We'd love to know some more about you.
To help you achieve the things that are most important to you we'd like to ask you some questions to gain a better understanding of your situation today and the personal and financial goals you have for the future.
start
 
In your own words, how may we best help you at this time?

 
Which of the following would you specifically like help with?


 
Which adviser are you seeing?


 
Your title


 
Your first name

 
Your surname

 
Your date of birth

 
Your mobile number.

 
Your residential address

 
What is your occupation?

 
What is the name of your employer?

 
What is your employment status?


 
What is your annual pre-tax income?

 
Do you have any other income sources?

e.g. rental, government support, pensions etc. please let us know the value of each.
 
Rate your health

One star being poor, five stars being excellent.





 
Have you smoked in the last 12 months?

     
 
What is your relationship status?


 
What is your partner's title?


 
What is your partner's first name?

 
What is your partner's surname?

 
What is your partner's date of birth?

 
What is your partner's mobile number?

 
What is your partner's occupation?

 
What is the name of your partner's employer?

 
What is your partner's employment status?


 
What is your partner's annual pre-tax income?

 
Does your partner have any other income sources?

e.g. rental, government support, pensions etc.
 
How would your partner rate their health?

One star being poor, five stars being excellent.





 
Has your partner smoked in the last 12 months?

     
 
Do you have a valid Will or Power(s) of Attorney?

     
 
Please briefly tell us what you have in place.

 
Do you have any financial dependants?

     
 
Please tell us how they are related to you, their names, sex and dates of birth.

e.g.  Daughter, Linda, female, 4/8/1985
 
What are your current living arrangements?


 
What is the value of your home and mortgage? (if applicable)

ie, Home market value $600,000 and $550,000 mortgage with NAB 3.9%
 
How is your mortgage set up?


 
Repayment type


 
Do you have any other debt?


 
Please tell us some details about your other debts.

e.g. Credit card debt $6,000
 
Do you have one or more investment properties?

     
 
Please tell us some details about your investment property/ies

e.g. Woolloomooloo apartment, market value $750,000, debt of $500,000 interest only.
 
How much do you have in savings accounts or term deposits?

e.g. $5,000 in online savings account or $40,000 in 12 month term deposit.
 
Please provide us with some details of all your existing superannuation accounts.

e.g.  Linda, First State Super  (if you know approximate balances please include these too)
 
Do you have any personal insurance in place?

Personal insurance is Life (death) cover, TPD cover, Income Protection cover or Trauma cover (sometimes known as critical illness cover).
     
 
Please tell us some information about your current cover.

e.g. Life cover (inside super) of $500,000 and Income Protection of $3,000 per month (paid personally).
 
Are there any other assets or liabilities that you would like us to know about?

e.g. Telstra Shares $10,000
 
How would you rate your financial literacy?

No science here, just your own view. 1 star being low and 10 being excellent.










 
Please indicate any preferences you have in relation to product costs and features/benefits, keeping in mind there may be a trade-off between the two. *


 
Any other comments or things you might think we'd like to know about you?

 
Legal *

Via Financial Group Privacy Policy.
The privacy of your personal information has always been important to us at Via Financial Group. In addition to complying with existing laws that govern confidential information that you provide to us, we are also required to comply with the Australian Privacy Principles. We will always seek to comply with the Australian Privacy Principles as well as other applicable laws affecting your personal information. This privacy policy outlines our policy on how we manage your personal information. It also sets out generally what sort of personal information we hold, for what purposes and how we collect, hold, use and disclose that information.

Collecting Your Personal Information
Your personal information will be collected and held by Via Financial Group who are an authorised representative of Apogee Financial Planning, an Australian Financial Services Licensee, for the purposes of:
- providing you with the advisory services that you have requested;
- managing our relationship with you; or
- contacting you about products and services in which you may be interested.

To enable your financial adviser to provide you with financial advice you request that is suitable for your investment objectives, financial situation and particular needs we need to obtain and hold personal information about you. This includes:
- your name, contact details and date of birth;
- employment details and history;
- financial details including information about your financial needs and objectives, your current financial circumstances including your assets and liabilities, income, expenditure, insurance cover and superannuation;
- details of your investment preferences and risk tolerance;
- family circumstances and social security eligibility; and
- any other information that we consider necessary.

The personal information collected may include sensitive information such as health information and memberships of professional or trade associations. If it is reasonable and practicable we will only collect your personal information from you. Generally, your personal information will be collected when you meet with your adviser in person, provide your adviser with information over the telephone or with written material. We may need to collect personal information from third parties, such as your accountant.

