Financial Wellbeing Checkup Questionnaire

Your Name: __________________ Gender: _________ Age: ___________ Marital Status: __________ Children: _______

I Strongly I I Strongly
I Do Somewhat I Don't
S. N. Question Do Don’t
**** Do **
***** *
***
I channelize savings into investments on a regular basis.
1
They don’t lie idle in bank savings account.
I organize and protect all my financial statements and
2
online login details securely
I am aware of charges by insurance, investment and
3 credit card companies for the various products I have
taken.
I am aware of how my employment benefits like PF,
4
Superannuation, Gratuity, Insurance are structured.
I am aware of all the income tax exemptions &
5
deductions available for me and I am utilizing them
I know my family's actual monthly & annual expenses
6
and we follow a budgeted expenditure plan.
I have calculated and know my networth (all assets
7
minus all liabilities)
I have a emergency fund set aside to be prepared for
8
job/business loss and medical emergencies
I have a health Insurance cover for myself and my family
9
members
I have a term insurance life cover which is good enough
10
for my family in my absence

11 I have identified my financial goals with specific amounts

and dates

12 I always make all my investments with a purpose/for a

future goal. Not on an ad-hoc basis
I have a consolidated portfolio of Mutual Funds,
13
Insurance, Deposits, Stocks & other investments

14 I am aware of how much funds I require to retire

peacefully and manage the expenses for 25-30 years
I review performance of all my investments regularly (at
15
least once a year)
I am sure that all my investments are nominated to the
16 person of my choice.

I have a Will in place and I am sure of how my assets will

17
be distributed in case of my untimely death
I do some kind of a charity every year for those who are
18 not as fortunate as I am

I involve my spouse is all money related decisions and

19 she/he is aware of its relevance to our family

I regularly Invest in myself to upgrade my skills and

20
knowledge which helps me in my career growth

Total of Counts
Your Score (Out of 5): ________________ Your Result:
_____________________
Children: _______
 Scoring Worksheet
Score
S.N. Rating 5 4 3 2 1 Total (Out of
5)
1 Participant Name 1 4 4 5 4 3 20 3.1

2 Participant Name 2

3 Participant Name 3

4 Participant Name 4

5 Participant Name 5

6 Participant Name 6

7 Participant Name 7

8 Participant Name 8

9 Participant Name 9

10 Participant Name 10

11 Participant Name 11

12 Participant Name 12

13 Participant Name 13

14 Participant Name 14

15 Participant Name 15

16 Participant Name 16

17 Participant Name 17

18 Participant Name 18

19 Participant Name 19
20 Participant Name 20
Feedback Scoring

Good 0.0 1.0 Very Poor

1.1 2.0 Bad

2.1 3.0 Average

3.1 4.0 Good

4.1 5.0 Excellent

How to Use Financial Wellbeing Checkup Questionniare

1 Tell audience to take your appointment for a 30 minute free meeting

2 Brief the Participant about entire exercise of "Financial Wellbeing Checkup" and what is its objective?

3 Read out questions one by one to the participant, you mark the answers on behalf of them in the Questionnaire

4 Explain the question in case the participant doesn’t understand. Try to educate the participant if they are doing

7 Once you finish all 20 questions, take total count of each colum

8 Enter the counts in the "Scoring Sheet" in same worksheet

9 Get Score automatically and mention the corresponding result

10 Write the Score & Result on Participants Questionnaire Sheet

11 Summarise your observations as a Financial Advisor based on the answers and interactions

12 Handover their Questionnaire Sheet to them. You can also attach your business card and mention they can con
d what is its objective?

lf of them in the Questionnaire

he participant if they are doing bad with any of areas. Praise them on things where they are doing well

nteractions

card and mention they can contact you for any further help.