the relevant area:

    Life coverSerious illness / income insuranceSavings and investmentsPensions / retirement planningMortgage protection only – you may wish to complete sections 1 and 10 only


    ABOUT YOU

    Yourself

    NAME

    MARTIAL STATUS

    ADDRESS

    PHONE

    EMAIL

    AGE

    DO YOU SMOKE?

    HEALTH / FAMILY HEALTH

    Partner (if applicable)

    NAME

    MARTIAL STATUS

    ADDRESS

    PHONE

    EMAIL

    AGE

    DO YOU SMOKE?

    HEALTH / FAMILY HEALTH


    YOUR FAMILY

    CHILD ONE'S NAME

    DATE OF BIRTH

    EDUCATION DETAILS & PLANS

    CHILD TWO'S NAME

    DATE OF BIRTH

    EDUCATION DETAILS & PLANS

    CHILD THREE'S NAME

    DATE OF BIRTH

    EDUCATION DETAILS & PLANS

    CHILD FOUR'S NAME

    DATE OF BIRTH

    EDUCATION DETAILS & PLANS


    YOUR INCOME & EXPENDITURE

    Yourself

    OCCUPTATION

    MANUAL WORK/DRIVING/HEIGHTS

    INCOME P.A./TAX RATE

    BIK

    PENSION SCHEME IN WORK

    NET INCOME PER WK/MTH

    EMPLOYMENT STATUS S/E, E/E, OWNER-DIRECTOR

    OTHER INCOME (RENT, ETC.)

    TOTAL INCOME (NET)

    REGULAR OUTGOINGS (EST.)

    DISPOSABLE INCOME

    Partner

    OCCUPTATION

    MANUAL WORK/DRIVING/HEIGHTS

    INCOME P.A./TAX RATE

    BIK

    PENSION SCHEME IN WORK

    NET INCOME PER WK/MTH

    EMPLOYMENT STATUS S/E, E/E, OWNER-DIRECTOR

    OTHER INCOME (RENT, ETC.)

    TOTAL INCOME (NET)

    REGULAR OUTGOINGS (EST.)

    DISPOSABLE INCOME


    ASSETS & LIABILITIES

    Yourself

    HOME

    OTHER PROPERTY

    BUSINESS ASSETS

    DEPOSITS/BANK BALANCES

    OTHER INVESTMENTS

    MORTGAGE

    OTHER LOANS

    NET ASSETS

    Partner

    HOME

    OTHER PROPERTY

    BUSINESS ASSETS

    DEPOSITS/BANK BALANCES

    OTHER INVESTMENTS

    MORTGAGE

    OTHER LOANS

    NET ASSETS


    EXISTING FINANCIAL PROVISION

    Life Assurance cover

    YOURSELF

    PARTNER

    Serious Illness/Income Insurance

    YOURSELF

    PARTNER

    Savings & Investments

    YOURSELF

    PARTNER

    Pensions Provisions

    YOURSELF

    PARTNER

    Mortgage & Loan Details

    YOURSELF

    PARTNER


    RISK ASSESSMENT QUESTIONNAIRE

    Investment Experience

    How experienced an investor are you?
    I am not experienced, I have rarely invested in the pastI have invested before but only in relatively simple productsAlthough I am not an expert, I do understand how markets work and am comfortable in my ability to make most investment decisionsI have made investments in the past and would consider myself an experienced investor

    Importance of this Investment

    How important to you, is the investment you are considering now?
    I am very reliant on this investment and would be in trouble if I lost any of itI have other funds/sources of income but would feel pain if I suffered significant losses nowI will not be reliant on this investment in the next 10 years, but I will be after thatThese are surplus funds and I am unlikely to be dependent on them

    Safety of this Investment

    Thinking of the investment you are about to make, do you agree/disagree with the following statement: ‘I want my investment to be safe even if it means lower returns in the long run’
    I strongly agree with this statementI tend to agree with this statementI neither agree nor disagree with this statementI tend to disagree with this statementI strongly disagree with this statement

    Risk and Return Expectations

    What risk and return expectations do you have for this investment?
    I would only invest if I had a guarantee of getting at least my original investment backI want to earn a little more than I could on deposit. I would only take on a small amount of risk to achieve thisI am looking for steady long term growth and am prepared for some short term fluctuations in the value of my investmentI am looking for strong long term growth and understand this could lead to large fluctuations in the value of my investmentI want to maximise returns and am very comfortable taking on a high degree of risk to achieve this

    Attitude to Short Term Loss

    In order to achieve higher returns you need to be comfortable with short term losses. What is the maximum percentage of loss you could tolerate in any 12 month period, before becoming uncomfortable?

    As per our Privacy Statement, we take your Data Protection seriously. OBI Wealth Management will contact you from time to time using the following methods;
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    GETTING TO KNOW YOU

    In life, future, family and business, we’ll help you make the right decisions

    Get in touch

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