Your Names

Title Person 1

Name Person 1

First Name

Last Name

Preferred Name Person 1

Sex Person 1

Male

Female

Date of Birth Person 1

YYYY

Title Person 2

Name Person 2

First Name

Last Name

Section 1 - Reasons Why You Are Seeking Advice

In your own words, please set out your 3 main reasons for seeking financial advice:

Reason 1

Reason 2

Reason 3

Section 2 - Your Details

Employment Status

Employer (If Employed)

Occupation

Qualifications

Start Date of Current Employment

YYYY

Personal Health Insurance

Other Health Fund

If other please include here

Cover Type

What is your current health cover

How do you describe your current health

Are you a smoker

Yes

Marital Status

Contact Details (Please Indicate your preferred method of contact)

Preferred Method of Contact

Home

Work

Mobile

Home

(##) #### ####

Work

(##) #### ####

Mobile

(####) ### ###

Fax

(##) #### ####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Postal Address (if different from main address)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Section 3 - Your Dependants

Please Provide a list of Children (Including Adult Children) and other Financial Dependants

Dependant 1

First Name

Last Name

Relationship - Dependant 1

Date of Birth - Dependant 1

YYYY

Or Age Now Dependant 1

Future Period of Likely Dependancy - Dependant 1

Number of years

For children, please set out your existing or planned education for them

Eg. Private Schooling, University or Tertiary Studies etc. with expected annual costs using todays dollars

If any of the above are not children, please explain the nature of future dependency

Dependant 2

First Name

Last Name

Relationship - Dependant 2

Date of Birth - Dependant 2

YYYY

Or Age Now - Dependant 2

Future Period of Likely Dependancy - Dependant 2

Privacy Statement *

I/we acknowledge that I/we have read and understood the Arc Financial Solutions Pty Ltd Privacy Statement

Financial Services Guide *

I/we acknowledge that I/we have received, read and understood the Financial Services Guide (FSG) for Mr Howard Pitts of Arc Financial Solutions Pty Ltd.

Information Accuracy *

I/we acknowledge that I/we and testify to the accuracy of the information provided in this Fact Find questionnaire and accompanying documents.

Written Advice *

I/we acknowledge and understand that I/we can only rely and act upon written advice based on this Fact find questionnaire.

FACT FIND QUESTIONNAIRE - COUPLEs

PRIOR TO COMMENCING THE QUESTIONNAIRE PLEASE READ THE IMPORTANT INFORMATION ON THE QUESTIONNAIRES PAGE

YOUR ACKNOWLEDGEMENT