CLIENT DATA COLLECTION FORM Private & Confidential Client Name(s) Adviser Name Date THE IMPORTANCE OF COMPLETING A DATA COLLECTION FORM : To provide a reasonable basis for making a recommendation as required by the Corporations Act. Instructions on completing this form : 1. Cross out any sections you do not wish to complete with a line and your initials. Sections may be crossed out for a number of reasons including : • They are not applicable to you • You do not wish to divulge that information 2. If you simply do not know the information at this stage, please insert a question mark “? ” 3. Complete all pages of the form unless otherwise instructed by your Adviser. 4. Supply statements/information marked in red on pages 3, 4, 10. Licensee: McPherson & Associates Pty Ltd ABN 15 087 681 561 AFS Licence No 229883 Level 6, 500 Queen Street Brisbane Qld 4000 GPO Box 482, Brisbane Qld 4001 Telephone: (07) 3833 3100 Facsimile: (07) 3833 3199 PRIVACY POLICY M&A abides by the National Privacy Principles under the Privacy Amendment (Privacy Sector) Act 2001. A copy of our Privacy Policy is available on request. In accordance with our Privacy Policy you may at any time request access to your personal information. M&A is required under The Corporations Act and ASIC regulations to hold your personal details on file. The information is used to substantiate any financial recommendations we make. Please note our recommendations may be inappropriate if this information is inadequate or incorrect.
Transcript
CLIENT DATA COLLECTION FORM
Private & Confidential
Client Name(s)
Adviser Name
Date
THE IMPORTANCE OF COMPLETING A DATA COLLECTION FORM : To provide a reasonable basis for making a recommendation as required by the Corporations Act.
Instructions on completing this form : 1. Cross out any sections you do not wish to complete with a line and your initials.
Sections may be crossed out for a number of reasons including :
• They are not applicable to you • You do not wish to divulge that information
2. If you simply do not know the information at this stage, please insert a question mark “? ”
3. Complete all pages of the form unless otherwise instructed by your Adviser.
4. Supply statements/information marked in red on pages 3, 4, 10.
Licensee:
McPherson & Associates Pty Ltd ABN 15 087 681 561 AFS Licence No 229883
M&A abides by the National Privacy Principles under the Privacy Amendment (Privacy Sector) Act 2001. A copy of our Privacy Policy is available on request. In accordance with our Privacy Policy you may at any time request access to your personal information. M&A is required under The Corporations Act and ASIC regulations to hold your personal details on file. The information is used to substantiate any financial recommendations we make. Please note our recommendations may be inappropriate if this information is inadequate or incorrect.
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 2 of 23
P E R S O N A L D E T A I L S
Client 1 Client 2
Title �Mr �Mrs �Miss�Ms �Other Title �Mr �Mrs �Miss�Ms �Other
Surname Surname
Given Names Given Names
Preferred Name Preferred Name
Address Address
Suburb/Town Suburb/Town
State Post Code State Post Code
Date of Birth / / Date of Birth / /
Marital Status (please circle below):
Single Married Defacto
Separated Divorced Widowed
Marital Status (please circle below):
Single Married Defacto
Separated Divorced Widowed
Australian Resident Yes No Australian Resident Yes No
Contact Details
Contact Details
Home phone Home phone
Work phone Work phone
Mobile phone Mobile phone
Fax number Fax number
Email address Email address
Preferred method of contact (please tick) :
� Home � Work � Mobile � Email
Preferred method of contact (please tick) :
� Home � Work � Mobile � Email
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 3 of 23
T R U S T D E T A I L S
Trust Name
Trustees
Type of Trust Fixed / Unit or Discretionary
Use of Trust Investment Only / Carrying on a Business Only / Both Investment & Business
Beneficiaries’ Names
C O M P A N Y D E T A I L S
Company Name ACN
Nature of Business
Directors
Shareholders Shareholding %
Shareholding %
Shareholding %
Use of Company Investment Only / Carrying on a Business Only / Both Investment & Business
If insufficient space, please attach schedule.
