New Client Data – Initial Enquiry

NEW CLIENT FACT FIND

For us to assist you with review of your Overseas Pension Entitlements, we require the following information from you.

Please refer to our Financial Services Guide (FSG), which explains why we collect personal information and how you can access this.We can provide you with a copy of this form, our FSG or our Privacy Policy at no charge.

Personal Details - Your Personal Details

Full Name:

Dependants:

Marital status:

Current Address:

Last Overseas Address:

Date of Birth:

National Insurance No.:

Tax File No.

Contact No.:

(H)

(W)

(M)

Email Address:

Date left the UK:

Date of Arrival in Australia:

Visa type:

Any Time Spent in Australia Prior to This Date (excl hols):

Spouse’s Personal Details

Full Name:

Maiden Name:

Date of Birth:

National Insurance No.:

Tax File No.

Overseas Pension Provider Details - Your Overseas Pension Details

Name of Overseas Pension Provider:

Address of Overseas Pension Scheme: (If Known):

Policy / Plan or Reference No.:

Transfer Value (approx.):

Spouse’s Overseas Pension Detail

Name of Overseas Pension Provider:

Address of Overseas Pension Scheme: (If Known):

Policy / Plan or Reference No.:

Transfer Value (approx.):

Client Declaration & Acknowledgements

DECLARATIONS

By signing below I/we declare the following:

position, and certify that the information contained in this document (Including any annexure) is true and correct. I/We understand that I/we will be required to input further personal information into a secure online database in order to assist our advisers to complete advice that addresses my/our objectives and is relevant for my/our circumstances.

I /We understand where relevant information has NOT been provided, any recommendations made may not be appropriate for my/our needs.

I/We understand that the advisor is not to be held responsible for the advice to the extent advice may be based on incomplete or inaccurate information.

I/We have been made aware of the Total Wealth Advisory Privacy Policy and consent to the process of collection, I/We have been provided with a current Financial Services Guide before any advisory services or work undertaken
on my/our behalf.

TAX FILE NUMBER

By completing and signing this declaration

I/We are authorising Total Wealth Advisory to hold my/our Tax File Number(s) (TFN) in a secure location, and use with legislative requirements including: matters for superannuation investment purposes as required by the Superannuation Laws; such as inclusion on application forms.

That I/we have been informed of the legal basis for collection and are aware the declining to provide a TFN is not accepted if TFN is compulsory (i.e. superannuation member contributions etc). That the manner of obtaining the TFN was not intrusive. My/our TFN will only be disclosed to Fund Managers and Life Insurance Companies as relevant.

Additional Information

Details of Any Overseas Investments and Assets:

Details of Australian Superannuation Fund:

How did you hear about TWA?(eg. internet search, press advertisement, referral)

Other Additional Information/Specific Requirements:

Declaration

I/We declare that the information provided to Total Wealth Advisory is factual and correct. Should any of these details change I/We shall notify TWA immediately.

Signature: Applicant one (you)

Date:

Print Name:

Signature:Applicant two (spouse)

Date:

Print Name: