WEALTH PLANNING DATA GATHERING SHEET

A. PERSONAL INFORMATION

A.1 Personal Information

Self Spouse
Surname
First Name
Age
Gender
Marital Status

A.2 Employment Details

Self Spouse
Employment Status (Employed / Self
employed /Retired)
A.3 Family members
Examples Include: Children or parents; any other persons who are financially dependent upon you. If Dependent status is "Yes" then at what age you
Male / Marital Status of
Name Relationship Current Age Dependent expect them to be self (Yes/No) supporting (member's
Female Children
Mother age)
Father
Child 1
Child2
Child 3
Any other relative

Any other information:

B. GOALS

B.1 Retirement Goal

Retirement Age (Your targeted age to retire)
Monthly pension required
Any lump sum amount required

B.2 School and College Education

How much will be required and for which year towards school and college education (in today's value)

Name of Child Age School College

Age to start / Age to Finish/ Annual Age to start / Age to Finish/ Annual
Year to Start Year to Finish Expenses Year to Start Year to Finish Expenses

B.3 Children Marriage Goals

How much will be required in which year for marriage (in today\s value)

Name of Child Year Amount

B.4 Asset Building Goals

Today's Value Are you open
Description Year
Amount (Rs.) to take a loan
Real Estate: Primary Home
Real Estate: Rental Property
Real Estate: Vacant Land
Purchase of Car
Jewellery

B.5 Other Goals

Today's Value
Description Year
Amount (Rs.)
Vacation: International
Vacation: Domestic Annual
Charity
Gift
Up gradation of house
Medical Corpus
Others

Any other information

For Reference
Illustrative higher education costs in India

ENGINEERING (Four-year BE/B-Tech) per annum cost

- IITs: Rs. 3.50-4.50 lakh
- Private colleges: Rs. 5.50-7 lakh

MEDICINE (Five-year MBBS)

- Govt-funded colleges: Rs. 7-8 lakh
- Private colleges: Rs. 25-35 lakh

BUSINESS MANAGEMENT (Two-year course)

- IIMs: Rs. 6-7.5 lakh
- Private institutes: Rs. 7-16 lakh

Illustrative higher education costs in Abroad

- Annual tuition Rs. 18-21 lakh
- Annual living Rs. 12-14 lakh
C. INCOME

Expected Growth Rate

Self (p.m.) Spouse
(% p.a)
Salary (Gross)
Business or profession
House Property (Rental)
Other sources

Retirement Assets
Amount of Retirement Benefits you expect to receive on your & your spouse's retirement

Self Nominee
-Provident Fund
-Superannuation
-Gratuity
-Others

D. EXPENSES/OUTFLOWS

Description Monthly (Rs.)

A. Housing
(rent and maintenance expenses)
B. Utilities
(Electricity, Gas, Water, Telephone, Mobile Phone, Internet, Cable TV)
C. Food, Clothing, Transport
(Fruit/Vegetable/Groceries, Takeaway food/restaurants, Pet Food, Clothing,
Petrol, Vehicle Maintenance, Vehicle Taxes/License)
D. Education
(School Fees, Tutoring / Books, Sports / out of school activities, School Bus/transport)
E. Other expenses
(Medical cost, Personal care, Dependent care, Entertainment, Club membership,
Hobbies, Gift/donation to Charities, Gift to family and others,
Subscriptions - newspapers and magazines, Gardening expenses, Servants,
Drivers, Pocket Money children
F. Investments/Savings
Loan EMIs
Insurance Premiums
Other regular saving obligations
Total Expenses (A+B+C+D+E+F)

Any other information:

Expected Growth Rate
(% p.a)

Annual (Rs.)
E. POLICIES

E.1 Life Insurance (Specify if provided by employer)

Who is Insured? Premium Paying

Sl No. Type of Policy Nominee Survival/Maturity Benefit
(Policy Owner) Term/ Term of policy

E.2 Motor Insurance

Sl No. Insurance Company Type of Policy Value Insured Annual Premium Term of policy
1
2

E.3 Health Insurance (Specify if provided by employer)

Sl No. Insurance Company Type of Policy Life Insured Sum Assured Annual Premium
1
2

E.4 Home Insurance

Sl No. Insurance Company Term of the Policy Value Insured Annual Premium Commencement Date
1
2

Any other information:

 Annual Date
Premium Sum Assured
Maturity

Commencement Date Renewal Date

Term of Policy Commencement Date Renewal Date

Renewal Date
F. ASSETS
F.1 Personal Assets
Ownership (Single or Joint) If
Sl No Description Cost of Acquisition Date of Acquisition
joint specify the co-owner
1 Real Estate
Primary Home
Vacant Land
Secondary Home
Any other property

2 Jewellery

F.2 Saving Bank Accounts (Banks, Post Office) Holding (Single

Sl No Type of Account Holder Name /Joint) If joint specify Nominee
1 the Co-Holder
2

F.3 PPF Accounts

Sl No Type of Account Holder Name Nominee Present Balance
1
2

F.4 Deposits- Banks, Post Office, Bonds, company (Excluding Mutual Funds, Shares
Holding )
(Single
Sl No Type of Account Holder Name /Joint) If joint specify Nominee
1 the Co-Holder
2

F.5 Recurring Deposits Holding (Single

Sl No Type of Account Holder Name /Joint) If joint specify Nominee
1 the Co-Holder
2

F.6 Demat Accounts / Mutual Funds Folios

 Holding (Single
SI No Description Holder Name /Joint) If joint specify Nominee
1 the Co-Holder
2
3

F.7 Mutual Funds SIP's Holding (Single

SI No Description Holder Name /Joint) If joint specify Nominee
1 the Co-Holder
2
3

