FACT FIND QUESTIONNAIRE

Prior to commencing please ENSURE THAT YOU read the PRIVACY STATEMENT AND THE FINANCIAL SERVICES GUIDE

Privacy Statement

Financial Services Guide

Fact Find Questionnaire – Individual

Your Name

Title

Name

First Name

Last Name

Preferred Name

Sex

Male

Female

Date of Birth

YYYY

Section 1 – Reasons Why You Are Seeking Advice

In your own words, set out 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 – Name

First Name

Last Name

Dependant 1 – Relationship

Dependant 1 – Date of Birth

YYYY

Dependant 1 – Or Age Now

Future Period of Likely Dependancy - Dependant 1

Number of years

Dependant 2 – Name

First Name

Last Name

Dependant 2 – Relationship

Dependant 2 – Date of Birth

YYYY

Dependant 2 – Or Age Now

Future Period of Likely Dependancy – Dependant 2

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

Section 4 – Your Income (Per Annum)

a. If employed - If Not employed go to (B)

A. Employed (If Possible, Please Provide a copy of your latest pay slip/s)

Gross Taxable Salary (Base)

Fringe Benefit – Car

Fringe Benefit – Other

Employer Superannuation

Voluntary Superannuation – Salary Sacrifice or Deductible

Voluntary Superannuation – Post Tax

Annual Bonus (Expected)

When is Bonus Paid (Month)

Special Note Regarding Salary Package

Are You Eligible for Employee Share Plan Benefits or Similar?

If Yes, please provide details of entitlements and rules of operation in seperate documents

Yes

B. Other Income

Do you receive income from other sources other than investments? If Yes, Please Provide Details of Other Income, EXCLUDING INVESTMENT INCOME:

Centrelink Pension

Per fortnight

Type of Benefit

Other Pension 1

Other Pension 1 – Timing

Per Week

Per Fortnight

Per Month

Per Quarter

Per Six Months

Per Year

Other Pension 1 – Source and Type

Other Pension 2

Other Pension 2 – Timing

Per Week

Per Fortnight

Per Month

Per Quarter

Per Six Months

Per Year

Other Pension 2 – Source and Type

Other Pension 3

Other Pension 3 – Timing

Per Week

Per Fortnight

Per Month

Per Quarter

Per Six Months

Per Year

Other Pension 3 – Source and Type

Special Note Regarding Pensions

Please Provide Most Recent Statements From Each of These Pensions

Section 5 – Your Living Expenses

Please Set Out Your Requirements to Meet Regular Living Expenses.

OPTION 1

If you know exactly how much you need per month to cover living expenses (excluding all loan repayments). Please show amount here:

Option 2

Alternatively, Fill in the details below

Rates (Water, Council, Electricity, Telecom, Gas, Strata Levies etc.)

Rates – Timing

Specify if expense shown is per week/ fortnight/ month/ quarter or annual

Weekly

Fortnightly

Monthly

Quarterly

Annually

Insurance (Home, Contents, Car, Health etc.)

Insurance – Timing

Weekly

Fortnightly

Monthly

Quarterly

Bi-annually

Annually

Food

Food – Timing

Weekly

Fortnightly

Monthly

Quarterly

Bi-annually

Annually

Clothing

Clothing – Timing

Weekly

Fortnightly

Monthly

Quarterly

Bi-annually

Annually

Entertainment

Entertainment – Timing

Weekly

Fortnightly

Monthly

Quarterly

Bi-annually

Annually

Rent

Rent – Timing

Weekly

Fortnightly

Monthly

Quarterly

Bi-annually

Annually

Hobbies

Hobbies – Timing

Weekly

Fortnightly

Monthly

Quarterly

Bi-annually

Annually

Regular Holidays

Regular Holidays – Timing

Weekly

Fortnightly

Monthly

Quarterly

Bi-annually

Annually

Regular Savings

Regular Savings – Timing

Weekly

Fortnightly

Monthly

Quarterly

Bi-annually

Annually

Other Expenses

Other Expenses – Timing

Weekly

Fortnightly

Monthly

Quarterly

Bi-annually

Annually

Special Notes Regarding Expenses

Section 6

Do You Own Your Own Home?