S E L F M A N A G E D
S U P E R A N N U A T I O N F U N D D E T A I L S
Fund Name:
Names of Trustees:
Name of Administrator/ Accountant
Phone number:
O T H E R P R O F E S S I O N A L A D V I S E R S
Name Company Contact Details
Solicitor
Accountant
Other
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 4 of 23
I N C O M E
Client 1 Client 2
Occupation Occupation
Status Full time Part time Casual Temp Status Full time Part time Casual Temp
Business Status (sole proprietor, partnership, trust, private company)
Business Status (sole proprietor, partnership, trust, private company)
Employer Name Employer Name
Commencement Date / / Commencement Date / /
Gross (before Tax)
Salary/Wages $ pa
Gross (before Tax)
Salary/Wages $ pa
Business Income $ pa Business Income $ pa
Pension payments $ pa Pension payments $ pa
* Centrelink payments $ pa * Centrelink payments $ pa
Investment Income $ pa Investment Income $ pa
Other: $ pa Other: $ pa
Other: $ pa Other: $ pa
Total : $ pa
Total : $ pa
Please attach copy of Payslip
Please attach copy of Payslip
Any likely changes to the above details?
Any likely changes to the above details?
* Insert name of the Centrelink payment below: * Insert name of the Centrelink payment below:
Eg Age Pension/ Newstart : Eg Age Pension/ Newstart :
S A L A R Y P A C K A G I N G
Salary Packaging is an alternative way of being paid or remunerated by sacrificing some gross salary in return for non-cash employer provided benefits.
Client 1 Client 2
Salary Packaging Available? Yes No
Can it be changed at any time? Yes No
List benefits currently Salary Packaged :
Are you considering Salary Packaging any benefits?
Yes No
Provide a list of benefits you would like to consider packaging eg car, superannuation, other
Salary Packaging Available? Yes No
Can it be changed at any time? Yes No
List benefits currently Salary Packaged :
Are you considering Salary Packaging any benefits?
Yes No
Provide a list of benefits you would like to consider packaging eg car, superannuation, other
B A
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 5 of 23
E X P E N S E S
Note: Do not include one-off payments here eg overseas holiday. Include one-off payments under “Objectives” on the next page. Please check expenses are recorded only once in the table below.
Yearly Total
$
Yearly Total $
Household Expenses Living Expenses
Rent Payments Groceries
Home Mortgage Payments Clothing
House & Contents Insurance Education
Council / Shire Rates Child Care
Water Rates Child Support / Maintenance
Electricity Children’s Activities
Gas Subscription Fees eg magazines
Telephone – Household / Mobile Entertainment
Internet / Pay TV Subscriptions Dining Out
Household Maintenance Sport and Memberships
Furniture and Appliances Haircuts
Transport Costs Gifts
Car Loan / Lease Payments Holidays
Running Costs / Fuel Cigarettes
Registration Fees Alcohol
Car Insurance Donations
Car Maintenance Gambling
Licence Fees / Fines Pet Care
Other Transport Salary Deductions
Healthcare Costs Deductions from Gross salary
Life Insurance Super (after-tax/salary sacrifice)
Disability Insurance Other salary deductions
Medical / Dental / Optical Costs Business Expenses
Health Benefits / Insurance
Chemist
Liability Expenses
Regular Investment payments Other
Other regular loan repayments
Credit card payments
Sub Total $ pa Grand Total $ pa
Cashflow Reconciliation
Net income [A + B from page 4]
Less expenses [C above] ( )
Less Tax (Adviser calc) ( )
= Surplus/Deficit
C
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 6 of 23
F I N A N C I A L O B J E C T I V E S ( M O N E T A R Y )
Tips for writing a Financial Objective: a) Start the objective with a Verb eg Retire, Increase, Reduce, Build, Take b) Order the objective according to “Timeframe” ie objectives with shorter timeframes are listed first.