How Your Personal Information is Held
Your personal information is generally held in client files or a computer database. Your personal information may also be held in a secure archiving facility. We will seek to ensure that we take reasonable steps to ensure that the personal information that we hold is protected from misuse and loss and from unauthorised access, modification and disclosure. Some of the measures that we have adopted are having facilities for the secure storage of personal information, having secure offices and access controls for our computer systems. We will also take reasonable steps to destroy or permanently de-identify personal information that we no longer need for any purpose for which may be used or disclosed under the Australian Privacy Principles.

Using and Disclosing Your Personal Information
Your personal information may be disclosed for purposes related to the provision of the financial advice you have requested. The types of service providers that may be provided with your personal information are:
- other financial advisers and organisations involved in providing the financial advice you have requested (which may include ongoing service) such as fund managers who assist us in providing financial advice and paraplanners;
- insurance providers, superannuation trustees and product issuers in connection with the provision to you of the financial advice you have requested;
- organisations that assist in operating a financial planning business such as those that provide administrative, financial, accounting, insurance, research, legal, computer or other business services;
- your representatives or service providers such as your accountant, solicitor, tax agent, stockbroker or bank;
- organisations involved in a business restructure or a transfer of all or part of the assets of our business or the due diligence procedures prior to any such sale or transfer;
- government authorities and other organisations when required by law; and
- organisations that you have consented to your personal information being disclosed to.

Your personal information may also be used in connection with such purposes. We will seek to ensure that your personal information is not used or disclosed for any purpose other than:
- the primary purpose for which it was collected or a related secondary purpose;
- where you have consented to the use or disclosure; or
- in other circumstances where the Australian Privacy Principles authorise the use or disclosure such as when it is required by or authorised under law.

We may disclose your personal information to third parties who provide services to us, in which case we will seek to ensure that the personal information is held, used or disclosed consistently with the Australian Privacy Principles.

Organisations outside Australia
Currently, we do not share your information with organisations outside Australia. We may store your information in the cloud or other types of networked or electronic storage.  As electronic or networked storage can be accessed from various countries via an internet connection, it’s not always practicable to know in which country your information may be held.  If your information is stored in this way, disclosures may occur in countries other than those listed. Overseas organisations may be required to disclose information we share with them under a foreign law. In those instances, we will not be responsible for that disclosure.

Accessing your Personal Information
You can gain access to your personal information that we hold. This is subject to exceptions allowed by law such as where providing you with access would have an unreasonable impact upon the privacy of others. If we deny a request for access we will provide you with the reasons for this decision. To request access please contact us (see “Contacting Us and Privacy Issues” below).

Correcting Your Personal Information
We endeavour to take reasonable steps to ensure that the personal information that we collect, use or disclose is accurate, complete and up-to-date. If you believe that any of the personal information that we hold is not accurate, complete or up-to-date please contact us (see “Contacting Us and Privacy Issues” below) and provide us with evidence that it is not accurate, complete and up-to-date. If we agree that the personal information requires correcting we will take reasonable steps to do so. If we do not correct your personal information we will provide you with the reasons for not correcting your personal information. If you request that we associate with the information a statement claiming that the information is not accurate, complete and up-to-date we will take reasonable steps to comply with this request. Contacting Us and Privacy Issues You can obtain further information on request about the way in which we manage the personal information that we hold or you can raise any privacy issues with us, including a complaint about privacy, by contacting us on 1300 402 833. We are committed to resolving your complaint.
Via Financial Group Privacy Policy.
The privacy of your personal information has always been important to us at Via Financial Group. In addition to complying with existing laws that govern confidential information that you provide to us, we are also required to comply with the Australian Privacy Principles. We will always seek to comply with the Australian Privacy Principles as well as other applicable laws affecting your personal information. This privacy policy outlines our policy on how we manage your personal information. It also sets out generally what sort of personal information we hold, for what purposes and how we collect, hold, use and disclose that information.

Collecting Your Personal Information
Your personal information will be collected and held by Via Financial Group who are an authorised representative of Apogee Financial Planning, an Australian Financial Services Licensee, for the purposes of:
- providing you with the advisory services that you have requested;
- managing our relationship with you; or
- contacting you about products and services in which you may be interested.

To enable your financial adviser to provide you with financial advice you request that is suitable for your investment objectives, financial situation and particular needs we need to obtain and hold personal information about you. This includes:
- your name, contact details and date of birth;
- employment details and history;
- financial details including information about your financial needs and objectives, your current financial circumstances including your assets and liabilities, income, expenditure, insurance cover and superannuation;
- details of your investment preferences and risk tolerance;
- family circumstances and social security eligibility; and
- any other information that we consider necessary.

