FINANCIAL PLANNING QUESTIONNAIRE

1. NAME:2. CONTACT No:3. EMAIL:4. ADDRESS:A. MAILING ADDRESS:B. PERMANENT ADDRESS:5. PARTICULARS:NAME

APPLICAN
T
SPOUSE
CHILD 1
CHILD 2
DEPENDE
NT 1
DEPENDE
NT 2

DAT SE HIGHEST
E OF X
EDUCATI
BIRT
ON
H

OCCUPATI
ON

HEALTH
CONDITI
ON

SMOK
ER

6. EMPLOYMENT DETAILS:SELF
EMPLOYED

EMPLOYEE

RETIRED

APPLICANT
SPOUSE
CHILD 1
CHILD 2
DEPENDENT 1
DEPENDENT 2

7. DETAIL OF INSURANCE, PENSION PLAN AND PROFIDENT

FUND:COVERAGE
AMOUNT
LIFE
INSURANCE
NON LIFE
INSURANCE
HEALTH
INSURANCE
PENSION PLAN
EPF
PPF
OTHER

PREMIUM

COVERED
UNTILL AGE

8. ASSESTS:ITEM

YES / NO

SINGLE / JOINT

APPROX
VALUE

SELF
OCUPIED
HOUSE
REAL
ESTATE
LAND
VEHICLE
OTHERS

9. CASH AND EQUIVALENT:ITEM

CASH
SAVINGS A/C
RECURRING
A/C
FIXED
DEPOSITS
BONDS
MUTUAL
FUNDS
EQUITY/
STOCK
PRECIOUS
METALS
ULIP

VALUE

MATURITY

REMARKS

OTHERS

10. LIABILITIES:MONTHLY
AMOUNT
CREDIT
CARD
EMI FOR
CAR
EMI FOR
RESIDENTI
AL HOUSE
EMI FOR
REAL
ESTATE
EMI FOR
PERSONAL
LOAN
EMI FOR
EDUCATIO
N LOAN
EMI FOR
TOUR
MARRIAGE
EXPENSES
OWN /
CHILD

YEARLY
AMOUNT

ONE TIME

HOW MANY
YEARS
LEFT

OTHERS

11. EXPENSES (PER ANNUM):CURRENT

RENT
HOUSE
MAINTENANCE
Income tax
Property tax
Utilities
FOOD
TELEPHONE &
MOBILE
INTERNET
CLOTHING
PERSONAL
CARE
CHILDS
EDUCATION
TRANSPORTATI
ON

AFTER
RETIREMENT
(before inflation)

REMARKS

ENTERTAINME
NT
MEDICINES
HOLIDAYS
OTHERS

12. INCOME SOURCES (PER ANNUM):GROSS

SALARY

NET
SALARY

FROM
INVESTMENT

OTHER
SOURCES

TOTAL

13. FINANCIAL GOALS:GOAL

BUY A
HOUSE
FOR
RESIDENC
E
CLEAR
HOUSING
LOAN
REAL
ESTATE
BUY A

TOTAL
REQUIR
AMOUNT ED
AMOUN
T

REQUIRE
D DATE

WEIGHTA
GE

REMARK
S

CAR
CHILDS
EDUCATIO
N
CHILDS
MARRIAG
E
HOLIDAY
RETIREME
NT
OTHERS

14. OTHER QUESTIONS:A. DO YOU HAVE A PLAN TO SAVE A FIXED AMOUNT OR %

PER MONTH?
B. DO YOU SAVE AND THEN EXPENSE?
C. DO YOU EXPENSE AND THEN SAVE?
D. IF, YOU WANT TO BUY SOMETHING, WILL YOU PLAN FOR
MONEY AND THEN BUY OR BUY FIRST AND THEN PLAN
FOR MONEY?
E. DO YOU STRUGGLE TO CLEAR YOUR MONTHLY CREDIT
CARD BILLS?
F. DO YOU HAVE LOANS OUTSTANDING? IF, YES, WHAT %
OF YOUR SALARY DO YOU USE TO REPAY YOUR LOANS?
G. IF YOU GET A GOOD AMOUNT FROM LOTTERY. WHAT
WILL YOU DO WITH IT?
H. IF, YOU HAVE A PLAN TO GO FOR A HOLIDAY AND YOU
LOOSE YOUR JOB, WHAT WILL YOU DO? GO FOR HOLIDAY
AS PLANNED OR CANCELLED IT?
I. DO YOU PREFER FD/MUTUAL FUNDS OR STOCKS?
J. DO YOU UNDERSTAND ALL TAX RELIEFS AND USE THEM
TO REDUCE YOUR TAX?