Client Needs Analysis Form PARENT FORM Next Client 1 Title: Mr Mrs Ms Miss Surname * Given names * Date of birth Gender: Male Female Other Marital status: Single Married De facto Widowed Divorced Residential (if not Australia) Number of dependents Ages Current address Select State New South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Pin Code Time at current address 1 year2 year3 year4 year5 year6 year7 year8 year9 year10 year11 year1 2year1 3year1 4year1 5year1 6year17 year18 year1 9year20 year21 year22 year23 year24 year25year26 year27 year28 year29 year30year31 year32 year33 year34 year35 year36 year37 year38 year39 year40 year40 year41 year42 year43 year44 year45 year46 year47 year48 year49 year50 year Select Months 1 month2 month3 month4 month5 month6 month7 month8 month9 month10 month11 month12 month Current residential status: Own home Mortgaged Renting Boarding Live with family Other If under 2 years, please provide previous address details Select State New South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Pin Code Postal address (if different from current residential address) Select State New South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Pin Code Email address Phone number Mobile number Work phone number Fax number Preferred daytime contact number: Home Work Mobile End Section Client 2 Title: Mr Mrs Ms Miss Surname * Given names * Date of birth Gender: Male Female Other Marital status: Single Married De facto Widowed Divorced Residential (if not Australia) Number of dependents Ages Current address Select State New South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Pin Code Time at current address 1 year2 year3 year4 year5 year6 year7 year8 year9 year10 year11 year1 2year1 3year1 4year1 5year1 6year17 year18 year1 9year20 year21 year22 year23 year24 year25year26 year27 year28 year29 year30year31 year32 year33 year34 year35 year36 year37 year38 year39 year40 year40 year41 year42 year43 year44 year45 year46 year47 year48 year49 year50 year Select Months 1 month2 month Current residential status: Own home Mortgaged Renting Boarding Live with family Other If under 2 years, please provide previous address details Select State New South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Pin Code Postal address (if different from current residential address) Select State New South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Pin Code Email address Phone number Mobile number Phone number Mobile number Preferred daytime contact number: Home Work Mobile End Section Next YOUR EMPLOYMENT DETAILS End Section Client 1 Employment status: PAYG employee Self employed Family business Full time Part time Casual Contractor Temporary Home duties Retired Student Not employed Govt. benefit recipient Other Occupation Employment sector or nature of business Employer/Company name and address Address Select State New South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Pin code Employer contact name and phone number (HR / Payroll contact) Phone number Employer email Time at current employment Select year1 year2 year3 year4 year5 year6 year7 year8 year9 year10 year11 year12 year13 year14 year15 year16 year17 year18 year19 year20 year21 year22 year23 year24 year25 year26 year27 year28 year29 year30 year31 year32 year33 year34 year35 year36 year37 year38 year39 year40 year41 year42 year43 year44 year45 year46 year47 year48 year49 year50 year Select month 1 month2 month3 month4 month5 month6 month7 month8 month9 month10 month11 month12 month Average hours per week If employed or in business for less than 2 years, please provide previous employment details. Previous employers name and address Address Select State New South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Pin code Previous employment status: PAYG employee Self employed Family business Full time Part time Casual Contractor Temporary Home duties Retired Student Not employed Govt. benefit recipient Other Time at previous employment Select year1 year2 year3 year4 year5 year6 year7 year8 year9 year10 year11 year12 year13 year14 year15 year16 year17 year18 year19 year20 year21 year22 year23 year24 year25 year26 year27 year28 year29 year30 year31 year32 year33 year34 year35 year36 year37 year38 year39 year40 year41 year42 year43 year44 year45 year46 year47 year48 year49 year50 year Select month 1 month2 month3 month4 month5 month6 month7 month8 month9 month10 month11 month12 month End Section Client 2 Employment status: PAYG employee Self employed Family business Full time Part time Casual Contractor Temporary Home duties Retired Student Not employed Govt. benefit recipient Other Occupation Employment sector or nature of business Employer/Company name and address Address Select State New South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Pin