1 of 22 | Fact Find

Client 1
Surname


First name(s)

Client 2
Surname

First name(s)

Date completed

/

/

Adviser Details
Adviser name
Adviser Prole version supplied (version date)
Date FSG provide to client

/

/

FSG version supplied (version date)
Fact Find
Private and Condential
A condential analysis of goals and nancial situation.
Important Notice
The Corporations Act requires that an adviser have reasonable basis for any recommendation or advice that they
provide. As such, advisers must make reasonable inquiries to determine a clients objectives, needs and circumstances.
The information requested in this Fact Find and/or on any subsequent occasion(s) is necessary to ensure the
recommendations made or advice provided to you is appropriate to your objectives, needs and circumstances.
Consultum Financial Advisers Pty Ltd ABN 65 006 373 995 | AFSL 230323 | Part of the IOOF group
Head Ofce: Level 6, 161 Collins Street, Melbourne Victoria 3000.
www.consultum.com.au
D
D
D
D
M
M
M
M
Y
Y
Y
Y
Y
Y
Y
Y
1 of 22 | Fact Find
Contact Details
Residential address







Postal address


(if not same as home)





Home phone number

Business phone number

Mobile phone number

Fax number

Email Address

Preferred method of

contact?
Do you have a computer

Yes No Yes No

and internet access?
If yes are you happy to

Yes No Yes No

receive information online?
Personal Data
( )
( )
( )
( )
( )
( )
Personal Data Client 1 Client 2
Title

Surname

First name(s)

Preferred name

Date of birth

/

/

/

/

Marital status

Place of birth

Are you an


Yes

No

Yes

No
Australian resident?
D D D D M M M M Y Y Y Y Y Y Y Y
2 of 22 | Fact Find
Employment

This section has been left blank intentionally as it is not applicable
Client 1 Client 2
Please supply a copy of your latest payslip or tax return and salary packaging details.
Please complete Section G (if applicable) of the Advice Booklet if giving Salary Packaging advice.
Occupation/Title
Employer name
Employment status i.e.
full-time, part-time, casual
Duties
Details of salary packaging
arrangement i.e. superannuation
Details of accrued sick, annual
or long service leave
Dependant Details

This section has been left blank intentionally as it is not applicable
Name Dependent Date of birth Dependant Receiving any
(for SIS purpose) until age government benets?
General Health
Client 1 Client 2
Do you have private health insurance?
What is your present health status?
i.e. good, fair, excellent.
Are you a smoker?
Have you recently changed your
smoking habit?
What, if any, medical issues need
to be noted? i.e. are you taking any
medication?
Yes No Yes No
Yes No Yes No
3 of 22 | Fact Find
Please complete Section H of the Advice Booklet if giving Corporate Entity advice.

This section has been left blank intentionally as it is not applicable
Client 1 Client 2
Expenditure
Type of expenses i.e. Details e.g. gross or net Monthly Annually
education, insurance
Entity type (company, trust or SMSF)
Entity Name
Principal activity
Corporate Entities
Financial Details
Total
Total $
$
$

This section has been left blank intentionally as it is not applicable
Income
Type of income i.e. Details e.g. gross or net Client 1 Client 2
salary, investment income
4 of 22 | Fact Find
Is any aspect of your income or expenditure expected to change over the next 12 months?
If yes, please detail the changes.
Notes
5 of 22 | Fact Find
N
o
n

d
e
d
u
c
t
i
b
l
e

l
o
a
n
s

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w
n
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r

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a
n
d
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b
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p
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m
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u
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d
/
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y

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m



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p
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g
a
g
e


$

$
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d
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t

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a
r
d


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r


$

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t
h
e
r


$

$
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a
l

n
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d
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c
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l
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a
n
s


$

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a
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p
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s
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t
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n


$

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i
f
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s
t
y
l
e

A
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t
s

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r

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n
t

v
a
l
u
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t
e
s
P
r
i
n
c
i
p
a
l

r
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s
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d
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n
c
e


$
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m
e

c
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t
e
n
t
s


$
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-
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m
e

p
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d
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a
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1


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v
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2


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a
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/
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n


$
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a
b
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/
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/
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a
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b
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s


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r


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r


$
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s


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t
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a
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b
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s

6 of 22 | Fact Find
D
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b
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y