PRIORITY CLIENT
(INITIALS)
FINANCIAL OBJECTIVES
(Order of priority)
TIME-FRAME
TARGET AMOUNT
1 KP Take a holiday overseas to visit relatives in England 2 years $10,000
2 JP Build a share portfolio. Diversification of current investments.
7 years $150,000
Would you like to apply for Centrelink Benefits if eligible? Client 1 Yes No Client 2 Yes No?
Expected after-tax income pa in retirement Client 1 $ Client 2 $
F I N A N C I A L S U M M A R Y ( $ )
(details of the investment assets below are requested on pages 7 to 9)
Asset Type Assets Owner
(initials) Market Value
(A) Liability
(B) Net Value
(A)-(B)
Lifestyle Residence ( )
House Contents ( )
Car(s) ( )
Boat/Caravan ( )
Holiday Home ( )
Personal Debts (eg credit card) ( )
Other ( )
Investment Cash Accounts N/A
Fixed Term Investments N/A
Managed Funds ( )
Superannuation Funds N/A
Pension Funds N/A
Investment Properties ( )
Other Investments eg shares ( )
Totals $ $ $
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 7 of 23
I N V E S T M E N T D E T A I L S
CASH ACCOUNTS
Institution and Account Type eg Bank (savings), Building Society, Credit Union
Owner Initials
Balance $
Interest Rate % (pa)
Income $ (pa)
Totals $ N/A $
FIXED TERM INVESTMENTS
(eg Deposits, Debentures, Government Bonds, Bills)
Institution and Account Type Owner Initials
Balance $
Interest Rate %
(pa)
Income $ (pa)
Maturity Date
Totals $ N/A $ N/A
MANAGED FUNDS
If geared (complete columns below) Institution
Owner Initials
Policy Number
Balance $ Outstanding
Loan $
Interest Rate % pa
Repayment (monthly)
1 ($ ) % $
For the above investment have you nominated to:
Receive income OR Reinvest income
Contribute $________ per mth own equity
Contribute $________ per mth through gearing
2 ($ ) % $
For the above investment have you nominated to:
Receive income OR Reinvest income
Contribute $________ per mth own equity
Contribute $________ per mth through gearing
3 ($ ) % $
For the above investment have you nominated to:
Receive income OR Reinvest income
Contribute $________ per mth own equity
Contribute $________ per mth through gearing
Totals ($ ) % $
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 8 of 23
S U P E R A N N U A T I O N I N F O R M A T I O N
S U P E R A N N U A T I O N
Client 1 Client 2
Fund Type Employer Personal Employer Personal
Fund Name
Date Joined / / / /
Eligible Service Date / / / /
Account Balance $ $
- as at what date / / / /
Tax Free Component $ $
Taxable Component $ $
Death / Disability Benefit $ $
Benefit Structure Accum Defined Benefit Accum Defined Benefit
Please attach latest member statements.
Client 1 Client 2
Fund Type Employer Personal Employer Personal
Fund Name
Date Joined / / / /
Eligible Service Date / / / /
Account Balance $ $
- as at what date / / / /
Tax Free Component $ $
Taxable Component $ $
Death / Disability Benefit $ $
Benefit Structure Accum Defined Benefit Accum Defined Benefit
Please attach latest member statements.
If you have more than 2 superannuation funds, please attach details.
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 9 of 23
TERMINATION PAYMENTS
If leaving employment, please provide details of estimated employer payment.
