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proceeds from business sale, redundancy payments, transfer from foreign super funds, personal injury) Contributions (please detail) Adviser Notes on Superannuation – Client 1 Adviser Notes on Superannuation – Client 2 P a g e 14 20 This section is not applicable Client/s chosen not to complete this section PENSION AND/OR ANNUITY FUND/S Investor / Owner FUND 1 FUND 2 FUND 3 FUND 4 Client 1 / Client 2 Client 1 / Client 2 Client 1 / Client 2 Client 1 / Client 2 Type Product name / provider Member number Beneficiary Type of nomination / Inception date / / / / / / Current value Purchase price Tax free amount Term at purchase Payment / year year year Year pa pa pa pa Payment frequency Payment indexation Centrelink / DVA deductable amount Fees Exit fee Management cost (per annum) Administration costs Other fees Other fees (detail) Adviser Notes on Other Pension and/or Annuities – Client 1 Adviser Notes on Other Pension and/or Annuities – Client 2 P a g e 15 20 YOUR RETIREMENT ESTATE This section asks about your retirement and your estate.. Please provide documentation if possible (ie Policy schedules) This section is not applicable Client/s chosen not to complete this section PERSONAL AND BUSINESS INSURANCE Life insured FUND 1 FUND 2 FUND 3 FUND 4 Client 1 / Client 2 Client 1 / Client 2 Client 1 / Client 2 Client 1 / Client 2 Policy owner Policy number Life cover TPD cover Income protection benefit pm pm pm pm Trauma / critical Illness cover pm pm pm pm Business expense pm pm pm pm Total premium Insurance provider Premium frequency Is the policy through Super fund Yes / No Yes / No Yes / No Yes / No Is the benefit indexed Yes / No Yes / No Yes / No Yes / No Level / Stepped Level / Stepped Level / Stepped Level / Stepped Any / Own Any / Own Any / Own Any / Own Agreed / Indemnity Agreed / Indemnity Agreed / Indemnity Agreed / Indemnity Increasing claims options Yes / No Yes / No Yes / No Yes / No Super continuance Yes / No Yes / No
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