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n


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g
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n

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n


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r


$

$
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n
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$

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$

7 of 22 | Fact Find
D
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8 of 22 | Fact Find
Superannuation Lump Sum Benet

This section has been left blank intentionally as it is not applicable

Please tick if pre-payment quote is attached, otherwise you must complete.
Note: Preference is that the client supplies you with a copy of the pre-payment quote.
Owner
Annual leave (net of tax)
Long service leave (net of tax)
Redundancy/early retirement (tax free amount)
Redundancy/early retirement (EFT amount)
Post June invalidity payment
Ex gratia/golden handshake
Other
Total amount of the ETP
$
$
$
$
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$
$
$
$
Notes
9 of 22 | Fact Find
T
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10 of 22 | Fact Find
$ $
$ $

This section has been left blank intentionally as it is not applicable
Client 1 Client 2
What Centrelink/DVA benets do you
currently receive?
What are the fortnightly
benet amounts?
Do you intend to apply for any
Centrelink/DVA benets in the
near future?
If yes, please provide details.
Would you like to be eligible for
Centrelink/DVA benets?
If yes, which benets, when and why?
Have you gifted assets in
the last 5 years?
If yes, please detail.
Social Security
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Notes
11 of 22 | Fact Find
In order to provide appropriate advice, we need to consider various strategies.
These strategies can be inuenced by your intentions regarding the distribution of your assets after your death.
Client 1 Client 2
The following details relate to your plans for your nances after your death or during a period where you are
not able to control your nances e.g. due to illness.
Client 1 Client 2
Do you have a Will?
When was your Will last reviewed?
Would you like to be referred for
advice on estate planning?
Does the Will incorporate a
testamentary trust?
Who is the executor of your Will?
Relationship to the trust?
Relationship to the company?
Estate Planning
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Have your circumstances
changed in this time?
If yes, briey provide details.
Have you arranged for anyone to have
Power of Attorney over you?
If yes, what type e.g. enduring.
Are you a trustee or beneciary of a
discretionary trust?
If yes, please name the trust.
Are you a director or associated
with a company?
If yes, please name the company.
Have you arranged for
guardianship over your children?
If yes, who is the guardian?
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
12 of 22 | Fact Find
Objectives
Reason for seeking Financial Advice
What is the primary reason for you seeking Financial Advice?
What expectations do you have about seeking Financial Advice?
Please tick the goals and objectives that are relevant to you. I/We would like to:

Build an investment portfolio

Consolidate and/or manage debts

Minimise tax obligations

Provide for retirement

Consolidate superannuation funds

Receive an ongoing income stream

Provide for dependants in the event of death, illness or injury

Buy or sell shares

Effectively manage a lump sum or inheritance

Effectively manage nancial risk

Review existing nancial arrangements

Other

Other
Lifestyle Objectives
What lifestyle objectives are important to you?
What issues or events may affect your lifestyle objectives over the next 5 years?
13 of 22 | Fact Find
Retirement: When do you intend to retire? e.g. anticipated cost of living in retirement,
Social Security expectations.
Priority or
time frame
Liquidity: What sort of access do you need from your investments? How much cash do you
need to hold in reserves and why?
Priority or
time frame
Income: Do you currently rely on the income from your investments to cover your living
expenses? If yes, what level of income do you require?
Priority or
time frame
Anticipated Capital Expenditure: Describe details of one off lump sum expenditure you may
be planning now or in the future e.g. overseas holiday, new car.
Priority or
time frame
Anticipated Capital Inows: Describe details of any lump sums you anticipate in the future
e.g. sale of assets, future inheritance.
Priority or
time frame
Risk Management: What requirements do you have (for yourself and your dependants)
in the event of death, disability, trauma and extended illness? (Please refer to the
Risk Needs Analysis on page 16 for more detail.)
Priority or
time frame
Objectives
For each of your objectives, please include a priority or time frame and a value in todays dollars.
14 of 22 | Fact Find
General commentary on objectives/client requests
Estate Planning: What intentions do you have regarding the distribution of your assets after
your death? What is the maximum value you would want to leave to your estate?
Priority or
time frame
Other: Priority or
time frame
Other Advisers Name Contact Details
Accountant
Solicitor/Lawyer
Other (please list)
15 of 22 | Fact Find
Immediate needs Client 1 Client 2
Mortgage repayment/rental provision $ $
Total outstanding debts $ $
Business liabilities $ $
Tax provision (e.g. capital gains, income tax) $ $
Education funding allowance $ $
Emergency income (approx. 3 - 6 months) $ $
Related fees (e.g. legal, accounting, appraisal) $ $
Final expenses (e.g. funeral, executor, probate) $ $
Sub-total A $ $
Summary Client 1 Client 2
Immediate needs (A) $ $
Income needs (B) $ $
Total estate required (A + B) $ $
Less estate assets (C) $ $
Estate shortfall (if any) $ $
Cover required $ $
(rounded to the nearest thousand)
Replacement income needs Client 1 Client 2
Income for survival of partner* (p.a.) (1) $ $
Income for survival of children (p.a.) (1) $ $
*Suggested amount is two-thirds current gross income.
Number of years income required (2) $ $
Sub-total (1) multiplied by (2) = B $ $
Estate assets (realisable) $ $
Investment assets (exclude family home) $ $
Superannuation assets $ $
Life insurance (use existing level of cover) $ $
Business assets (if applicable) $ $
Sub-total C $ $

