1.

PERSONAL DETAILS
CLIENT
Title (Mr. / Mrs. / Ms.) and Family Name * Rosemarie Hechaniva

Forenames *
*Date of Birth
Sex / Date of Birth Male Female
13-Feb-68
Marital Status *

Home: *Work:

*Mobile: Fax
Contact Numbers
*Email 1:

Email 2:
Country of Residence

Nationality and Country of Birth *

Physical Residential Address *

Mailing Address
Country and Length of Residence

Future Plans

Smoker Yes No

Medical History

Names

CHILDREN AND DEPENDENTS DETAILS

 SPOUSE / PARTNER
*

*
*Date of Birth
Age: 46 Male Female Age:

Home: *Work:

*Mobile: Fax

*Email 1:

Email 2:

*
*

No Yes No

Relationship D.O.B / Age

2. OCCUPATION, EARNINGS and EXPENSES
Currency Used US$ AED BD QR KD
CLIENT
*
Employer
*
Occupation

Monthly Earnings from Occupation *

Other Income (including bonus) *

Anticipated Changes to income

Total Monthly Income *

Monthly Expediture
Anticipated Changes to Expenditure
Total Monthly Expenditure Total for Couple

Monthly Surplus Total for Couple *

Expenditure Monthly Amount

Housing (Rent or mortgage repayments. Deduct any amount paid directly by
Utilities (telephone, water, electricity, cable etc.)
Food
Transport costs
Debt payments (car loans, personal loans, etc)
Credit card(s) balance
Life Assurance premiums
General insurances
Current education fees payable
Domestic help
Holidays
Entertainment
Remittances to home country
Charities / Zakat
Miscellaneous
Total Monthly Expenditures
Total Expenditure and Investments

Surplus Monthly Income

KD SR Others
SPOUSE / PARTNER
*

*
*

Investment outlays Monthly Amount

Retirement benefits funding
Education fees funding
Other savings plans
Total investment outlays
Client Spouse
Employers Benefits
Group Medical Self
Group Medical (Family Members)
Group Life Insurance
House Rent
Children Education Fee
Company Car Insurance / Maintenance
Total
3. PROTECTION - Medical CLIENT
Covered privately or by employer:

In-patient only or comprehensive:

Scope of coverage (Local, Regional, Worldwide exc. USA, Worldwide):

Dental Benefits:

Maternity Benefits:

Wellness/Screening:

Current Insurance provider:

Renewal Date:

Other Information

CLIENT
4. PROTECTION - Life
Death Disability

What Monthly Income would you / your Family Need A

Percentage to be used in Calculation B

Capital Needed to Generate Monthly Income A x 12 x 100 / B = C #DIV/0! #DIV/0!

Outstanding Loans D

Total Capital + Loan C+D = E #DIV/0! #DIV/0!

Total Current Provisions (Refer to Section 11) F

SHORTFALL E-F=G #DIV/0! #DIV/0!

5. RETIREMENT CLIENT
Where and what Age would you wish to Retire 65

Term Remaining for your Retirement (Years) A 14

Required Monthly Income to Maintain Current Lifestyle B 568

Percentage on which you will assume the capital requirement? C 10

Capital Required for Retirement B x 12 x 100 / C = D 68,182

Anticipated Rate of Inflation? E 1.4070

Capital Requirement including Inflation D x (1+E/100)^A = F 95,932

Total Current Provisions (Refer to Section 11) G 0

SHORTFALL F-G=H 95,932

Would you like to see this shortfall covered in the event of
death/Disability/Illness?

6. EDUCATION 1. Child Name

Current Age of Child? A 5

Year when the Child will start Education? B 13

Number of Years of Education Planned? C 4

Current Annual Cost? D 3,750

Total Cost of Education? CxD=E 15,000

Inflation Rate % F 1.8860

Cost including Inflation in the Year of Fee payment ExF=G 28,290

Total Current Provisions (Refer to Section 11) H

SHORTFALL G-H=I 28,290

Would you like to see this shortfall covered in the event of
death/Disability/Illness?

