Life Insurance Get Advice FactFindIntroductionClient DetailsPartner DetailsChildren and/or Other Dependants | Current or ExpectedClient annual incomePartner annual incomeAnnual Expenses for HouseholdAssets - LifestyleAssets - Financial (Non Superannuation)LiabilitiesExisting superannuation assets and income streamsAdvice you requireWhat are your goals in relation to risk insuranceAdvice required for your PartnerWhat are your Partner's goals in relation to risk insuranceYour healthYour Partner's healthClient underwriting - Your health historyPartner underwriting - your Partner's health historyYour existing insurance policiesYour Partner's existing insurance policiesContact detailsClient Acknowledgement This Insurance Fact Find is required to assess your need for insurance protection.Your adviser must have reasonable grounds for making an insurance recommendation and therefore must obtain information about your personal objectives, financial situation and needs.Please provide as accurate information as possible so that any recommendations made are appropriate for your needs:Step 1 - Complete details about yourselfStep 2 – If you have a partner and dependants provide their detailsStep 3 - Provide a snapshot of your financial situation - income, expenses, assets and liabilitiesStep 4 – Tell us about your health history, your insurance objectives and any existing insurance coverStep 5 - Submit and one of our advisers will contact you to discuss your situation and make recommendations START FACT FIND:Do you have a Partner? Yes NoDo you want advice for your Partner? Yes NoFact Find Entity Name (Hidden, Calculated)PreviousNextPART 1 - ABOUT YOUClient DetailsTitle- Select -MrMrsMsDrProfessorSirGiven name(s)SurnameAddressSuburbState- Select -NSWVICQLDWASATASACTNTPostcodeDate of birth- Year -194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025 - Month -010203040506070809101112 - Day -01020304050607080910111213141516171819202122232425262728293031Date of birthPhone/Mobile number?EmailGender Male Female OtherEmployment status- Select -Full-timePart-timeCasualUnemployedHome dutiesRetiredSelf-employedStudentName of employer/businessOccupation Tertiary qualifications Yes NoHow many years in this occupationHours worked per weekMarital status- Select -SingleMarriedDivorcedWidowedAustralian permanent resident Yes NoPreviousNextPartner DetailsPartner title- Select -MrMrsMsDrProfessorSirPartner given name(s)Partner surnamePartner Phone/Mobile numberPartner emailDate of birth- Year -194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025 - Month -010203040506070809101112 - Day -01020304050607080910111213141516171819202122232425262728293031Partner date of birthPartner gender Male Female OtherPartner employment status- Select -Full-timePart-timeCasualUnemployedHome dutiesRetiredSelf-employedStudentPartner name of employer/businessPartner occupation Partner tertiary qualifications Yes NoPartner how many years in this occupationPartner hours worked per weekPartner marital status- Select -SingleMarriedDivorcedWidowedPartner Australian permanent resident Yes NoPreviousNextChildren and/or Other Dependants | Current or expectedDo you have any dependants? Yes NoNumber of dependants Current or Expected (1 - 6)1 Full nameBirthdateGender- Select -MaleFemaleOtherRelationship- Select -SonDaughterBrotherSisterFatherMotherDependant until Age2 Full nameBirthdateGender- Select -MaleFemaleOtherRelationship- Select -SonDaughterBrotherSisterFatherMotherDependant until Age3 Full nameBirthdateGender- Select -MaleFemaleOtherRelationship- Select -SonDaughterBrotherSisterFatherMotherDependant until Age4 Full nameBirthdateGender- Select -MaleFemaleOtherRelationship- Select -SonDaughterBrotherSisterFatherMotherDependant until Age5 Full nameBirthdateGender- Select -MaleFemaleOtherRelationship- Select -SonDaughterBrotherSisterFatherMotherDependant until Age6 Full nameBirthdateGender- Select -MaleFemaleOtherRelationship- Select -SonDaughterBrotherSisterFatherMotherDependant until AgeAdditional details (e.g. expected private school fees and number of years):PreviousNextClient annual incomeClient gross salaryClient self-employed income (after expenses)Client estimated bonus/incentiveClient government benefitClient pension / foreign pension / annuity incomeClient other annual incomeFringe BenefitsSGC Percentage (usually 12% of Salary)%SGC Contribution AmountClient Other Entitlements (e.g. allowances)PreviousNextPartner annual incomePartner gross salaryPartner self-employed income (after expenses)Partner estimated bonus/incentivePartner government benefitPartner pension / foreign pension / annuity incomePartner other annual incomePartner Fringe BenefitsPartner SGC Percentage (usually 12% of Salary)%Partner SGC Contribution AmountPartner Other Entitlements (e.g. allowances)PreviousNextAnnual Expenses for HouseholdRentRatesUtilities (phone, gas, electricity, internet, water)General Household Expenses (food, clothing, entertainment)Transport (car expenses, public transport)General Insurance (health, home, car)Regular Savings AmountEducationHolidays/TravelChild SupportPreviousNextAssets - LifestyleCurrent Value - Family homeHousehold itemsMotor vehiclesPreviousNextAssets - Financial (Non Superannuation)Current Balance/Annual Return - Bank DepositValue ($)Annual Return ($)SharesValue ($)Annual Return ($)Investment PropertyValue ($)Annual Return ($)Offset AccountValue ($)Annual Return ($)Other AssetsValue ($)Annual Return ($)PreviousNextLiabilitiesCurrent Balance/Annual Repayments - Mortgage on homeOutstanding Amount ($)Annual Repayment ($)Investment property loanOutstanding Amount ($)Annual Repayment ($)Motor vehicle loanOutstanding Amount ($)Annual Repayment ($)Personal loanOutstanding Amount ($)Annual Repayment ($)Other investment loanOutstanding Amount ($)Annual Repayment ($)Credit cardOutstanding Amount ($)Annual Repayment ($)PreviousNextExisting Superannuation AssetsDo you have any superannuation? Yes NoHow many superannuation funds do you have (1-6)?1. Fund nameOwner(s)- Select -SelfPartnerValue($)Receives SGC?