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 Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Pin Code Time at current address 1 year 2 year 3 year 4 year 5 year 6 year 7 year 8 year 9 year 10 year 11 year 1 2year 1 3year 1 4year 1 5year 1 6year 17 year 18 year 1 9year 20 year 21 year 22 year 23 year 24 year 25year 26 year 27 year 28 year 29 year 30year 31 year 32 year 33 year 34 year 35 year 36 year 37 year 38 year 39 year 40 year 40 year 41 year 42 year 43 year 44 year 45 year 46 year 47 year 48 year 49 year 50 year Select Months 1 month 2 month 3 month 4 month 5 month 6 month 7 month 8 month 9 month 10 month 11 month 12 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 Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Pin Code Postal address (if different from current residential address) Select State New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western 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 Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Pin Code Time at current address 1 year 2 year 3 year 4 year 5 year 6 year 7 year 8 year 9 year 10 year 11 year 1 2year 1 3year 1 4year 1 5year 1 6year 17 year 18 year 1 9year 20 year 21 year 22 year 23 year 24 year 25year 26 year 27 year 28 year 29 year 30year 31 year 32 year 33 year 34 year 35 year 36 year 37 year 38 year 39 year 40 year 40 year 41 year 42 year 43 year 44 year 45 year 46 year 47 year 48 year 49 year 50 year Select Months 1 month 2 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 Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Pin Code Postal address (if different from current residential address) Select State New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western 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 Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Pin code Employer contact name and phone number (HR / Payroll contact) Phone number Employer email Time at current employment Select year 1 year 2 year 3 year 4 year 5 year 6 year 7 year 8 year 9 year 10 year 11 year 12 year 13 year 14 year 15 year 16 year 17 year 18 year 19 year 20 year 21 year 22 year 23 year 24 year 25 year 26 year 27 year 28 year 29 year 30 year 31 year 32 year 33 year 34 year 35 year 36 year 37 year 38 year 39 year 40 year 41 year 42 year 43 year 44 year 45 year 46 year 47 year 48 year 49 year 50 year Select month 1 month 2 month 3 month 4 month 5 month 6 month 7 month 8 month 9 month 10 month 11 month 12 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 Wales Northern Territory Queensland South Australia Tasmania Victoria Western 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 year 1 year 2 year 3 year 4 year 5 year 6 year 7 year 8 year 9 year 10 year 11 year 12 year 13 year 14 year 15 year 16 year 17 year 18 year 19 year 20 year 21 year 22 year 23 year 24 year 25 year 26 year 27 year 28 year 29 year 30 year 31 year 32 year 33 year 34 year 35 year 36 year 37 year 38 year 39 year 40 year 41 year 42 year 43 year 44 year 45 year 46 year 47 year 48 year 49 year 50 year Select month 1 month 2 month 3 month 4 month 5 month 6 month 7 month 8 month 9 month 10 month 11 month 12 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 Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia Pin code Employer contact name and phone number (HR / Payroll contact) Phone number Employer email Time at current employment Select year 1 year 2 year 3 year 4 year 5 year 6 year 7 year 8 year 9 year 10 year 11 year 12 year 13 year 14 year 15 year 16 year 17 year 18 year 19 year 20 year 21 year 22 year 23 year 24 year 25 year 26 year 27 year 28 year 29 year 30 year 31 year 32 year 33 year 34 year 35 year 36 year 37 year 38 year 39 year 40 year 41 year 42 year 43 year 44 year 45 year 46 year 47 year 48 year 49 year 50 year Select month 1 month 2 month 3 month 4 month 5 month 6 month 7 month 8 month 9 month 10 month 11 month 12 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 Wales Northern Territory Queensland South Australia Tasmania Victoria Western 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 year 1 year 2 year 3 year 4 year 5 year 6 year 7 year 8 year 9 year 10 year 11 year 12 year 13 year 14 year 15 year 16 year 17 year 18 year 19 year 20 year 21 year 22 year 23 year 24 year 25 year 26 year 27 year 28 year 29 year 30 year 31 year 32 year 33 year 34 year 35 year 36 year 37 year 38 year 39 year 40 year 41 year 42 year 43 year 44 year 45 year 46 year 47 year 48 year 49 year 50 year Select month 1 month 2 month 3 month 4 month 5 month 6 month 7 month 8 month 9 month 10 month 11 month 12 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 If you are human, leave this field blank.