Company Payments Client 1 Client 2
Long Service Leave (net)
Annual Leave (net)
Redundancy / Early Retirement (tax free)
Redundancy / Early Retirement (ETP)
Ex Gratia / Golden Handshake
Other
TOTAL
Previous Withdrawals from Superannuation (only if currently under age 60)
Client 1 Client 2
Pre / Post Component
Or Pre 83
Post 83
Post ’94 Invalidity / Concessional
Undeducted Contributions
CGT Exempt Component
TOTAL
Payment Date
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 10 of 23
PENSION FUNDS
Fund Name Owner initials
Policy / Member Number
Type of Pension – Life expectancy,
Lifetime, TAP (Growth), Allocated Pension,
Current Account Balance
($)
Eligible Start Date
Initial Purchase
Price $
Annual Pension Payment
Annual Deductible
Amount
Relevant Number on
commencement
1 / /
2 / /
Totals N/A N/A N/A $ N/A N/A $ N/A $
Please attach a copy of your latest Pension Statement
INVESTMENT PROPERTIES
If Debt (complete)
Description / Location Owner initials
Date of Purchase
Purchase Price Gross Income
$pa
Gross Expenses
$pa
Estimated Market Value
Today $ Outstanding Loan $
Interest Rate % pa
Repayment (monthly)
1 / / ( )
2 / / ( )
3 / / ( )
Totals N/A N/A N/A $ $ $ ($ ) N/A $
LIST ALL OTHER INVESTMENTS (eg Shares, Insurance Bonds, Friendly Societies etc)
If Debt (complete)
Description Owner initials
Unlisted / Listed
Date of Purchase
Amount originally invested/
no. of shares
Expected Income
$pa
Estimated Market Value
Today $
Outstanding Loan $
Interest Rate % pa
Repayment (monthly)
1 / / ( )
2 / / ( )
3 / / ( )
Totals N/A N/A N/A N/A $ $ ($ ) N/A $
If insufficent space, please attach schedule
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 11 of 23
S P E C I F I C I N V E S T M E N T Q U E S T I O N S
1. Do you have any accumulated Tax Losses that you can carry forward?
Client 1 Yes No Amount: $
Client 2 Yes No Amount: $
2. What would you like to change about your current investments?
Client 1 Client 2
E M P L O Y E R T E R M I N A T I O N P A Y M E N T S
(eg Long Service Leave, Redundancy)
Client 1 Client 2
Are you expecting to receive an Employer Termination Payment this Financial Year?
Yes No Yes No
Have you received any Employer Payments as cash in the past?
The following questions have been designed by Finametrica and will assist our Advisers to assess the level of risk you are comfortable in taking, particularly in relation to investments. The following questions do not replace discussions with your Adviser. Please complete each question and enter the appropriate number in the columns marked. If the question is not appropriate to your current situation, you may have to imagine what you would do in similar circumstances. There is no right or wrong answer. We are simply trying to gauge your attitude towards risk. Client 1
(Enter Choice eg “ 1 “)
Client 2 (Enter Choice
eg “ 1 “)
1. Compared to others, how do you rate your willingness to take financial risks?
1. Extremely low risk taker 2. Very low risk taker 3. Low risk taker 4. Average risk taker 5. High risk taker 6. Very high risk taker
7. Extremely high risk taker
2. How easily do you adapt when things go wrong financially?
1. Very uneasily 2. Somewhat uneasily 3. Somewhat easily 4. Very easily
3. When you think of the word “risk” in a financial context, which of the following words come to mind first?
1. Danger 2. Uncertainty 3. Opportunity 4. Thrill
4. Have you ever invested a large sum in a risky investment mainly for the ‘thrill’ of seeing whether it went up or down in value?
1. No 2. Yes, very rarely 3. Yes, somewhat rarely 4. Yes, somewhat frequently 5. Yes, very frequently
5. If you had to choose between more job security with a small pay increase, and less job security with a big pay increase, which would you pick?
1. Definitely more job security with a small pay increase 2. Probably more job security with a small pay increase 3. Not sure 4. Probably less job security with a big pay increase 5. Definitely less job security with a big pay increase
6. When faced with a major financial decision are you more concerned about the possible losses or the possible gains?
1. Always the possible losses 2. Usually the possible losses 3. Usually the possible gains 4. Always the possible gains
7. How do you usually feel about your major financial decisions after you make them?
1. Very pessimistic 2. Somewhat pessimistic 3. Somewhat optimistic
4. Very optimistic
8. Imagine you were in a job where you could choose whether to be paid salary, commission or a mix of both. Which would you pick?