- Select -YesNo2. Fund nameOwner(s)- Select -SelfPartnerValue($)Receives SGC?- Select -YesNo3. Fund nameOwner(s)- Select -SelfPartnerValue($)Receives SGC?- Select -YesNo4. Fund nameOwner(s)- Select -SelfPartnerValue($)Receives SGC?- Select -YesNo5. Fund nameOwner(s)- Select -SelfPartnerValue($)Receives SGC?- Select -YesNo6. Fund nameOwner(s)- Select -SelfPartnerValue($)Receives SGC?- Select -YesNoPreviousNextPART 2 - YOUR INSURANCE NEEDSAdvice required for youAnalysis of your risk insurance needs Yes NoReview of your existing risk insurance policies Yes NoLife insurance Yes NoTrauma insurance Yes NoTotal & permanent disability insurance Yes NoIncome protection insurance Yes NoAny other reasons you are seeking adviceIf you die or are permanently disabled will your partner continue (or commence) working Yes NoDo you anticipate any inheritance or other windfall at any time Yes NoPlease provide details of the inheritance or windfallDo you have a Will in place? Yes NoWhere is the Will located?What date was the Will last reviewed?PreviousNextWhat are Your goals in relation to risk insuranceOn Death or TPD do you want to cover for: Funeral costs Medical expenses/home modifications Paying off the mortgage on family home Paying off other debts eg. car loan, investment property Emergency/rainy day fund Supplementing family income for a number of years Children's education cost over a number of years OtherIf other please specifyFor other serious illness or injuries would you like cover for: Loss of income while unable to work Medical treatment costs Rehabilitation and recuperation costs Loss of family member income while caring for you OtherIf other please specifyPreviousNextAdvice required for your PartnerAnalysis of your risk insurance needs Yes NoReview of your existing risk insurance policies Yes NoLife insurance Yes NoTrauma insurance Yes NoTotal & permanent disability insurance Yes NoIncome protection insurance Yes NoAny other reasons your partner is seeking adviceIf you die or are permanently disabled will your partner want to continue (or commence) working Yes NoDoes your Partner anticipate any inheritance or other windfall at any time Yes NoPlease provide details of the inheritance or windfall for your PartnerDoes your partner have a Will in place? Yes NoWhere is the Will located?What date was the Will last reviewed?PreviousNextWhat are your Partner's goals in relation to risk insuranceOn Death or TPD does your partner want to cover for: Funeral costs Medical expenses/home modifications Paying off the mortgage on family home Paying off other debts eg. car loan, investment property Emergency/rainy day fund Supplementing family income for a number of years Children's education cost over a number of years OtherIf other please specifyFor other serious illness or injuries would your partner like cover for: Loss of income while unable to work Medical treatment costs Rehabilitation and recuperation costs Loss of family member income while caring for you OtherIf other please specifyPreviousNextYour healthWhat is your height in cms?What is your weight in kgs?Have you smoked or vaped in the last 12 months? Yes NoDaily quantityDo you drink alcohol? Yes NoWeekly quantity and typePreviousNextYour Partner's healthWhat is your partner's height in cms?What is your partner's weight in kgs?Has your Partner smoked or vaped in the last 12 months? Yes NoDaily quantityDoes your Partner drink alcohol? Yes NoWeekly quantity and type your Partner drinksPreviousNextYour Health HistoryHow would you rate your own health?- Select -ExcellentGoodPoorAre you taking any prescription medication? Yes NoProvide details of the prescription medicineDo you participate in hazardous hobbies (e.g. abseiling, football, scuba diving, motor racing)? Yes NoProvide details of the hazardous activities you intend to engage in:Have you ever suffered from:(a) - High blood pressure? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(b) - High cholesterol? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(c) - Chest pain? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(d) - Heart attack? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(e) - Stroke? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(f) - Cancer/tumor or lump of any kind? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(g) - Mental or nervous disorder including stress, anxiety or depression? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(h) - Asthma or any lung or respiratory disorder? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(i) - Back or neck pain? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(j) - Shoulder or knee problems? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(k) - Broken bones? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(l) - Repetitive strain injury? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(m) - Gout? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(n) - Muscle or joint pain? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(o) - Diabetes? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(p) - Epilepsy? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(q) - Multiple sclerosis? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(r) - Hepatitis? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(s) - Any other sickness, injury or physical impairment you have been hospitalised or treated for? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:Do you have a family history of hereditary disease eg. cancer, diabetes, heart disease, stroke, mental illness etc? Yes NoProvide details of your hereditary disease, how many of your family members are affected and at what age?PreviousNextYour Partner's Health HistoryHow would your partner rate their own health?- Select -ExcellentGoodPoorIs your partner taking any prescription medication? Yes NoProvide details of the prescription medicine for your partner:Does your partner participate in hazardous hobbies (e.g. abseiling, football, scuba diving, motor racing)? Yes NoProvide details of the hazardous activities your partner intend to engage in:Has your partner ever suffered from:(a) - High blood pressure? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(b) - High cholesterol? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(c) - Chest pain? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(d) - Heart attack? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(e) - Stroke? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(f) - Cancer/tumour or lump of any kind? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(g) - Mental or nervous disorder including stress, anxiety or depression? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(h) - Asthma or any lung or respiratory disease? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(i) - Back or neck pain? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(j) - Shoulder or knee problems? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(k) - Broken bones? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(l) - Repetitive strain injury? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(m) - Gout? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(n) - Muscle or joint pain? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(o) - Diabetes? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(p) - Epilepsy? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(q) - Multiple sclerosis? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(r) - Hepatitis? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:(s) - Any other sickness, injury or physical impairment you have been hospitalised or treated for? Yes NoProvide details of the condition/test, date started, date of last symptoms, % of recovery and treatment:Does your partner have a family history of cancer, diabetes, heart problems, stroke, mental illness or any other hereditary disease? Yes NoProvide details of your partner's hereditary disease, how many of their family members are affected and at what age?PreviousNextYour existing insurance policiesHow much of the following insurance covers do you currently have (leave blank if none):Life InsuranceTPD InsuranceTrauma InsuranceIncome ProtectionUpload Client policy documents Now or Later? Now LaterClient File UploadChoose File PreviousNextYour Partner's existing insuranceHow much of the following insurance covers does your partner currently have (leave blank if none):Life InsuranceTPD InsuranceTrauma InsuranceIncome ProtectionUpload Partner policy Documents Now or Later? Now LaterPartner File UploadChoose File PreviousNextLast detailsPreferred days of the week to call? Monday Tuesday Wednseday Thursday FridayPreferred time to call you?- Select -MorningAfternoonAny additional information you would like to provide?PreviousNextBEFORE SUBMISSIONWhat will happen after I submit?Following the submission of your online Fact Find a qualified adviser will contact you by email or phone (usually within 3 business days) to discuss the information you have submitted and your insurance options. Your adviser will provide you with a Financial Services Guide (FSG) which explains who they are, what services they can provide, how they are paid, how your personal information will be dealt with and your rights of complaint. If any recommendations are made you will receive a Statement of Advice which will outline details of the recommended strategy, as well as how our adviser is to be remunerated for their advice. If there a recommendation to purchase a policy you will also be provided with the insurer’s Product Disclosure Statement.Acknowledgments: I consent to my personal, sensitive and health information being collected and understand that this information will be handled in accordance with our Privacy Policy and Website Terms and Conditions. I confirm that the information provided is accurate and relevant to my personal situation. Where full and complete information has not been provided, I acknowledge that the recommendations derived may not be appropriate to my situation and needs. I give my consent for Insurance Watch to contact me by email or phone regarding my insurance needs and the insurance products and services that Insurance Watch provide, including sending newsletters and marketing offers (which can be unsubscribed from at any time). Previous Submit Form
