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This questionnaire is designed to help us understand your current financial situation and goals. By filling out this form and walking through it with your advisor, we can create a wealth recommendations report tailored to your needs.

Rest assured that the privacy and security of your data is our top priority. All information provided in this questionnaire will be kept confidential and stored securely.

Name

First Last

Partner name

First Last

Preferred Name

Preferred name

Partners preferred name

Partners preferred name

Nationality

Partner Nationality

Country of residence

Partner Country of residence

Occupation

Partner Occupation

Date of birth

MM slash DD slash YYYY

Partner Date of birth

MM slash DD slash YYYY

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Partner Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you live offshore?

Yes

No

Partner live offshore?

Yes

No

How many years have you lived offshore?

How many years has your partner lived offshore?

How many years do you plan to continue to live offshore?

How many years does your partner plan to continue to live offshore?

Number of dependents

Please enter a number from 0 to 20.

Dependant 1

First Last

Dependant 1 Age

Please enter a number from 0 to 99.

Dependant 1 Sex

Male

Female

Dependant 1 Relationship

Dependant 2

First Last

Dependant 2 Age

Please enter a number from 0 to 99.

Dependant 2 Sex

Male

Female

Dependant 2 Relationship

Dependant 3

First Last

Dependant 3 Age

Please enter a number from 0 to 99.

Dependant 3 Sex

Male

Female

Dependant 3 Relationship

Dependant 4

First Last

Dependant 4 Age

Please enter a number from 0 to 99.

Dependant 4 Sex

Male

Female

Dependant 4 Relationship

Dependant 5

First Last

Dependant 5 Age

Please enter a number from 0 to 99.

Dependant 5 Sex

Male

Female

Dependant 5 Relationship

Is there a need to financially support dependence now or in the future?

Yes

No

Preferred correspondence medium

Phone

Email

Whatsapp

Private mobile

Private email

Company

Company address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work phone

Work email/backup email

Additional notes

Your income

Currency

Basic earned income

Partner Basic earned income

Joint Basic earned income

Bonus/Commission

Partner Bonus/Commission

Joint Basic earned income

Housing Allowance

Partner Housing Allowance

Joint Basic earned income

Pension Income

Partner Pension Income

Joint Basic earned income

Investment Income

Partner Investment Income

Joint Basic earned income

Other Income

Partner Other Income

Joint Basic earned income

Total income

Total partner income

Total joint income

Are you expecting any changes to your income?

Yes

No

Describe the changes you expect to your income

Target retirement date

MM slash DD slash YYYY

Ideal retirement age

Your expenditure

Accommodation costs

Utilities

Saving pensions and insurance contributions

Education costs

Fixed bills loans credit card payments

Travel costs

Food

Overcommitted outgoings

Total fixed expenditure

Discretionary spending

Entertainment

Leisure and holidays

Other discretionary spending

Total entertainment spending

Do you expect your expenditure to increase?

Yes

No

Explain how you expect your expenditure to increase

Annual disposable income

Additional income notes

Current assets

Current Assets (e.g. Provider/Location/Rationale)

Main current account(s)

Deposit accounts

Total current assets

Do you have a 3 to 6 month cash reserve?

Yes

No

Are you satisfied with the current rates of return on investments

Yes

No

Do you require information on how Indigo can help with foreign exchange?

Yes

No

Fixed assets

Principal property value

Investment property portfolio

Other investments

Total estimated fixed assets

Note on fixed assets

Medium and Long Term Assets

Medium and Long Term Assets (not including regular savings and retirement schemes), Direct Equity Holdings, Insurance Bonds, Fund Platforms, Loan Stocks & Gilts, Unit Trusts, Investment Trusts, Other (Assets), Personal Effects (Cars), Total Estimated Medium to Long Term Assets (not including any regular savings / pension schemes), Regular Savings, Education Plans and Retirement Schemes.

Total estimated value of medium and long term assets

Total assets

Total liabilities

Investment property portfolio mortgages

Principal property mortgage

Other liabilities

Liabilities notes

Personal loans (Maturity, Date, Type of Loan, Interest Rate, Outstanding Balance), Investment Property Borrowing, Credit Card, Overdraft, Other

Total liabilities

Estimated net worth

In todays terms what level of income would you want to receive in retirement?

Do you believe your current provisions are adequate?

Yes

No

Do you require IndigoWM to conduct a retirement shortfall analysis?

Yes

No

Insurance policies

Which insurance products would you like to view?

Medical cover

Income replacement

Critical illness

Life assurance

Key man insurance

Other insurance

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