If Yes, please provide the following details below:

Yes

Location

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Owner

Estimated Value

Do You Have Any Plans to Move?

If Yes, please provide details in the notes section below

Yes

Is there a Mortgage on the Property?

Yes

If Yes, Who is the Lender

What is the Current Interest Rate?

What is the Regular Repayment?

What is the Frequency of the Repayments

Weekly

Fortnightly

Monthly

Quarterly

What is the Outstanding Loan Amount

Special Note Regarding Residence

Personal Loans and Credit Cards

Do you Have a Personal Loan or Other Credit Loan Outstanding at This Time?

If Yes, please provide the following details below

Yes

Personal Loan 1 – Name

Personal Loan 1 – Purpose

(eg. For Car, Renovation etc.)

Personal Loan 1 – Type

(eg. Personal, Interest Free, Car Lease etc.)

Personal Loan 1 – Loan End Date

YYYY

Personal Loan 1 – Residual Amount at the End of the Loan

Personal Loan 1 – Repayment Frequency

Weekly

Fortnightly

Monthly

Quarterly

Bi-annually

Anually

Personal Loan 1 – Loan Balance Outstanding

Personal Loan 1 – Interest Rate on Loan (If Known)

Personal Loan 2 – Name

Personal Loan 2 – Purpose

Personal Loan 2 – Type

Personal Loan 2 – Loan End Date

YYYY

Personal Loan 2 – Residual Amount at the End of the Loan

Personal Loan 2 – Repayment Frequency

Weekly

Fortnightly

Monthly

Quarterly

Bi-annually

Annually

Personal Loan 2 – Interest Rate on Loan (If Known)

Do You Have a Credit Card(s)?

Yes

If Yes, How do you Handle the Outstanding Balance Each Month? (Please Choose the Most Appropriate Answer)

Pay off balance in full each month on due date.

Pay off as much as you can afford each month on the due date.

Make minimum required payment.

Do(es) your Credit Card(s) have an 'interest free' period?

Yes

Unsure

Assets

Superannuation or Retirement Income Stream Investments

Please provide copies of the most recent statements from all of your Superannuation accounts. If a Self Managed Superannuation Fund, please provide copy of most recent Financial Statements, including Member Statements.

Please provide details of all contributions to superannuation for the following periods:

Superannuation 1 – Name

Superannuation 1 – Contributions Since 1 July 2008 - Pre Tax

Superannuation 1 – Contributions Since 1 July 2008 - Post Tax

Superannuation 2 – Name

Superannuation 2 – Contributions Since 1 July 2008 - Pre Tax

Superannuation 2 – Contributions Since 1 July 2008 - Post Tax

Do You Have a Preference to Retain any or all of these Superannuation Accounts?

Yes

Seeking Advice

Please Provide Further Details as to Why:

Investment Properties

If you own any Investment Properties, please provide the following details for each property (if you have more than two properties, please provide a separate schedule):

Investment Property 1 – Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Investment Property 1 – Ownership

Investment Property 1 – Type (eg. House, Semi, Unit or Land)

Investment Property 1 – Year of Purchase

Investment Property 1 – Purchase Price

Investment Property 1 – Estimated Value

Investment Property 1 – Gross Rent Before Tax and Expenses

Investment Property 1 – Frequency of Rent Payments

Weekly

Fortnightly

Monthly

Quarterly

Bi-annually

Annually

Investment Property 1 – Expenses (Exclude Loan Repayments)

Investment Property 1 – Monthly Loan Repayment

Investment Property 1 – Outline Strategy for Investment (eg. Retain, Sell, Sell in 5 Years, Not Sure etc.)