1. All salary 2. Mainly salary 3. Equal mix of salary and commission 4. Mainly commission
5. All commission
9. What degree of risk have you taken with your financial decisions in the past?
1. Very small 2. Small 3. Medium 4. Large
5. Very large
10. What degree of risk are you currently prepared to take with your financial decisions?
1. Very small 2. Small 3. Medium 4. Large
5. Very large
11. Have you ever borrowed money to make an investment (other than for your home)?
1. No 2. Yes
12. How much confidence do you have in your ability to make good financial decisions?
1. None 2. A little 3. A reasonable amount 4. A great deal 5. Complete
13. Suppose that 5 years ago you bought shares in a highly regarded company. That same year the company experienced a severe decline in sales due to poor management. The price of the shares dropped drastically and you sold at a substantial loss. The company has been restructured under new management and most experts now expect it to produce better than average returns. Given your bad past experience with this company would you buy shares now?
1. Definitely not 2. Probably not 3. Not sure 4. Probably
14. Investments can go up and down in value and experts often say you should be prepared to weather a downturn. By how much could the total value of all your investments go down before you would begin to feel uncomfortable?
1. Any fall would make me feel uncomfortable 2. 10% 3. 20% 4. 33% 5. 50% 6. More than 50%
15. Assume that a long-lost relative dies and leaves you a house which is in poor condition but it is located in a suburb that's becoming popular. As is, the house would probably sell for $300,000, but if you were to spend about $100,000 on renovations, the selling price would be around $600,000. However, there is some talk of constructing a major highway next to the house, and this would lower its value considerably. Which of the following options would you take?
1. Sell it as is 2. Keep it as is, but rent it out 3. Take out a $100,000 mortgage and do the renovations
16. Most investment portfolios have a mix of investments - some of the investments may have high expected returns but with high risk, some may have medium expected returns and medium risk, and some may be low risk/low return. (For example, shares and property would be high risk/high return whereas cash and term deposits would be low risk/low return.)
Which mix of investments do you find most appealing? Would you prefer all low risk/low return, all high risk/high return, or somewhere in between?
Please select one of the seven portfolios listed below. Mix of Investments in Portfolio
Portfolio High Risk/Return Medium Risk/Return
Low Risk/Return
1 0% 0% 100%
2 0% 30% 70%
3 10% 40% 50%
4 30% 40% 30%
5 50% 40% 10%
6 70% 30% 0%
7 100% 0% 0%
17. You are considering placing one-quarter of your investment funds into a single investment. This investment is expected to earn about twice the term deposit rate. However, unlike a term deposit, this investment is not protected against loss of the money invested. How low would the chance of a loss have to be for you to make the investment?
1. Zero, i.e., no chance of any loss 2. Very low chance of loss 3. Moderately low chance of loss
18. With some types of investment, such as cash and term deposits, the value of the investment is fixed. However inflation will cause the purchasing power of this value to decrease.
With other types of investment, such as shares and property, the value is not fixed. It will vary. In the short term it may even fall below the purchase price. However, over the long term, the value of the shares and property should certainly increase by more than the rate of inflation.
With this in mind, which is more important to you, that the value of your investments does not fall or that it retains its purchasing power?
1. Much more important that the value does not fall 2. Somewhat more important that the value does not fall 3. Somewhat more important that the value retains its purchasing power
4. Much more important the value retains its purchasing power
19. In recent years, how have your personal investments changed?
1. Always toward lower risk 2. Mostly toward lower risk 3. No changes or changes with no clear direction 4. Mostly toward higher risk
5. Always toward higher risk
20. When making an investment, return and risk usually go hand-in-hand. Investments which produce above average returns are usually of above average risk. With this in mind, how much of the funds you have available to invest would you be willing to place in investments where both returns and risks are expected to be above average?
21. Think of the average rate of return you would expect to earn on an investment portfolio over the next ten years. How does this compare with what you think you would earn if you invested the money in term deposits?
1. About the same rate as from term deposits 2. About one and a half times the rate from term deposits 3. About twice the rate from term deposits 4. About two and a half times the rate from term deposits 5. About three times the rate from term deposits
6. More than three times the rate from term deposits
22. People often arrange their financial affairs to qualify for a government benefit or to obtain a tax advantage. However a change in legislation can leave them worse off than if they'd done nothing. With this in mind, would you take a risk in arranging your affairs to qualify for a government benefit or obtain a tax advantage?
