FINANCIAL PLANNING QUESTIONNAIRE

PERSONAL INFORMATION


Clients Name __________________________________________________
Gender: Male Female Male
Date of Birth (DD/MM/YY)
Address:- Housing Board Colony, Mapusa, Bardez- Goa
Pin Code:- 403507
Tele-Phone
Mobile No
E-Mail Address
Marital status: Married
Occupation:- Advocate


Spouse Details
Name:
Gender: Female
Date of Birth (DD/MM/YY)
Address:-
Tele-Phone
Mobile No
E-Mail Address _____________
Occupation:- Housewife


Family members
Name Relationship with the
client
Age Dependant
(Yes/No)
occupation Annual
financial
implication
1.
2
3.
wife
Son
Son
52
25
17
YES
YES
YES
Housewife
Student
Student
Dependent
Dependent
Dependent



Details of any health Issues of client, family members and other dependents:
1. Diabetic




Clients Employment Details
Current or most recent
employment
Name and address of
employer
Position Period
Advocate


Spouses Employment Details
Current/ most recent
employments
Name and address of
employer
Position Period
Housewife -----





CLIENTS FINANCIAL GOALS:


Please briefly outline your reasons for seeking advice:
1. Educational fees of younger son:- 1,50,000 to 2,00,00 after 10 months
2. To buy an private shop:- 50 Lakh after 3 years
3. To buy a land at prime location in city of around Rs 80 lakhs after 6 years
4. To go on domestic holiday every alternate year.



List down specific goals:
Goal Estimated Fund
required
Target date Rank/ Priority
Purchase of immovable
Property
80 Lakhs 6 years 2
Car
Childrens Education 1,50,000 to 2,00,00/- 10 months 1
Childrens wedding 500000-600000 &
550000-650000
5 years & 10 years 3
Holiday 15000 Every alternate year 4
Repayment of Loans
Other(specify)
Other(specify)
Total Funds required


Retirement Planning
Particulars Client Spouse
At what age do you plan to retire Professional
no retirement
but monthly
15 k is
contributed
towards future
savings
housewife
What are your expected annual income needs in retirement?
How much do you contribute each year to your retirement plan(s)?
How much does your employer contribute each year to your
retirement plan(s)?

During retirement how much monthly
income do you expect to receive from

Employer Pension(s)

Family Members Education Plans
Name Current education
status
Education intend to
pursue
Expected expenses Expected year of pursuing
education
12
th
standard Graduation
(Engineering or Law)
Law 15k/year (5 years)
Eng 25k/year (4 years)
2015

ANNUAL INCOME

Particulars Client Spouse
Basic Salary (Income) 450000/- -----
Perks and allowances ----- -------
Net Salary
Business income
Investment Income(Dividends, interest etc)
Other income (specify)
TOTAL INCOME 450000
(Please attach your salary slip)


MONTHY EXPENSES
Details of monthly expenses of the client:
Particulars Amount Spent
Household expense
Electricity bills 900 -1000
Water bills 600 700
Rent Shop Rent & 2
nd
office rent total 1500 & 2000
Transportation and Fuel 2500 -3000
EMI
Education fees Expense only not fees as such 6000 to 7000
Extracurricular activities fees
Repairs and Maintenance Depends office 2000 and other if any upto 5000
Entertainments, magazines and journals 275 to 300
Medical expenses 500 to 700
Personal expenses Daily shopping& Marketing 8500 to 9000/-
Any other





LIABILITY
Type Date of
availing
Amount
Of loan
EMI

Interest
Rate
Maturity date Security Provided
Long Term
Loan:
Vehicle Loan
House Loan
Business Loan
Personal loan
Education
loans
Others

No loans
at all.
All loans
got
cleared 2
months
back
especially
vehicular
and
office..

Short term
credit:
Credit Card
CC a/c




PHYSICAL ASSETS
Assets Date of Purchase Cost of Purchase Present Market Value
Self-Occupied house

Land - March 1988 1,00,000 6000000
Additional House

---- ----- -----
Land

Agricultural Land
Non agricultural Land
Inherited
Inherited
Unknown
1500000
Business Premises

Office - 2006 18,00,000/- 3000000
Two-wheeler

Honda Dio 15 March 2005
Honda DIo -
Kinetic Flyte -
42,000
56000
35000
8000
51000
5000
Car

Maruti 800 -1993
Corsa Sail September 10 2002
300000
6.5 lakhs
40000
100000



FINANCIAL ASSETS
Type Company Number of
shares,
bonds held
Face
Value
Market
Value
Dividend Purchase
Date
Maturity
Date
Shares


Bonds


Debentures


CD



CP


Any other





BANK ACCOUNT
Type of
Account
Principal
Amount
Bank Rate Date of
opening
Maturity
date(TD,
RD)
Maturity
value
Hypothecation
(if any)
FD:


RD:

8 lkhs
4 lkhs
8 lkhs
SBI
BoB
BOI


Savings:


Current:





INSURANCE PLANS
Policy Name
& company
Policy
Type
Policy term Premium Amount (
And Frequency)
Sum assured on
maturity
Date of maturity


LIC, Term of 1 year, of 5 vehicles, 2 cars and 3 bikes around 12k per year. No insurance besides that.

TAX PLANNING
Year Total
Income
Taxable
Income
Tax Paid Amount Of Deduction Availed
Under Sec 80c
2014-13
2013-12...




Are there any contingencies (payments) that are to be paid in future? Any litigations etc (please write in
details)

NO


Have you planned for your estate? Do you have any executor then please provide the details of the
same.
No