7. LIFETIME ASPIRATIONS 1
Purpose of Saving (Property / Buisness / Holiday)

When the Capital is required

Lump Sum Required

Regular Income Required

Current Provisions (refer to Section 11)

SHORTFALL
Would you like to see this shortfall covered in the event of
death/Disability/Illness?
IENT SPOUSE / PARTNER CHILDREN / DEPENDENTS

CLIENT SPOUSE / PARTNER

Disability Critical Illness Death Disability Critical Illness

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

IENT SPOUSE / PARTNER JOINT

65

14

568

10

,182

4070

,932

,932
2. Child Name 3. Child Name 4. Child Name
2

16

3,750

15,000 0 0

2.1830

32,745 0 0

32,745 0 0

2 3 4
 COMPOUND GROWTH TABLE
YRS 3% 4% 5% 6%
1 1.0300 1.0400 1.050 1.060
2 1.0609 1.0816 1.102 1.124
3 1.0927 1.1249 1.158 1.191
4 1.1255 1.1699 1.216 1.262
5 1.1593 1.2167 1.276 1.338
6 1.1941 1.2653 1.340 1.419
7 1.2299 1.3159 1.407 1.504
8 1.2668 1.3686 1.477 1.594
9 1.3048 1.4233 1.551 1.689
10 1.3439 1.4802 1.629 1.791
11 1.3842 1.5395 1.710 1.898
12 1.4258 1.6010 1.796 2.012
13 1.4685 1.6651 1.886 2.133
14 1.5126 1.7317 1.980 2.261
15 1.5580 1.8009 2.079 2.397
16 1.6047 1.8730 2.183 2.540
17 1.6528 1.9479 2.292 2.693
18 1.7024 2.0258 2.407 2.854
19 1.7535 2.1068 2.527 3.026
20 1.8061 2.1911 2.653 3.207
21 1.8603 2.2788 2.786 3.400
22 1.9161 2.3699 2.925 3.604
23 1.9736 2.4647 3.072 3.820
24 2.0328 2.5633 3.225 4.049
25 2.0938 2.6658 3.386 4.292
7% 8%
1.070 1.080
1.145 1.166
1.225 1.260
1.311 1.360
1.403 1.469
1.501 1.587
1.606 1.714
1.718 1.851
1.838 1.999
1.967 2.159
2.105 2.332
2.252 2.518
2.410 2.720
2.579 2.937
2.759 3.172
2.952 3.426
3.159 3.700
3.380 3.996
3.617 4.316
3.870 4.661
4.141 5.034
4.430 5.437
4.741 5.871
5.072 6.341
5.427 6.848
8. ASSETS * LIABILITIES *

1 2 3 TOTAL

Cash in Bank Loans

Property Value Credit Cards

Shares / Equities Mortgage

Business Assets Others

Others

GRAND TOTAL GRAND TOTAL

IES *

End Date Amount Outstanding Monthly Payments

GRAND TOTAL
9. LUMP SUM INVESTMENT
Do you have a lump sum available for investment?

What is the Objective of your Cash in Bank?

How Many Years do you have to Fulfill your Objective?

How much is your Emergency Fund?

What Percentage of Return does your Cash in Bank earn?

Do you have any other Lump Sum Invested?

Where have you Invested?

What is the Objective and Time Frame of this Investment?

What Percentage of Return your Investment earns?

Does your above Cash and Investment beat Inflation?

Would you like to Explore other Investments?

If so, How Much?

CLIENT PARTNER
10. PERSONAL INSURANCE

Contents: Villa /Apartment Owned Rented Value

Reinstatement
Buildings / Villa: Owned Mortgage Cost

Motor Vehicle: Model Type Model Year Value

Existing Insurer

Dates of Travel From To Country or Countries being visited during the Travel

Pleasure Craft: Model Type Model Year Value

Existing Insurer
 Location

Location

Renewal Date No of Claims in Current Year

being visited during the Travel

Renewal Date No of Claims in Current Year

11. CURRENT PROVISIONS / EXISTING POLICIES *

Purpose of the Premium / Status

Policy Number Company (live, Paid up, Surr,
Policy Frequency PH etc)

10

TOTAL If there are more than 10 existing Policies, Please use

 Policy Protections / Start Policy Payer Primary Beneficiary
Benefit Date Term

are more than 10 existing Policies, Please use an additional copy of the page
12. PRIORITIES * 13. BUDGET, GROWTH and AFFORDABILITY *

