Personal Protection Factfind

PERSONAL PROTECTION FACTFIND

1. Client Identification

Client Name:

Date of Birth:    Gender:

2. Household & Dependents

Marital Status:

3. Employment & Income

Annual Gross Income:

4. Health & Lifestyle

Are you a smoker or tobacco user? Yes   No

Regular alcohol consumption or recreational drug use? Yes   No

5. Existing Insurance & Cover

Life Insurance: Yes    No

Income Protection: Yes    No

Total monthly premium for all personal protection policies:

6. Assets & Liabilities

7. Objectives, Priorities & Needs

Primary objective for protection (select all that apply):
Death benefit for dependents    Income replacement if unable to work    Lump-sum trauma cover    Total & Permanent Disability cover

8. Risk Profile

Client risk tolerance: Low   Moderate   High

9. Recommended Needs & Proposed Cover (Adviser Use)

Recommended life sum insured:

Recommended monthly income protection benefit:

10. Authorisation, Declaration & Consents

I confirm that the information provided in this Factfind is true and complete to the best of my knowledge. I understand that this information will be used to assess insurance needs and to prepare recommendations. I authorise the collection, use and disclosure of personal, financial and medical information by insurers, medical practitioners and other relevant persons where reasonably necessary to assess, underwrite or administer insurance and related claims. I understand that incorrect or incomplete information may affect my entitlement to benefits.

Consent to obtain information: I consent to the adviser and insurers obtaining records and information held by medical practitioners, hospitals, employers, financial institutions and government agencies where required for the purpose of assessment, underwriting or claims handling. This consent extends to information necessary to verify identity and financial position.

Electronic communications: I consent to receiving communications, policy documentation and marketing material in electronic format where appropriate, and acknowledge my responsibility to ensure the adviser has current contact details.

11. Adviser / Preparer Notes

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