PAN CARD IS REQUIRED TO CHECK YOUR KYC STATUS, AN ACRONYMFOR “ KNOW YOUR CLIENT “

PAN* ____________
FIRST NAME ___________
MIDDLE NAME __________
LAST NAME ____________
DATE OF BIRTH _________ (DD/MM/YYYY)
GENDER _________
MARITAL STATUS ____________
PHONE ___________
ALTERNATE PHONE _________
OCCUPATION _________
COMPANY/ SELF EMPLOYEED ____________
HOW DID YOU KNOW ABOUT US __________ (INTERNET/FRIEND/HOLDING/OTHER)
ADDRESS ______________
EMAIL-ID _____________
COUNTRY _____________
STATE __________
CITY _____________
PINCODE _________
FAMILY DETAILS

PARTICULAR MEMBER 1 MEMBER 2 MEMBER 3

RELATIONSHIP
NAME
OCCUPATION
DATE OF BIRTH
EMAIL-ID
PHONE NUMBER

INCOME

NAME MONTHLY AMOUNT YEARLY AMOUNT

POST TAX TAKE HOME
SALARY
INCOME FROM INVESTMENT
(DEPOSITS,SECURITIES)
 RENTAL INCOME
INTEREST EARN ON SAVING
TOTAL

UTILITIES

NAME MONTHLY AMOUNT YEARLY AMOUNT

ELECTRICITY
GAS
WATER
TELEPHONE
MOBILE
INTERNET
DISH TV
NEWSPAPER
OTHER
TOTAL

HOUSEHOLD

NAME MONTHLY AMOUNT YEARLY AMOUNT

MILK
VEG/NON-VEG/FRUIT
RENT
FUEL
MEDICAL EXPENSE
MONTHLY SOCIETY
MAINTENANCE CHARGES
AUTO MAINTENANCE
EDUCATION
GROCERIES/ SUPPLIES
MAID/COOK/NANNY/DRIVER
PERSONAL CARE( HAIR
CUT/SALON/SPA ETC
PROPERTY TAX
LAUNDRY / DHOBI
GYM EXPENSE
TOTAL

ENTERTAINMENT & TRAVEL

NAME MONTHLY AMOUNT YEARLY AMOUNT

WORK EXPENSE (LUNCH,
COFFEE)
ENTERTAINMENT (MOVIES,
PLAYS ETC.)
 DINING OUT
TRAVEL VACATION
HOBBIES
OTHER
TOTAL

MISCELLANEOUS

NAME MONTHLY AMOUNT YEARLY AMOUNT

CLOTHES
GIFTS
CHARITY
FURNITURE
ELECTRONICS
PET CARE
SHOES
OTHER
TOTAL

LOANS & DEBT

NAME BANK LOAN AMOUNT LOAN TENURE EMI (INTEREST)

PERSONAL LOAN
HOME LOAN
BUSINESS LOAN
AUTO LOAN
TWO WHEELER
LOAN
GOLD LOAN
EDUCATION
LOAN
LOAN AGAINST
PROPERTY
CREDIT CARD 1
CREDIT CARD 2
CREDIT CARD 3
CREDIT CARD 4
OTHERS
TOTAL

INSURANCE PAYMENT

NAME COMPANY PRIMIUM POLICY TERM SUM PREMIUM

NAME MODE( CARD/CHEQU (YEARS) ASSURED
E/CASH)
LIFE
INSURANCE
HEALTH
INSURANCE
MEDICLAIM
PLANS
GENERAL
INSURANCE
TOTAL

STOCKS
COMPANY NAME ________
NUMBER OF SHARE _________
SHARE PRICE _____________
MUTUAL FUNDS
FUND NAME ___________
NUMBER OF UNITS _________
NAV ____________
PURCHASE YEAR __________

FUTURE AND OPTIONS

INVESTMENT TYPE:- FUTURE / OPTIONS
ASSET TYPE:- EQUITY / COMODITY / FOREIGN EXCHANGE
ASSET NAME _____________
NO. OF CONTRACTS __________
PURCHASE DATE ______________ (DD/MM/YYYY)
CONTRACT PURCHSE VALUE ____________
CONTRACT MARKET VALUE ________________ AS OF DATE_____________ (DD/MM/YYYY)
SAVING SCHEME

NAME ORG. DIVIDEND AMOUNT ROI TENURE START END FUND

NAME TYPE INVESTED (%) (YEARS) DATE DATE VALUE
(M/Q/H/Y)
FIXED DEPOSIT
RECURRING
DEPOSIT
POST OFFICE
SAVING
NATIONAL SAVING
SCHEME
INDIRA VIKAS
PATRA
KISAN VIKAS
PATRA
MONTHLY INCOME
SCHEME
PF
PPF
GRATUITY
SUPERANNUATION

NPS
GOVERNMENT
BONDS
CORPORATE
BONDS
INFRA BONDS
NATIONAL SAVING
CERTIFICATE

TOTAL

ALTERNATIVE SCHEME

NAME FUND NAME PURCHASE DATE AMOUNT MARKET VALUE

INVESTED AS OF DATE
(DD/MM/YYYY)
REIT
PE/VC
STRUCTURED
PRODUCTS
ESOP
RSU
TOTAL

CASH

NAME AMOUNT
IN BANK
PERSONAL POSSESSION
HAND LOAN
OTHER SOURSE
TOTAL

PROPERTY, JEWELLERY & OTHER

NAME RESIDENTIAL COMMERCIA VEHICLES JEWELLERY OTHERS

L
PROPERTY
NAME
PROPERTY
SIZE/
WEIGHT.
CURRENT
MAKET
VALUE
TOTAL

CHIT FUNDS
CHIT FUND NAME___________
CHIT START DATE_____________
CHIT VALUE___________
TENURE(MONTHS)___________
MONTHLY PAYMENTS____________
CURRENT VALUE_____________
GOALS

NAME AMOUNT NEEDED GOAL YEAR LOAN REQUIREMENT (%)

HOME
EDUCATION
VEHICLE
CHILD BIRTH
MARRIAGE
BUSINESS
FAMILY SUPPORT
VACATION
EMERGENCY FUND
RETIREMENT FUND
OTHERS
TOTAL
RISK PROFILE QUESTIONNARIES
1) When you think of the word RISK which of the following first comes to mind?
Danger
Opportunity
Uncertainty
Thrill
Cautiousness but not fear

2) Assuming normal market conditions, you expect your investments

To have some stability and make modest profits
To preserve capital at all costs
To greatly exceed returns provided by equity market index
To atleast match returns provided by equity market index

3) Due to lost mail, your car will be without insurance for seven days. What will you do?
Take a ride with friends/family
Take public transport
Drive car carefully and as little as possible
No problem

4) You are on a TV game show and you just answered a question right. You are now entitled for a gift. The
options would you choose?
80% chance of winning 1 crore
10% chance of winning 10 crores
30% chance of winning 3 crores
50% chance of winning 2 crores

5) You have lost 5 lakhs at a casino. How much are you prepared to risk to win Rs. 5 lakhs back?
2,50,000
1,00,000
5,00,000
More than 5,00,000
Nothing more

6) Your attitude towards personal investments recently has inclined towards?

Mostly towards higher risk
Sometimes towards higher risk
Mostly towards lower risk
 Sometimes towards lower risk
No changes

7) Which of the following describes your attitude towards your investment?

Prefer investments with little or no fluctuations in value and low levels of risk. I am willing to accept lower rate of returns a
a mix of investments that have a low risk. Small part of portfolio could be directed towards higher risk assets
Balanced portfolio
Emphasis on higher risk
Only high return assets

8) How do you adapt/react to unfavourable financial changes in your life?