1. I would not take a risk if there was any chance I could finish up worse off 2. I would take a risk if there was only a small chance I could finish up worse off 3. I would take a risk as long as there was more than a 50% chance that I would finish up better off
23. Imagine that you are borrowing a large sum of money at some time in the future. It's not clear which way interest rates are going to move - they might go up, they might go down, no one seems to know. You could take a variable interest rate that will rise and fall as the market rate changes. Or, you could take a fixed interest rate which is 1% more than the current variable rate but which won’t change as the market rate changes. Or, you could take a mix of both.
24. Insurance can cover a wide variety of life’s major risks – theft, fire, accident, illness, death, etc. How much cover do you have?
1. Very little 2. Some 3. Considerable 4. Complete
25. This questionnaire is scored on a scale of 0 to 100.
When the scores are graphed they follow the familiar bell-shaped curve of the Normal distribution shown below. The average score is 50. Two-thirds of all scores are within 10 points of the average. Only 1 in 100 is less than 20 or more than 80.
What do you think your score will be?
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 17 of 23
E S T A T E P L A N N I N G
Client 1 Client 2
Do you have a Will? Yes No Yes No
Date of Will / / / /
Location of Will
Last Reviewed / / / /
Executors of Will
Do you have a Power of Attorney?
Yes No Yes No
Do you have an Enduring Power of Attorney?
Yes No Yes No
Estate Planning
Objectives/Comments
Do you have a binding death benefit nomination for superannuation?
Yes No
Fund
Binding Date / /
Fund
Binding Date / /
Yes No
Fund
Binding Date / /
Fund
Binding Date / /
List Dependants and/or beneficiaries below
Name Date of
Birth
Relationship to you eg spouse,
child, sister
Beneficiary %
Dependant * Y / N
Years to
support
On binding form Y / N
Client 1
Client 2
* Definition of Dependant: for superannuation purposes include a spouse, child, financial dependant or a person with an ‘interdependency relationship’ with the member.
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 18 of 23
C U R R E N T H E A L T H
Client 1 Client 2
Are you aware of any health conditions you may have which may reduce your ability to earn income or increase your medical expenses in the next 10 years?
Please provide details: Yes No
Are you aware of any health conditions you may have which may reduce your ability to earn income or increase your medical expenses in the next 10 years?
Please provide details: Yes No
Does your family history suggest a long life?
Please provide details: Yes No
Does your family history suggest a long life?
Please provide details: Yes No
Are you a smoker? Yes No Are you a smoker? Yes No
Do you have private health insurance?
Yes No
Do you have private health insurance?
Yes No
M E D I C A L I N S U R A N C E
Client 1 Client 2
Insurance Company
Policy Description
Level / Type of Cover
Annual Premium $
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 19 of 23
O T H E R I N S U R A N C E S
DEATH AND TOTAL AND PERMANENT DISABLEMENT (TPD) – Outside Superannuation
Client 1 Client 2
Insurance Company
Policy Description Term / Endowment / Whole of Life Term / Endowment / Whole of Life
Sum Insured ($)
Death
TPD
Annual Premium ($)
INCOME PROTECTION / SALARY CONTINUANCE
Client 1 Client 2
Insurance Company
Monthly Benefit ($)
Waiting Period
Benefit Period
Annual Premium ($)
TRAUMA / TERMINAL ILLNESS
Client 1 Client 2
Insurance Company
Events Covered
Policy Owner
Sum Insured ($)
Annual Premium ($)
OTHER INSURANCES
Type of Insurance
Insurance Company
Client 1 Client 2
House and Contents
Yes No
Annual Premium $
Yes No
Annual Premium $
Car Yes No
Annual Premium $
Yes No
Annual Premium $
Business Yes No
Annual Premium $
Yes No
Annual Premium $
Other Yes No
Annual Premium $
Yes No
Annual Premium $
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 20 of 23
S I G N - O F F O N I N F O R M A T I O N S U P P L I E D
Note: Please do not complete/sign this Request for Advice until such time as you meet with your adviser and discuss with him/her your needs, the scope of their engagement and the fee payable.