code Employer contact name and phone number (HR / Payroll contact) Phone number Employer email Time at current employment Select year1 year2 year3 year4 year5 year6 year7 year8 year9 year10 year11 year12 year13 year14 year15 year16 year17 year18 year19 year20 year21 year22 year23 year24 year25 year26 year27 year28 year29 year30 year31 year32 year33 year34 year35 year36 year37 year38 year39 year40 year41 year42 year43 year44 year45 year46 year47 year48 year49 year50 year Select month 1 month2 month3 month4 month5 month6 month7 month8 month9 month10 month11 month12 month Average hour per week If employed or in business for less than 2 years, please provide previous employment details. Previous employers name and address Address Select State New South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern Australia Pin code Previous employment status: PAYG employee Self employed Family business Full time Part time Casual Contractor Temporary Home duties Retired Student Not employed Govt. benefit recipient Other Time at previous employment Select year1 year2 year3 year4 year5 year6 year7 year8 year9 year10 year11 year12 year13 year14 year15 year16 year17 year18 year19 year20 year21 year22 year23 year24 year25 year26 year27 year28 year29 year30 year31 year32 year33 year34 year35 year36 year37 year38 year39 year40 year41 year42 year43 year44 year45 year46 year47 year48 year49 year50 year Select month 1 month2 month3 month4 month5 month6 month7 month8 month9 month10 month11 month12 month End Section Next YOUR FINANCIAL POSITION The following asset and liability information provides a snapshot of your net worth position. ASSET TYPE VALUE LIABILITY TYPE LIMIT MONTHLY REPAYMENT AMOUNT OWING Principal home Client1 Client2 Both Amount($) Principal home Client1 Client2 Both Amount($) Amount($) Amount($) Address Interest rate(%) Lender Investment property Client1 Client2 Both Amount($) Investment property Client1 Client2 Both Amount($) Amount($) Amount($) Address Interest rate(%) Lender Investment property Client1 Client2 Both Amount($) Investment property Client1 Client2 Both Amount($) Amount($) Amount($) Address Interest rate(%) Lender Holiday home Client1 Client2 Both Amount($) Holiday home Client1 Client2 Both Amount($) Amount($) Amount($) Address Interest rate(%) Lender Motor vehicle Client1 Client2 Both Amount($) Motor vehicle finance Client1 Client2 Both Amount($) Amount($) Amount($) Type Interest rate(%) Lender Motor vehicle Client1 Client2 Both Amount($) Motor vehicle finance Client1 Client2 Both Amount($) Amount($) Amount($) Type Interest rate(%) Lender Investments (eg. shares, managed funds, term deposits) Client1 Client2 Both Amount($) Line of credit Client1 Client2 Both Amount($) Amount($) Amount($) Cash (including savings) Interest rate(%) Lender Client 1 Client 2 Both Amount($) Credit cards and retail store cards(Total combined limits etc.) Superannuation Client 1 Client 2 Both Amount($) Amount($) Amount($) Client 1 Client 2 Both Amount($) Margin lending or other invest.loans Contents (insured value) Client 1 Client 2 Both Amount($) Amount($) Amount($) Client 1 Client 2 Both Amount($) Interest rate(%) Lender Other assets (eg. boats, caravans collections) Other liabilities – provide details Client 1 Client 2 Both Amount($) Interest rate(%) Lender Other provide details Client 1 Client 2 Both Amount($) Interest(%) Lender Address Interest free debt Client 1 Client 2 Both Amount($) Amount($) Amount($) Client 1 Client 2 Both Amount($) Overdrafts and other bank facilities Client 1 Client 2 Both Amount($) Amount($) Amount($) Client 1 Client 2 Both Amount($) Loans as guarantor Client 1 Client 2 Both Amount($) Amount($) Amount($) Client 1 Client 2 Both Amount($) Hire purchase(Total of all HP agreements) Client 1 Client 2 Both Amount($) Amount($) Amount($) Client 1 Client 2 Both Amount($) Personal debt Client 1 Client 2 Both Amount($) Amount($) Amount($) TOTAL ASSETS (A) HECS liability / Taxation debt Client 1 Client 2 Both Amount($) Amount($) Amount($) TOTAL LIABILITIES (B) Amount($) Amount($) NET WORTH (A-B) End Section Next YOUR INCOME AND EXPENDITURE Your income if PAYG clients Client1 Client2 ANNUAL INCOME GROSS NET ANNUAL INCOME GROSS NET Base incomes/salary Bonuses Amount($) Amount($) Base incomes/salary Bonuses Amount($) Amount($) Period of receipt Amount($) Amount($) Period of receipt Amount($) Amount($) Regular overtime(Period of receipt) Amount($) Amount($) Regular overtime(Period of receipt) Amount($) Amount($) Rental income Rental income Investment income Investment income Government allowances Government allowances Other($) Amount($) Other($) Amount($) SUBTOTAL(1) Amount($) SUBTOTAL (2) Amount($) TOTAL NET ANNUAL INCOME (1+2) Amount($) End Section Next Next Next Next Next Next Next Submit