The personal information collected may include sensitive information such as health information and memberships of professional or trade associations. If it is reasonable and practicable we will only collect your personal information from you. Generally, your personal information will be collected when you meet with your adviser in person, provide your adviser with information over the telephone or with written material. We may need to collect personal information from third parties, such as your accountant.

How Your Personal Information is Held
Your personal information is generally held in client files or a computer database. Your personal information may also be held in a secure archiving facility. We will seek to ensure that we take reasonable steps to ensure that the personal information that we hold is protected from misuse and loss and from unauthorised access, modification and disclosure. Some of the measures that we have adopted are having facilities for the secure storage of personal information, having secure offices and access controls for our computer systems. We will also take reasonable steps to destroy or permanently de-identify personal information that we no longer need for any purpose for which may be used or disclosed under the Australian Privacy Principles.

Using and Disclosing Your Personal Information
Your personal information may be disclosed for purposes related to the provision of the financial advice you have requested. The types of service providers that may be provided with your personal information are:
- other financial advisers and organisations involved in providing the financial advice you have requested (which may include ongoing service) such as fund managers who assist us in providing financial advice and paraplanners;
- insurance providers, superannuation trustees and product issuers in connection with the provision to you of the financial advice you have requested;
- organisations that assist in operating a financial planning business such as those that provide administrative, financial, accounting, insurance, research, legal, computer or other business services;
- your representatives or service providers such as your accountant, solicitor, tax agent, stockbroker or bank;
- organisations involved in a business restructure or a transfer of all or part of the assets of our business or the due diligence procedures prior to any such sale or transfer;
- government authorities and other organisations when required by law; and
- organisations that you have consented to your personal information being disclosed to.

Your personal information may also be used in connection with such purposes. We will seek to ensure that your personal information is not used or disclosed for any purpose other than:
- the primary purpose for which it was collected or a related secondary purpose;
- where you have consented to the use or disclosure; or
- in other circumstances where the Australian Privacy Principles authorise the use or disclosure such as when it is required by or authorised under law.

We may disclose your personal information to third parties who provide services to us, in which case we will seek to ensure that the personal information is held, used or disclosed consistently with the Australian Privacy Principles.

Organisations outside Australia
Currently, we do not share your information with organisations outside Australia. We may store your information in the cloud or other types of networked or electronic storage.  As electronic or networked storage can be accessed from various countries via an internet connection, it’s not always practicable to know in which country your information may be held.  If your information is stored in this way, disclosures may occur in countries other than those listed. Overseas organisations may be required to disclose information we share with them under a foreign law. In those instances, we will not be responsible for that disclosure.

Accessing your Personal Information
You can gain access to your personal information that we hold. This is subject to exceptions allowed by law such as where providing you with access would have an unreasonable impact upon the privacy of others. If we deny a request for access we will provide you with the reasons for this decision. To request access please contact us (see “Contacting Us and Privacy Issues” below).

Correcting Your Personal Information
We endeavour to take reasonable steps to ensure that the personal information that we collect, use or disclose is accurate, complete and up-to-date. If you believe that any of the personal information that we hold is not accurate, complete or up-to-date please contact us (see “Contacting Us and Privacy Issues” below) and provide us with evidence that it is not accurate, complete and up-to-date. If we agree that the personal information requires correcting we will take reasonable steps to do so. If we do not correct your personal information we will provide you with the reasons for not correcting your personal information. If you request that we associate with the information a statement claiming that the information is not accurate, complete and up-to-date we will take reasonable steps to comply with this request. Contacting Us and Privacy Issues You can obtain further information on request about the way in which we manage the personal information that we hold or you can raise any privacy issues with us, including a complaint about privacy, by contacting us on 1300 402 833. We are committed to resolving your complaint.
     
 
Would you like to upload any documents to assist us further with understanding your situation?

Some really useful examples might include Personal Insurance certificates of currency or superannuation statements.
     
 
File upload

If you have any documents that you would like to pass on to us to help us form a better picture of your situation please do so using the facility below. Examples of useful documents include Personal Insurance certificates of currency or superannuation statements.
 
Would you like to upload another document?

     
 
File upload

If you have any documents that you would like to pass on to us to help us form a better picture of your situation please do so using the facility below. Examples of useful documents include Personal Insurance certificates of currency or superannuation statements.
 
Would you like to upload another document?

     
 
File upload

If you have any documents that you would like to pass on to us to help us form a better picture of your situation please do so using the facility below. Examples of useful documents include Personal Insurance certificates of currency or superannuation statements.
 
Would you like to upload another document?

     
 
File upload

If you have any documents that you would like to pass on to us to help us form a better picture of your situation please do so using the facility below. Examples of useful documents include Personal Insurance certificates of currency or superannuation statements.
Thank you for taking the time to submit this form. Your adviser will be in touch shortly.
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