Investment Property 2 – Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Investment Property 2 – Ownership

Investment Property 2 – Type (eg. House, Semi, Unit or Land)

Investment Property 2 – Year of Purchase

Investment Property 2 – Purchase Price

Investment Property 2 – Estimated Value

Investment Property 2 – Gross Rent Before Tax and Expenses

Investment Property 2 – Frequency of Rent Payments

Weekly

Fortnightly

Monthly

Quarterly

Bi-annually

Annually

Investment Property 2 – Expenses (Exclude Loan Repayments)

Investment Property 2 – Monthly Loan Repayment

Investment Property 2 – Outline Strategy for Investment (eg. Retain, Sell, Sell in 5 Years, Not Sure etc.)

A List or Schedule of all of Your Other Investments showing:

Copy of most recent bank statements & term deposits

Otherwise, a description of the investment

The owner of the investment

Number of units of the investment owned

Purchase cost of investment

Current market value of the investment

Details of any loans used to fund the investment

Please provide most recent copies of statements for managed investments and statement from broker or issuer sponsor for direct share holdings.

Section 7 - Your Views About Investment And Money

A critical part of financial planning and investment of funds is the need to understand and articulate your Investment Risk Profile. By doing so, we have the best chance of ensuring that:

You are comfortable with the type of investments we may recommend to you.

We can illustrate the way in which you can expect those investments to perform in the future, including scope for gains and losses in short and long terms.

It is appropriate to meet your long term objectives.

It reflects your tolerance for investment risk and does not cause you unwarranted anxiety for the way in which your funds are managed.

Would you please answer the following questions in your own words:

1. We have just come through one of the most severe financial crises of modern times. Describe your feelings in relation to your own situation and investments through this period?

2. How frequently do you check the value of your investments? Why?

3. What is an investment would you describe as “High Risk”? Why?

4. What is more important to you – minimising the chance of an investment loss or maximising the chance of a capital gain? You cannot choose both.

5. What is the most important thing about money to you?

6. What would you prefer? Please choose one only – either (a) or (b).

a. Never experiencing a decline in the value of your investments over a 12 month period? or

b. Forgoing (a) and having investments worth 10% more than would have otherwise have been the case after 10 years?

Section 8

We need to understand your plans for items of large or significant expenditure to ensure that our advice best meets your particular requirements. We have provided some examples – if these are not appropriate, simply write “n/a”. As a general rule, please note any expenditure that will be in excess of $10,000.

Short Term Objectives (Within the Next 3 Years)

Short Term Objective 1

Short Term Objective 1 – Likely Timing

Short Term Objective 1 – Likely Cost (Todays $)

Short Term Objective 1 – Certainty of Event

Certain

Likely

If Affordable

Short Term Objective 2

Short Term Objective 2 – Likely Timing

Short Term Objective 2 – Likely Cost (Todays $)

Short Term Objective 2 – Certainty of Event

Certain

Likely

If Affordable

Short Term Objective 3

Short Term Objective 3 – Likely Timing

Short Term Objective 3 – Likely Cost (Todays $)

Short Term Objective 3 – Certainty of Event

Certain

Likely

If Affordable

Medium Term Objectives (In next 4 to 10 years)

Medium Term Objective 1

Medium Term Objective 1 – Likely Timing

Medium Term Objective 1 – Likely Cost (Todays $)

Medium Term Objective 1 – Certainty of Event

Certain

Likely

If Affordable

Medium Term Objective 2

Medium Term Objective 2 – Likely Timing

Medium Term Objective 2 – Likely Cost (Todays $)

Medium Term Objective 2 – Certainty of Event

Certain

Likely

If Affordable

Long Term Objectives (Beyond 10 years) – Excluding Retirement Plans

Long Term Objective

Long Term Objective – Likely Timing

Long Term Objective – Likely Cost (Todays $)

Long Term Objective – Certainty of Event

Certain

Likely

If Affordable

Section 9 – Personal Insurances

Please provide a copy of the most recent renewal notice for each policy shown.

