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Client Brief Form
Please take the time to fill out as much information as you can. If you have any questions, you can call our office on
(07) 3231 4250
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Client 1
Surname
*
Given Name
*
Middle Name
*
Date of Birth
Country of Birth
Country of Residence / Citizenship
Gender
Male
Female
Marital Status
Residential Address
Postal Address
Preferred Telephone
*
Preferred Email Address
*
Do you have any health concerns or issues?
Are you a smoker or have you smoked in the past 12 months?
Yes
No
Occupation
Employment Income
Other Income (Not Rental)
Do you have partner information to enter?
*
Yes
No
Client 2
Surname
*
Given Name
*
Middle Name
*
Date of Birth
Country of Birth
Country of Residence / Citizenship
Gender
Male
Female
Marital Status
Residential Address
Postal Address
Preferred Telephone
*
Preferred Email Address
*
Do you have any health concerns or issues?
Are you a smoker or have you smoked in the past 12 months?
Yes
No
Occupation
Employment Income
Other Income (Not Rental)
Dependant(s) Information
Name of Dependant(s) eg. children, parents
Date of Birth
Age
Relationship
Financially Dependant
Details on your Assets and Liabilities
Property
Value
Loan Amount
Interest rate
Monthly repayment
Rent received per week
Other Assets
Other Assets
Value
Loan Amount
Interest rate
Monthly repayment
Rent received per week
Superannuation
Superannuation
Fund Name
Value
Contributions (ie do you salary sacrifice or make additional contributions)
Do you have Insurance?
Insurance Type
Sum Insured
Owner
Premium (per month)
What you are looking to get out of your meeting with us?
Which adviser are you meeting with?
*
Please select adviser
Ross Vanderwolf
Gino Saggiomo
David Jackson
Jason Belcher
Justin Keating
Belinda Kennedy
Unsure
What is concerning you most about your finances?
What is the biggest issue in your life at the moment?
Why have you now decided it is time to seek a professional adviser?
Receiving documents and providing instructions electronically
We may send documents by the electronic means that you have nominated, including our financial services and credit guides, credit guides, advice documents and product disclosure statements. You can also authorise us to act on instructions we receive from your nominated electronic means and to receive your formal agreement via your nominated electronic means. Communications may be in the form of Email (including scanned documents), Fax, Mobile Phone and tablet devices.
Receiving Documents
*
I am willing to accept documents being supplied electronically as above, including the financial services and credit guide, credit guides, advice documents and product disclosure statement. I also consent to using electronic means to provide instructions, agreement and acknowledgements on documents from time to time using the email address and phone number provided. This applies to all contact details provided on the above form.
Financial Services and Credit Guide
By clicking submit, you acknowledge access to our latest Financial Services and Credit Guide (FSCG) which has been emailed to you with a link to this questionnaire. The FSCG can also be dowloaded by clicking this link below.
Your privacy is important to us and Charter Financial Planning, which is part of AMP. You may request access to your personal information at any time by calling us on 07 3231 4250 or contacting AMP on 1300 157 173. Information collected will be subject to AMP's Privacy Policy. You can also contact us or AMP if you do not wish to receive information about products, services or offers available from us or AMP from time to time.
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