Alexandra Headland

0414 197 522
PO Box 377, COTTON TREE, QLD 4558

  • Purpose of Enquiry

  • Business

  • Personal

  • Contact

  • Children

  • Nearest Living Relative (in Australia)

  • Employment

  • Income

  • Tax

  • Assets (a)

  • Real Estate

  • Savings

  • Motor Vehicles

  • Super

  • Share & Managed Funds

  • Business Value

  • Other Assets

  • Home & Content

  • Total Financial Assets

  • Liabilities (b)

  • Home loans

  • Credit lines

  • Car / equipment loans

  • Personal loans

  • Credit / Store cards

  • Other loans

  • Total liabilities

  • Calculate

  • Net worth

  • Personal insurance

    E.g. life, total & permanent disability, trauma & income protection cover.

    Please provide a copy of at the least policy schedules for all of any existing personal insurance policies where applicable.

    • Policy Provider Owner Life insured Type Sum insured Annual premium
    • X
    • Add extra field

  • Client Agreement

  • I/ we,

    • Have read and understood the privacy statement and consent to the uses described and the disclosures set out in the ‘Your privacy’ section of this document;
    • I/We understand that if I/we do not sign this Privacy form, then we may be unable to proceed with any further credit or financial activities and any personal information held, will be discarded in a safe and secure manner.
    • Have received a current Credit Guide and/ or Financial Services Guide for my/ our records.
    • Acknowledge that all the information provided in this document is true, current and correct to the best of our/ my knowledge;
    • Authorise my/ our adviser to obtain further details as required;
    • Understand the information provided will form the basis of any advice that I/ we may receive.
    • Give authority for you to send me/ us emails at the address supplied which relate to opportunities and/or information you become aware of which may be of interest to me/ us.
2