Possible Needs Priority Regular Budget

1. Medical Insurance for self and family members

2. Protecting your family against death and critical illness

Per______________
3. Security in retirement

4. Provision for your children's education Total Annual Premium Paid by the Client in all Policies, among a

5. Lifetime aspirations Annual Income of the Client / Couple

6. Lump sum investments Affordability of the Client against his / their Annual Income
(If the Affordability is above 35%, please provide a Clarification in Notes
7. General insurance (Motor / Home)
If the Total Premium is above $100,000 PA Regular Premium or
Audit Statements OR last 3 months Bank Statement OR Salary le
8. Others (Mortgage etc)
 AFFORDABILITY *

Lump Sum Growth Assumption for Illustration

the Client in all Policies, among all Providers

Couple
nst his / their Annual Income %
please provide a Clarification in Notes Section

100,000 PA Regular Premium or $1,000,000 Single Premium, then 2 years Company

nths Bank Statement OR Salary letter on the Compny letter head is required.
15. Risk Profile: What is your attitude towards investment Risk? *

Risk Profile

Low Risk

Medium/Low Risk

Medium Risk

Medium/High Risk

High Risk

Past Performance is not an accurate guide to future performance. Fund value may go down as well as up.
ttitude towards investment Risk? *

Description

You are prepared to take only limited risks with your money and re willing to accept potentially lower returns in exchange for
that security

You are seeking capital growth with funds that offer a broad spread of investments across a variety of markets. You are aware
that there may be volatility which could result in the value of your investments going down as well as up

You are prepared to accept some risk for a return that is potentially greater than inflation over the medium to long term. It
should be noted that this potential is balanced by the increased risk of negative as well as positive fluctuations in value.

You are prepared to see the value of your savings or investments fluctuate for potentially greater returns in the longer term and
are happy with exposure to some higher risk funds. You should note that the volatility of these funds increases the risk of loss.

You are aiming for high returns over the long term and accept higher levels of risk to achieve this. You should recognize that
the value of your investment may fluctuate significantly with possible large falls during periods of adverse volatility.

e to future performance. Fund value may go down as well as up.

16. INTRODUCTIONS
NAME TELEPHONE # OFFICE
TELEPHONE # MOBILE
18. SOURCE OF FUND SECTION *
Policy Owner / Life Insured / Payer's Relationship:
Policy Owner and Life Insured as same?

If NO Please provide the Reason:

YEAR ANNUAL INCOME BONUS OTHER INCOME IF ANY

Please Provide details of the Bankers of the Policy Owner

Account 1 Account 2

Bank Name

Account Number

Bank Address

Period of the Account held Years Years

Any other Personal's or Parties associated in
the account (Provide Details)
 Please Check the Appropriate
YES NO

INCOME IF ANY CURRENCY OF INCOME

Account 3

Years
19. RECOMMENDED SOLUTION * Date:
RECOMMENDED SOLUTION - PRIORITY 1 RECOMMENDED SOLUTION - PRIORITY 1

Provider: Provider:

Plan Type: Plan Type:

Term: Term:

Premium / Frequency: Premium / Frequency:

Protection Benefits: Protection Benefits:

WHY I RECOMMEND SOLUTION FOR PRIORITY 1 WHY I RECOMMEND SOLUTION FOR PRIORITY 1

CLIENT UNDERSTANDING
I understand that the advice given above is based upon the information provided by me and that this Confidential Personal Review will serve as a record of
given and Source of the Funds

I would like to be contacted by Nexus for future client's survey and promotions.

Priority 1 Priority 2
Signature of Client (Life 1) Signature of Client (Life 1)

Date: Date:
Signature of Client (Life 1) Signature of Client (Life 1)

Date: Date:
Signature of Consultant Signature of Consultant
Date: Date:
Management Review Management Review
Date: Date:

For Consultants only

Languages spoken: Islamic products only

ENDED SOLUTION - PRIORITY 1

COMMEND SOLUTION FOR PRIORITY 1

onfidential Personal Review will serve as a record of the advice (tick box)

(tick box)

Priority 2

(tick box)
20. SERVICE REVIEWS

Service Review Date:

Summary & Recommendations

Service Review Date:

Summary & Recommendations

Service Review Date:

Summary & Recommendations

Service Review Date:

Summary & Recommendations

Client / Spouse Signatures

Client / Spouse Signatures

Client / Spouse Signatures

Client / Spouse Signatures