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Client Information Form

Confidential Financial Fact Find

Personal Details - Person 1

Title (e.g. Mr, Ms)

Family name *

First name *

Middle name(s)

Date of birth

Gender

M

F

Driver's licence no.

Marital status

Single

Married

Defacto

Separated

Divorced

Widowed

No. & age of dependants, excluding spouse

My current residential address is: *

Date moved there

My current residential status is:

Home has mortgage

Rent/Board

Own home

Live with parents/relatives

Email *

Home phone number

Mobile phone number *

Employer Details

Employment Details - Person 1

The title of my job is: *

Self employed?

Yes

No

My employment is:

Full-time

Part-time

Temporary

Casual

Unemployed

Social Security

Student

Home duties

Family business

Employer's name *

Employer's address

Contact name

Contact number

Work phone number

Time at current employment

Income Details

Current Income - Person 1

Gross Annual Income (Before tax) *

$

MY MONTHLY INCOME (money you receive)

Wage or salary AFTER tax

$

Private pension

$

Interest income

$

Other income

$

Assets (What I Own) - All People

My real estate property assets are:

Address of Property

Description (e.g. house, unit)

Situation

Owner occupied

Rented

$

Ownership

Person 1

Person 2

Other

Market Value

$

Security?

Yes

No

My cheque, savings, term deposit and other accounts are:

Name of Institution

Account Type

Owner

P1P2Joint

Value/Balance

$

Name of Institution

Account Type

Owner

P1P2Joint

Value/Balance

$

Name of Institution

Account Type

Owner

P1P2Joint

Value/Balance

$

My investments including superannuation, life insurance, shares, etc are:

Name of Institution

Investment Type

Owner

P1P2Joint

Value/Balance

$

Name of Institution

Investment Type

Owner

P1P2Joint

Value/Balance

$

Name of Institution

Investment Type

Owner

P1P2Joint

Value/Balance

$

My motor vehicles are:

Make and Model

Year Built

Owner

P1P2Joint

Value/Balance

$

Make and Model

Year Built

Owner

P1P2Joint

Value/Balance

$

My other assets including household items, personal effects, tools, etc are:

Brief description of other assets

Owner

P1P2Joint

Value/Balance

$

Brief description of other assets

Owner

P1P2Joint

Value/Balance

$

Liabilities (What I Owe) - All People

My housing loans, overdrafts and other debts secured by mortgage are:

Mortgage / Debt 1

Address of security property

Lenders and account number

Interest Rate

%

Monthly Repayment

$

Borrower

P1P2

Debt Cleared?

YesNo

Amount to be repaid with this loan

$

Amount owing or limit

$

New amount owing or limit

$

My credit cards, store cards, personal loans, etc are:

Lender & Type

Limit

$

Amount Owing

$

Repayment

$

Borrower

P1P2

Lender & Type

Limit

$

Amount Owing

$

Repayment

$

Borrower

P1P2

Lender & Type

Limit

$

Amount Owing

$

Repayment

$

Borrower

P1P2

Lender & Type

Limit

$

Amount Owing

$

Repayment

$

Borrower

P1P2

Document Uploads

Document Uploads - Person 1

Government Issued ID

Driver's Licence or Passport

Upload

Recent Payslips

Last 2 consecutive payslips

Upload

Bank Statements

Last 3-6 months of statements

Upload

Tax Returns / NOA

Last 2 years (if self-employed)

Upload

Other Documents

Any other supporting info

Upload

Declaration

Privacy Disclosure Statement and Consent

We are collecting personal and financial information about you to provide you with our broking services.

The information you provide will be held by us and Risen Capital.
You appoint us your agent to obtain your credit information from a credit reporting body on your behalf.
We may use credit information and any other information you provide to arrange or provide finance and other services.

Applicant(s) Execution

Applicant 1

Print Name *Signature *

Date