Lump Sum Life Insurance

Lump Sum Life Insurance – Cover Type

Death

Death & Total and Total Permanent Disablement (TPD)

Lump Sum Life Insurance – Cover Via Super Fund?

Yes

Unsure

Lump Sum Life Insurance – Insured Person

Lump Sum Life Insurance – Policy Owner

Lump Sum Life Insurance – Sum Insured

Lump Sum Life Insurance – Insurer

Lump Sum Life Insurance – Policy Name

Lump Sum Life Insurance – Policy Number

Lump Sum Life Insurance – Policy Commenced

YYYY

Lump Sum Life Insurance – Premium

Lump Sum Life Insurance – Premium Frequency

Weekly

Monthly

Fortnightly

Quarterly

Annually

Disablement Definition (if Applicable & Known)

Own

Any Occupation

Salary Continuance/ Income Protection Insurance

Income Protection Insurance – Insured Person

Income Protection Insurance – Monthly Benefit

Income Protection Insurance – Waiting Period

14 Days

30 Days

90 Days

Six Months

1 Year

2 Years

Income Protection Insurance – Benefit Period

2 Years

5 Years

To Age 55

To Age 60

To Age 65

Income Protection Insurance – Benefit Indexed

CPI

Not Sure

Other %

Income Protection Insurance – If Other %

Income Protection Insurance – Disablement Definition (If Known)

Own

Any Occupation

Income Protection Insurance – Insurer

Income Protection Insurance – Policy Name

Income Protection Insurance – Policy Number

Income Protection Insurance – Policy Commenced

YYYY

Income Protection Insurance – Premium Amount

Income Protection Insurance - Premium Frequency

Weekly

Fortnightly

Monthly

Quarterly

Annually

Trauma or Crisis or Recovery Insurance

Recovery Insurance – Insured Person's Name

Recovery Insurance – Sum Insured

Recovery Insurance – Insurer

Recovery Insurance – Policy Name

Recovery Insurance – Policy Number

Recovery Insurance – Policy Commenced DateRecovery Insurance -

YYYY

Recovery Insurance – Premium Amount

Recovery Insurance – Premium Frequency

Weekly

Fortnightly

Monthly

Quarterly

Annually

Section 10 – Your Retirement Plans

Name

1. Are you retired?

(If Yes, or you are over 65 please continue to question 2. If No please go to question 4)

Yes

2. Do You Expect to Work for Paid Reward Again?

(If Yes please provide details in the Notes Section Below)

Yes

3. In the Current Financial Year, Have You Worked more than 40 Hours in a Consecutive 30 Day Period?

(After completing this question please ignore question 4 and go to Question 5)

Yes

4. At what Age do you plan to retire?

5. Do You Expect that your Living Expenses Will Change from those in Section 5 of this Questionnaire?

Option One

Option Two

Special Notes

Section 11 – Estate Planning Arrangements & Issues

Name

Do You Have a Will?

Yes

If Yes, when did you last review it?

Have you issued an Enduring Power of Attorney?

Yes

Who drafted your will?

Solicitor

Self

Not Applicable

If a solicitor drafted your will. What was their name and firm:

Does you will establish any testamentary trusts?

Yes

Unsure

Do you expect any inheritance in the near future (within 5 years)

Yes

If yes, please provide brief detail:

Do you expect any inheritance in the long term (beyond 5 years)

Yes

If yes, please provide brief detail:

What is the location of your will and other documents

Your Acknowledgement

Please Read and Accept the following terms prior to submitting this form.

Privacy Statement *

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

Financial Services Guide *

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

Information Accuracy *

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

Written Advice *

I acknowledge and understand that I can only rely and act upon written advice based on this Fact Find Questionnaire.