Any other Information

 Current Value

Present Balance

Maturity
Deposit Amount Period of Deposit Interest Rate
Amount

Period of Deposit/ Maturity

Installment Amount Interest Rate
Frequency Amount
 Current Value

Installment Amount Frequency

G. LIABILITIES

Examples Include: Any loans related to your personal assets and additional liabilities
Origination Original Interest Amount Monthly
Sl No Description Original Balance
Date Term Rate Outstanding Payment
1 Home Mortgage
2 Car Loan
3 Loan Against Policies

4 Loan Against Investments

5 Personal Loan
6 Credit Cards
7 Others

H. TAX PLANNING

Description Amount (Rs)

Interest paid on housing loan
for self occupied house

Deduction u/s 80C

Deduction u/s 80D
Deduction u/s 80E
Deduction u/s 80G
Others

Any other information:

 Insured
(Yes/No)
 I. ESTATE PLANNING

Estate & Succession Planning Questionaire- Need Analysis Questions YES NO

1 Do you want that
to retain control
your assets & over your assets
properties posttill
youryou are alive?
death are distributed as per your wishes and desires?
2 Only to people you want them to go at the time you
In case you become incapicitated or disabled have you made want, in the manner for
provisions yousomeone
want andtoinoperate
the propotion you owned
your singly want. bank
3 accounts, mutual fund investements, fixed deposits etc.
4 Do you want to ensure and easy peaceful transfer of your wealth post your death?
5 Is the
Do you nominee in alllegal
know your yourheirs?
financial holdings
i.e. in case yousame
passperson who youcreating
away without would like to inherit
a "WILL" who those assets
all will getafter
youryou?
property and in
6 what proporation

ESTATE PLANNING CONCERNS QUESTIONS

Read each statement and choose the level of Concern this is for you i.e. what is the chance of this occurring in your life or
after your death?
Risk that Your Assets after your Death, might not fully pass on to your spouse, because if you die without a ‘Will’ other HIGH MEDIUM LOW
1 people apart from your spouse are your legal heirs.
2 Risk that if after
youyou
andpass
youraway your
spouse children
pass or other
away while yourLegal Heirsare
children might fight someone
‘Minor’ over yourother
Assets
than your choice might become
their Guardian.
3, Risks of one of you child or other beneficiary losing his or her inheritance to creditors, lawsuits or to a divorcing spouse or to
4 mismanagement of the money.
5 Risk ofthatloss
an of
inheritance passing
information to a with
that dies minoryou
child or as
such grandchild
details ofmight be misspent
your assets, or stolen
debtors, by the
creditors, person inabout
information charge of managing
passwords to the money for that child or grandchild.
6 your email id etc.
7 Risk that your Business might not run smoothly after you pass away?
of unwanted
8 Risk that
of Creditors where
effortsyou
your ‘Incapacitated
madehave stood
Child’
to save Guarantor
‘Special
your Child’
life taking
if you feelyour
might not Assets
thatbe besttotopay
it’slooked the
after
cease loan.efforts
properly
such once both youpeaceably
and die and your and
spouse pass
without
9 away.
pain. For Ex. Suppose you become brain dead with no chance of recovering and Doctors keep you artificially alive. In this
10 case your Wealth goes to a Doctor or Hospital and also you have to bear lots of Pain.

Your Current State of Estate Planning

Answer the below questions to help us understand your current state of Estate Planning
SELF SPOUSE
1 Do you presently have a will? YES NO YES
2 Do you have a Financial Durable Power of Attorney?
3 Have you created a Letter of Guardianship for your minor child?
4 Do you have a 'Living Will" i.e Advanced Health Care Power of Attorney?
5 Have you created an " Asset Information Sheet" for your next generation?
 NO/NA

hat child or grandchild.

SPOUSE
NO
J. YOUR RISK PROFILE

Questions Answer A B
I plan to begin withdrawing money from
Less than 3 years 3-5 years
my investment within
I intend to spend all my investments after
Less than 2 years 2-5 years
withdrawal within
My knowledge of investments is None Limited
When I invest my money, I am Most concerned about my Equally concerned about my
investment losing value investment losing or gaining value
What investments have you owned in Money market funds or
Bonds and/ or bond funds
the past cash equivalent
Imagine that the NIFTY has dropped by
25%.You owned a Reliance stock which
also fell by 25%. Sell all my shares Sell some of my shares
What would you do?
Average, best case and worst case
scenarios for hypothetical investment Average: 7.2% Average: 9%
portfolio has been given below. Best Case: 15% Best Case: 25%
Which is most acceptable to you? Worst Case: -5% Worst Case: -13%

Any other information:

 C D

6-10 years More than 10 years

6-10 years More than 10 years

Good Extensive

Most concerned about my

investment gaining value

Stocks and/ or stocks funds

Do nothing Buy more shares

Average: 10.5% Average: 12%

Best Case: 33% Best Case: 50%
Worst Case:18% Worst Case: 28%
DECLARATION
I hereby declare that any information supplied in this questionnaire is correct and I understand that this
information will be used towards creating my Wealth Plan and for academic purposes by AAFM India.
I indemnify the company from any liability that may arise from this information being incorrect, or my
failure to implement any recommendations, which are made from this information. I understand that it is my
responsibility to choose to or not to implement any recommendations made as a result of this plan, or to
formally engage the company to implement these recommendations for me. I understand that any
Wealth Management advice will only remain valid while my situation does not change or while I am progressing
on a recommended course of action.
I am aware that AAFM India may use the data obtained from me for academic purposes.

Signed: YES
Date:

The statutory environment in this country may change from time to time therefore it is important that a client
should review any Wealth Management recommendations made to ensure that these remain valid. A client
should review any Wealth Management recommendations made to ensure that these remain valid. A client
dramatically necessitating an alteration of their plans
.