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Insurance Analysis

Your name(Required)

Do you have a spouse/partner?(Required)

Yes

No

Spouse/Partners name(Required)

Spouse/Partners date of Birth(Required)

MM slash DD slash YYYY

Spouse/Partners occupation(Required)

Spouse/Partners income(Required)

Do you own your own home?(Required)

Yes

No

What is the value of your home?(Required)

What is the debt against your home?(Required)

What percentage of your home mortgage would you want repaid in the event of:

Death

Total Permanent Disablement

Trama

What percentage of your home mortgage would you want repaid in the event of for your Spouse/Partner:

Death

Total Permanent Disablement

Trama

What is your monthly rent?

Do you have any investment properties?

Yes

No

Please provide details of your investment properties

What is the value of property?

What is the debt of property?

What is the current rent?

Please provide the above information for each by clicking the (+) icon

What percentage of investment debt would you want repaid in the event of:

Death

Total Permanent Disablement

Trauma

Please provide the above information for each by clicking the (+) icon

What percentage of your investment debt would you want repaid in the event of for your Spouse/Partner:

Death

Total Permanent Disablement

Trauma

Please provide the above information for each by clicking the (+) icon

Value of any cash at bank?

Value of any managed funds or shares?

Value of any assets you wish to include in the insurance analysis

Value of your superannuation fund?

Value of your spouse/partners superannation fund?

Do you have any other liabilities?

Yes

No

What is the current balance of these liabilities?

Do you have children?

Yes

No

Children

Child's Name

Date of Birth

What is their educational cost per child?

Please provide the above information for each by clicking the (+) icon

What is your current living expense (excluding debt, rent or educational costs)

Do you smoke?

Yes

No

Does your spouse/partner smoke?

Yes

No

Do you (or your spouse/partner) have any medical history that may impact your insurance application?

Yes

No

Medical history

Would you like assistance either way by nanny/home help to assist in the event of long term disabilty for both you and/or your partner?

Yes

No

Please provide detail of the assistance you require

Would you like assistance either way by nanny/home help to assist in the event of critical illness for both you and/or your partner?

Yes

No

Please provide detail of the assistance you require

Do you have any existing insurance?

Yes

No

Please provide detail of your existing insurance

Please attach any superannuation statements or insurance schedules to be included in the analysis

Max. file size: 128 MB.

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+61 2 9925 7222

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