Personal Information

Name
Client
Spouse
Child 1
Child 2
Dependant Father
Dependant Mother

Net Monthly Income

Net Monthly Expense

AVL

Outstanding

Liabilities
Home loan
Car loan
Personal loan
Other loan

Amount

Total

Description
(indicative list)
Emergency Fund
First Child Graduation
First Child Graduation (PG)
Second Child Graduation
Second Child Graduation (PG)
First Child Marriage

Amount to be
provided in Today's
Value (Rs.)

Second Child Marriage

Property Purchase
Car Purchase
Foreign Travel
Retirement
starting business after 10 years

Life Assured

Type

Example of types are endowment, money back, term, ULIP, ULPP, etc. If it is a pension plan, i
Please provide a copy of your policy documents. Surrender value and current fund value are t
Notes by financial planner and Client

Member Covered

Please provide a copy of your policy documents

Type

Notes by financial planner and Client

Personal Information
DOB

Age

A
B

Earnings per year

* A*12

Assets
Living house
Building/Land
Gold

Expected year of
usage

Cash in Hand
FD/Bond/NCD
EPF/PPF
Equity
Mutual FUNDS
Total

Asset mapping

Life insurance Details

Start Date
(dd/mm/yy)

Name of Plan

ULIP, ULPP, etc. If it is a pension plan, indicate which payout option has been choosen, example defin
ender value and current fund value are to be provided seperately, they are not available in the policy d

GENERAL INSURANCE
Start Date (dd/mm/yy)

Name of Plan

nce Details

Plan

Sum
Assured
(`)

Rider
Sum
Name Assured
(` )

Policy
Term

Premiu
Premiu
m
m
Frequen
paying
cy
Term
(M/Q/HY/Y)

n has been choosen, example defined benefit for 5 years, 10 years, etc.
hey are not available in the policy documents.

INSURANCE
Name of Plan

Sum
Assured
(`)

Rider
Name

Sum Assured
(` )

Premiu
m
( `
)

Current
Surrend
Premiu
Fund
er Value
m ( ` ) Value ( `
( `)
)

Renewal
Special Features
Date
(dd/mm)

10

MUTUAL FUND PORTFOLIO DETAIL

Ongoing
Option (G / DP
SIP/STP
/ DR)
(Amount if any)

Scheme Name

* Please provide a copy of A/c statements or broker/distributor portfolio statement

G=Growth, DP=Dividend Payout, DR=Dividend Reinvestment
Notes by financial planner and Client:

OTHER INVESTMENTS DETAIL

Instrument Name

Sum
Current Value
Invested
(` )
( `)

Maturity Value
(` )

Instrument Name

Sum
Current Value
Invested
(` )
( `)

Maturity Value
(` )

Equity shares
Bank fixed deposits
Accumalated EPF
Gold
Cash at Bank

Notes by consultant and client:

*Please indicate accumulated EPF, PPF balance if any.

Types of investments: Equity Shares, ESOP's, PMS, Accumulated EPF, PPF, Post Office Time Deposit
Deposits, Recurring Deposits, Capital Gain Bonds,Infrastructure Bonds, Physical Gold, Gold ETF, Jew
13

FUND PORTFOLIO DETAILS

Initial Purchase Date
(dd/mm/yy)

Units Currently Held

Asset
Available for
Plan (Y/N)

rtfolio statement

12

INVESTMENTS DETAILS
Interest
Rate (%)

Start /
Deposit Date
(dd/mm/yy)

Maturity
Date
(dd/mm/yy)

Tenure
(Yrs/
Months)

Asset
Available for
Plan (Y/N)

Interest
Rate (%)

Start /
Deposit Date
(dd/mm/yy)

Maturity
Date
(dd/mm/yy)

Tenure
(Yrs/
Months)

Asset
Available for
Plan (Y/N)
Y
Y
Y
Y
Y

F, Post Office Time Deposits, Post Office MIS, NSC, KVP, Bank Fixed Deposits, Company
Physical Gold, Gold ETF, Jewellery, Cash/Bank, Contingency Fund,etc.