This section has been left blank intentionally as it is not applicable
Life and/or TPD insurance
Risk Insurance Needs Analysis
16 of 22 | Fact Find
Income Protection insurance Client 1 Client 2
Gross annual income (before tax) $ $
Less business expenses (if applicable) $ $
Net annual income (before tax) (A) $ $
Maximum allowable annual benet (B) $ $
(75% of net annual income)
Divide annual benet by 12 (C) $ $
Less existing insurance (if applicable) (D) $ $
Monthly benet required (pre tax) $ $
(A * B)/(C D)
Total sick, annual + long service leave balances days days
Current cash reserve held $ $
Waiting period to be served days days
Age policy payable until years years
Trauma insurance Client 1 Client 2
Medical costs (to cover out-of-pocket health costs) $ $
Funds required for retirement $ $
Lump sum capital requirement $ $
Additional income (to cover 25% gap) $ $
Total funds required $ $
Less cash available or realisable estate assets $ $
(Shortfall)/surplus $ $
Cover required $ $
(rounded to the nearest thousand)
Risk insurance needs analysis notes
17 of 22 | Fact Find
Client Declaration
By completing and signing the declaration on the following page, I declare the following:
I/We declare that the information provided in this fact nd is complete and accurate to the best of my/our knowledge (except
where I/we have indicated that I/we have chosen not to provide the information). I/We understand and acknowledge that
by either, not fully or accurately completing the fact nd, that any recommendation or advice given by my/our Consultum
Authorised Representative may be inappropriate to my/our needs and that I/we risk making a nancial commitment to a
nancial product or strategy that may be inappropriate for the needs identied. I/We also understand that if I/we do not
provide all the requested information, my/our Consultum Authorised Representative may not be able to provide me/us with
nancial advice or other requested services or products.
Please provide a Statement of Advice for my/our consideration. I/We understand that the preparation of the Statement
of Advice will be subject to the payment model outlined in the Adviser Prole provided by my/our Consultum Authorised
Representative.
Privacy
I/We understand that Consultum and my/our Consultum Authorised Representative is required to collect my/our personal
information under the Corporations Act 2001 and the Anti-Money Laundering and Counter-Terrorism Financing Act 2006.
I/We acknowledge that I/we have received the Consultum Financial Services Guide (FSG) and Adviser Prole inclusive of
Consultums Privacy Disclosure Statement and understand that the information provided to my/our Consultum Authorised
Representative will primarily be used for the purpose of providing me/us with nancial advice and for other ancillary purposes
as detailed in the FSG and Privacy Policy, for example: to provide you with account statements.
I/We understand that Consultum and my/our Consultum Authorised Representative may disclose my/our personal information
(such as, name, contact details and account information ) to its related bodies corporate, a person with whom I/we receive
joint nancial services, my/our nancial and professional advisers, businesses that may have referred me/us to Consultum,
credit unions, building societies, banks and other nancial institutions in connection with providing services to me/us. I/We
understand that Consultum and my/our Consultum Authorised Representative may disclose my/our sensitive information,
such as, my/our health information to life companies to establish and maintain requested insurance. Consultum and my/our
Consultum Authorised Representative are not likely to disclose my/our personal information to overseas recipients.
I/We understand that my/our personal information will be used in accordance with the Consultum Privacy Policy.
I/We understand that the Consultum Privacy Policy (available to me/us by contacting Consultum on 1800 062 134 or via
www.consultum.com.au/Privacy) contains further information about how I/we may access or correct my/our personal
information and how I/we may complain about a breach of the Australian Privacy Principles.
No Call/No Contact
I/We wish to be placed on a No Call/No Contact Register which entitles me/us not to be contacted regarding any
nancial products without my/our express consent, unless otherwise directed.
Tick the box above if you DO NOT want us to contact you without your expressed consent.