Very easily
Somewhat easily
Somewhat uneasily
Very uneasily

9) If the market has fallen 40% over last 6 months would you
Sell all current investments
Sell part of current investment to invest into more stable, secure avenues
Invest more funds to lower purchase price
Status quo

10) Have you ever invested a large sum in a risky investment mainly for the thrill of seeing whether it went
No
Rarely
Somewhat frequently
Very frequently

11) Find below the potential yearly returns for five different portfolios ( Portfolio A to Portfolio E). Which P
Portfolio type Year 1 Year 2 Year 3 Year 4 Year 5

Portfolio-A -14% -8% 21% 12% 24%

Portfolio-B 10% -3% 12% 12% 10%

Portfolio-C 30% -26% -16% 38% -10%

Portfolio-D -5% 15% -10% 12% 16%

Portfolio-E 8% 9% 7% 5% 9%

12) How much of your portfolio has been acquired based on recommendations from your friends during a
None
Less than 20%
Less than 30%
 Less than 50%
Less than 75%

13) How familiar are you with investment matters?

No Clue
Basic Understanding of Banking Products
Basic Understanding of Banking Products & Mutual Funds
Basic Understanding of Banking Products, Equities and Mutual Funds
Very familiar. Use research and other investment info on my own

14) How would you consider your understanding of financial investments and markets as?
Lacking
Minimal
Inadequate
Adequate
Superior

15) What is Risk v/s Reward?

Increased Risk decreases the Reward
Risk and Reward do not go together
Less Risk increases the possibility of Reward
Increased Risk Increases possibility of Greater Reward

16) Which of the following describes your current stage in life?

Single with few financial burdens. Ready to accumulate wealth for future short term as well as long term needs
Couple without children. Establish a home. Expecting to or already have a high purchase rate of household and consume
and childcare costs and maintain only small cash balances
Mature family. In your peak earning years. Children grown up. Starting to think of retirement years
Retired

17) You have invested all your savings in the stock markets. The markets have suddenly started to crash.
portfolio?
6 Months
1 year
2 years
3 years
Less than 3 months

18) Which of the following describes your objective of investing?

You have an investment horizon of more than 5 years. You understand investment markets are mainly investing for grow
nearing retirement, have surplus funds to invest and are aiming to accumulate long term wealth from a balanced portfolio
You have a lumpsum and are uncertain about suitable investment options
Investing for retirement
You have specific obectives over next 5 years for which you are setting money aside
You want a regular income stream and protection of your capital

19) Choose one of the following attributes

Capital preservation
Reasonable Growth
Low volatility
Inflation protection
Aggresive growth
Tax efficiency
Leverage for Growth

20) Desired time horizon for portfolio?

0-1 years (Immediate Term)
1-3 years (Short Term)
3-7 Years (Medium Term)
8+ Years (Long Term)

TAX

GROSS INCOME
Name

Income From Salaries (per annum)

Basic Salary

DA

HRA (click checkbox If you are staying in a metro city)

Children(s) Education

LTA (click checkbox If you are claiming for the current year)

Other Allowances

Bonus
Income From House Properties
Rental Income
 GROSS INCOME
Name

Income from other source

Interest from savings ( FD, RD etc.)

Interest from bonds

Others

HOME DEDUCTION

Name

Deduction Under Section 24B

Interest on Housing Loan (click checkbox If possession is taken)

Deduction Under Section 80C
Principal Loan Repayment ( Housing Loan )
Rent for HRA
Mention the rent claimed for HRA
Deduction Under Section 80EE
Remaining Interest on Housing Loan
Rent claimed under section 80GG
Mentioned the rent claimed for section 80GG

80D DEDUCTION

Name

Medical Insurance Premium for Self

Medical Insurance Premium for Parents

Preventive Health Checkup

OTHER DEDUCTION

Name

Deduction Under Section 80G

 OTHER DEDUCTION

Name

Eligible Donations
Deduction Under Section 80 CCG
Investments in RGESS
Deduction Under Section 80DDB
Medical Treatment ( Specified Disease only )
Deduction Under Section 80DD
Medical Treatment / Insurance of handicapped Dependencies
Deduction Under Section 80CCD
NPS
Deduction Under Section 80E
Repayment of Loan of higher Self education

ADVICE

GOAL ADVICE
RISK ADVICE
TAX ADVICE
INVESTMENT ADVICE