I/we understand that this Client Data Collection Form will form the basis of a Statement of Advice that may be developed by McPherson Investment Consulting to achieve my/our financial objectives as detailed in this document.
I have read the instructions on the front of this form and have crossed out, and initialled the appropriate sections that I/we have not completed.
The information provided in this Client Data Collection Form is complete and accurate to the best of my knowledge.
I/we understand that your advice will be based on the information I/we provide you. If the information I/we have provided is incomplete or inaccurate, I/we understand that the advice might have its limitations and I/we should consider the appropriateness of the advice before acting on it.
I/we understand that this Client Data Collection Form may not be conclusive and I/we will supply any relevant additional information required.
I/we understand that I/we may raise any further matters with my adviser and my adviser may ask any further questions.
I/we confirm that I/we have received a copy of McPherson & Associates Pty Ltd’s Financial Services Guide and have read the Privacy Statement included with this Client Data Collection Form.
Client signature Client signature
Date / / Date / /
R E Q U E S T F O R P R E P A R A T I O N O F A S T A T E M E N T O F A D V I C E
I/We request that McPherson Investment Consulting Pty Ltd
� Prepare a comprehensive Statement of Advice for my/our personal circumstances and provide appropriate advice based on that analysis.
� DO NOT prepare a comprehensive Statement of Advice for my/our circumstances at this time. Rather, I/we require a limited Statement of Advice which specifically relates to the following issue/s:
I/we agree to pay a fee of $ for the preparation of this advice/plan.
Client signature Client signature
Date / / Date / /
Adviser Signature Date / /
(COMPLETED WITH ADVISER)
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 21 of 23
R E Q U E S T T O A C C E S S I N F O R M A T I O N
To Whom It May Concern
I/we and
Request that all relevant information on my/our investments, insurances, superannuation, bank
accounts or other financial information be released to McPherson Investment Consulting Pty Ltd as an
authorised representative of McPherson & Associates Pty Ltd, AFS Licence No 229883 , on request.
Please accept a photocopy or facsimile of this letter as authority as the original will be kept on file at
McPherson Investment Consulting Pty Ltd.
Client 1 signature Client 2 signature
Date / / Date / /
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 22 of 23
T A X F I L E N U M B E R A U T H O R I S A T I O N S
Collection of tax file numbers and their use and disclosure are strictly regulated by the tax laws and Privacy Act. Quotation of your tax file number to us is not compulsory. For more information about the use of tax file numbers, please contact the Australian Taxation Office. Your tax file number will only be quoted by us to relevant financial institutions where written authority has been obtained from you.
Client 1 Client 2
Tax File Number
_ _ _ _ _ _ _ _ _
_ _ _ _ _ _ _ _ _
I/we give permission for my/our tax file number(s), as provided above, to be forwarded to financial institutions as requested or as necessary.
Client 1 signature Client 2 signature
Date / / Date / /
McPherson Investment Consulting Pty Ltd – Client Data Collection Form Page 23 of 23
C L I E N T C H E C K L I S T
� Completed all sections of the form in the manner described on the front of this document
� Attached any extra information requested or required (see red italics- pages 3,4,10)
� Signed page 20 – Request for Advice
� Completed Request to Access Information (page 21)
� Please add below any questions or comments you have for the Adviser:
A D V I S E R C H E C K L I S T A N D N O T E S
Ensure:
� All sections have been completed or crossed out and initialled in Client Data Collection Form.
� The Financial Summary reflects the Investment details on the subsequent pages.
� Request for Advice has been signed and scope provided.
� The risk profile questions on pages 12 to 16 are all answered.
� All extra information supplied by the client is attached to this document.
� The Client is given a list of outstanding information they still need to supply. Refer to “?” appearing through Client Data Collection Form.