Opt out of Ongoing Review Service
I/We wish to Opt out Ongoing Review Service.
Electronic Communication Acceptance
I/We understand that Consultum and my/our Consultum Authorised Representative is required by law to provide
us with Advice Documents and Product Disclosure Statements for each product and investment option that they
recommend.
I/We conrm my/our acceptance that I/we am/are willing and able to receive and access these documents in electronic
format including, however not limited to email, web link, USB ash drive or CD-Rom where appropriate, which may
be viewed on my/our home or work computer at any time.
I/we understand that paper documents can be provided free of charge on request.
Disclaimer: Consultum and/or your Consultum Authorised Representative will not be held accountable if the email address provided can be viewed and/or
manipulated by multiple users. If at any time you believe your email address is insecure, please notify your nancial adviser either in person or over the telephone.
Declarations
18 of 22 | Fact Find
Adviser Declaration
I have provided you with a copy of the Consultum Financial Services Guide and Adviser Prole and Privacy Policy prior to any
nancial product and strategy recommendations being made and personal and sensitive information being collected.
As a recipient of TFN information, I as a Consultum Authorised Representative have taken reasonable steps to ensure:
That the client(s) is informed of the legal basis for collection, that declining to provide a TFN is not an offence and the
consequences of not providing a TFN.
That the manner of obtaining the TFN was not reasonably intrusive.
The disclosure of the TFN will only be disclosed to Fund Managers and Life Insurance Companies as relevant and required
by Superannuation and Taxation Laws.
D D / / M M Y Y Y Y
Adviser signature Date
D D / / M M Y Y Y Y
Client 1 signature
Tax File Number Print Name
Date
D D / / M M Y Y Y Y
Client 2 signature
Tax File Number Print Name
Date
Tax File Number Declaration
I/We are authorising our Consultum Authorised Representative, to hold my/our Tax File Number(s) in a secure location and
use it/them for the following nancial product and strategy recommendations related purposes/documents, in accordance
with the legislative requirements:
Matters for superannuation investment purposes as required by the Superannuation Laws;
such as inclusion on application forms.
Matters for non-superannuation investment purposes as required by the Taxation Laws; such as inclusion on application forms.
That I/we have been informed of the legal basis for collection and are aware that declining to provide a TFN is not an
offence and know the consequences of not providing a TFN.
That the manner of obtaining the TFN was not reasonably intrusive.
The disclosure of the TFN will only be disclosed to Fund Managers and Life Insurance Companies as relevant.
19 of 22 | Fact Find
To Whom it May Concern,
Please provide my Adviser with the appropriate information necessary for them to conduct an analysis of my current product
(described below), including information to understand my entitlements, administration and nancial conditions of the fund,
fund performance and particular investments pursuant to your requirements under (s1017C).
I, authorise you to provide my Adviser ( ),
Authorised Representative of Consultum Financial Advisers Pty Ltd with any information and documentation they require
regarding all my insurance, superannuation and investments with you.
I am aware of the provisions of the Privacy Act and release you from those provisions in respect of information
provided to my Adviser.
Please accept this facsimile copy/photocopy as authority, as the original will stay on le with my Adviser.
In addition, please consider this authorisation as being valid until formally revoked by me in writing.
Yours sincerely,
Adviser ofce address
Member/Account No.
Name of product
or investment
Authorisation to Collect Information
D D / / M M Y Y Y Y
D D / / M M Y Y Y Y
Signature
Date of birth
Date
Print Name
20 of 22 | Fact Find
Please tick the appropriate boxes after completing the Fact Find, but before the client(s) leave the interview.
You have handed a copy of the FSG and Adviser Prole to the client(s).
Write the date given to client(s) and FSG version number, on the cover page of the Fact Find.
You have highlighted and explained the Consultum Financial Advisers Privacy Policy
(as outlined in the FSG) to the client(s).
