Insurevest insurance services
CLIENT ANALYSIS
Advisor Full Name —Please choose an option—Name: Rodney Robinson ---- Mobile:078 084 1072 ---- Email:rodney@insurevest.co.zaName:Nassir Brown ---- Mobile:060 673 0792 ---- Email:nassir@insurevest.co.za
PERSONAL DETAILS
Your Full Name
Identity Number
Mobile number
Your Address
Email Address
Employer
Occupation
Marital Status —Please choose an option—SingleMarriedDivorcedSeparatedWidowed
Your Title —Please choose an option—MrsMrMissDrAdvJudgProf
Dependants
Date of Birth
Years until dependent is financially independent
Your Age
Years until retirement
INCOME AND EXPENSES
Income
Car repayments
Credit card/Overdraft
Domestic
Entertain/Holiday/Gifts
Fuel/Car maintenance
Grocery/Take-out
Hobby/Sport
Insurance premiums
Internet
Meds/Parmacy
Mobile
Netflix/DSTV/Showmax
Personal loans
Bond/Rent & Levies
Savings/invest
School Fees
Store accounts
Water/Elec/Rates
BALANCE
ASSETS AND LIABILITIES
Property Value
Property Balance
Vehicle value
Vehicle balance
Existing life cover
Existing funeral cover
Existing disability cover
Existing severe illness
Educational plan
Living annuity
Savings total
Investment total
Store accounts balance
Personal loans balance
Credit card balance
Overdraft balance
With the assistance of my financial adviser I have arranged my needs and made my decision in line with my priorities.
The amount I can afford to pay was determined after my financial adviser and I completed my Income and Expenses.
I was satisfied that I did not need to fully complete my Income and Expenses to decide what I can afford to pay.
After the consultation with my financial adviser, I am satisfied that I can afford the premium.
Advisor notes
REPLACE AN EXISTING POLICY
What implications there are when replacing my existing policy insurance.
That a replacement policy advice record must be completed if I do replace a policy.
DISCLOSURES AND ADVICE
• My financial adviser explained the charges, fees and information relating to the product I have selected. • My financial adviser disclosed that he/she will receive a fee(s) for the advice rendered for this product. • I was not offered any money to buy this product. • I have received advice from my financial adviser. • I fully understood the advice given to me by my financial adviser. • The information that I provided to my financial adviser was accurate and true at the time of my financial needs analysis being done.
Monthly expenses replacement amount, if you pass on
Amount to settle any debt, if you pass on
Life cover need
Estimated estate expenses
