: Name *
: Nationality *
: Email address *

: Mailing address (street and number)


: City
: Country
: Area code / Postal code

: Current address (if not resident at the mailing address)


: City
: Country
: Area code / Postal code

: Business Telephone
: Home Telephone
: Mobile Telephone
: Skype
: A convenient time to call

Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , Year 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 : Date of birth

: Partner's nationality

Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 , Year 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 : Partner's date of birth

Name and age of children :
Name ---- Age
Name ---- Age
Name ---- Age
Name ---- Age

: Expected period overseas
: What is the lenght of your current contract ?
: Will your contract be extended ?

The location of your bank accounts :


Amount of cash held in bank accounts and interest rates :




Amounts of any other fixed deposits :

Details of personal pension and or company pension,
investment portfolio's, stocks or shares, life assurance
plans and any other investments :


Properties owned - location and approx.
current value and details of any mortgages :


What is your attitude towards investment :


What is your monthly savings capacity i.e. what
goes into your savings account after expenses each month :


The money you are saving now and that you hope
to save, when will you want to spend/access it :


At what age do you intending on retiring :


How do you feel about the risk level on your
savings/investments :


Would you class yourself as low, medium or high risk :


What experience do you have of investing :


When you expatriate would you like to
minimise your taxes :

Which of the following areas are of interest to you

Financial security for your family.
Medical cover.
Education fee planning.
Retirement.
Investment planning.
Early repayment of mortgage.
Property purchase.
Others.

What do you hope to achieve at our next meeting :


Further information regarding your financial situation :


If you wish you may attach a relevant document here
(restricted to DOC / PDF / XLS / JPG / GIF / PNG ---- 1MB max)