Where relevant, you have completed an Investment Risk Prole for the client.
Client(s) has read and signed all the declarations.
Did the client(s) give you their tax le number?
YES Client(s) must complete the Tax File Number Declaration located in the Declaration section.
Did the client(s) refuse to supply any personal or nancial information?
YES Please include the incomplete info warning in the Statement of Advice (Xplan SoA Menu/Scope).
Ensure you have ticked the left blank not applicable box at the start of each section in the Fact Find which is not
relevant or applicable to the advice being provided.
Ensure the Services or Scope of Advice agreed with the client(s) has been documented in the
Term of Engagement and accepted (located in the Advice Booklet).
Did the client(s) tick the No Call/No Contact box in the Declaration section?
YES Ensure you ag the No Call/No Contact eld against the client(s) in Xplan (Admin/Interests and Marketing)
and record on your register.
Have you referred the client(s) to another Specialist Adviser?
YES You must disclose your relationship with the person and any fees applicable that result from the referral.
Are you providing advice on Salary Packaging? Tick one of the following options
No
Yes, please complete the applicable Salary Packaging section in the Advice Booklet.
Are you providing advice on a Corporate Entity? Tick one of the following options
No
Yes, please complete the applicable Corporate Entity section in the Advice Booklet.
Are you providing advice on Risk Insurance? Tick one of the following options
No
Yes, please complete the applicable Risk Insurance analysis section in the Advice Booklet.
Has the client(s) requested advice of a limited purpose or limited range of products?
Tick one of the following options
No
Yes, please outline request in Client Request section.
Fact Find Completion Checklist
21 of 22 | Fact Find
Know Your Client Checklist
This document is designed to assist you meet the Know You Client (KYC) requirements under the Anti Money Laundering
and Counter Terrorism Financing (AML/CTF) legislation. This document is for Ofce Use Only and needs to be completed in
conjunction with the FPA/IFSA Identication Form (or alternate Identication Forms as prescribed by the Product Issuer).
Please obtain a copy (either original or certied*) of ONE of the following documents and attach to the Fact Find:
Current Drivers Licence that contains a photograph
Current passport
A card issued under a Law of State or Territory which contains a photograph and clients date of birth
(e.g. working with children card, over 18 card)
Detail card type:
A National Identity Card issued by a foreign government, or United Nations containing a photograph and
signature of the customer
If client does not have any of the above forms of identication, then attach a copy of an original or certied* copy of
ONE of the following documents:
The clients Birth certicate (Birth extract not acceptable)
The clients Citizenship certicate
The clients Pension card issued by Centrelink
A National Identity Card issued by a foreign government, or United Nations containing a photograph and
signature of the client
AND
A copy of a notice issued to the client by the State, Federal or local Government, Australian Tax Ofce or utilities
provider within the preceding 12 months that contains the clients name and residential address
(e.g. electricity bill, ne, tax assessment notice)
*Certied copy means a document that has been certied as a true copy of an original document. An Authorised Representative of a holder of an Australian
nancial services licence, having 2 or more continuous years of service with one or more licensees can certify documents for this purpose.
Note: This checklist is for INDIVIDUAL CLIENTS ONLY. If client is applying as a company or trust, please refer to the relevant
Customer Identity Record for that customer type.
22 of 22 | Fact Find
Notes
Phone
1800 062 134
Email
info@consultum.com.au
Website
www.consultum.com.au
Postal
GPO Box 2544W
Melbourne VIC 3001
Partner with a Consultum
nancial adviser today.
Consultum Financial Advisers
ABN 65 006 373 995
AFS Licence No. 230323
Part of the IOOF group
Level 6
161 Collins Street
Melbourne VIC 3000
C
R
A
-
3
4
7
5
This material is current as at March 2009, but may be subject to change. This material
has been prepared by Consultum Financial Advisers Pty Ltd, ABN 65 006 373 995,
AFS Licence No. 230323.
R
ealise your plans