Private & Confidential

FACT FINDING SHEET

FOR COMPLETED BY DATE : : :

IMPORTANT NOTICE
Your financial advisor must have sufficient relevant information before he can make a suitable recommendation. The information that you provide on your investment objective, financial situation and your particular needs will be the basis of the advice given.

A POINT TO NOTE: A product purchased without completing this Fact Finding Form, or following partial or accurate completion, may not be appropriate to your needs. Some of the advantages that you would have of completing this form are that this form enables your advisor to Assess your financial health more accurately Cater for your total financial needs Ensure that there is no duplication in the recommendations proposed Provide you some form of financial planning to try to realize your financial goals

As such, the recommendations given can only be as accurate as the information that is provided.

Fact Finding Sheet

September 2012

1. CLIENT PARTICULARS What is your main reason for seeking advices?

Personal Information Client Name: Address: NRIC: DOB:

Tel: (H) : E-mail: Residential Status:

(O)

(Mobile): Marital Status:

Fax:

Malaysian

Others

Personal Information Spouse Name: Address: NRIC: DOB:

Tel: (H) : E-mail: Residential Status: Children / Dependants: Name 1: Name 2: Name 3: Name 4: Name 5:

(O)

(Mobile): Marital Status:

Fax:

Malaysian

Others

DOB: DOB: DOB: DOB: DOB:

Dependant: Dependant: Dependant: Dependant: Dependant:

Y Y Y Y Y

N N N N N

Fact Finding Sheet

September 2012

1. CLIENT PARTICULARS Employment Details - SELF: Occupation : Business name : Address: Employment Details - SPOUSE: Occupation : Business name : Address: Health: SELF: Are you in good health? SPOUSE: Are you in good health? Employment status: Retirement Age: Retirement Date Employment status: Retirement Age: Retirement Date

N (If no, give details on last page) Smoker?

N (If no, give details on last page) Smoker?

Are there any histories of medical hereditary problems?

Estate Details - SELF: WILL: Last updated: Do you have a Testamentary Trust Setup? Do you have a Power of Attorney? Do you have a Living Trust Setup? Estate Details - SPOUSE: WILL: Last updated: Do you have a Testamentary Trust Setup? Do you have a Power of Attorney? Do you have a Living Trust Setup? Y Y Y Y Y Y

Held by: N N Name of Attorney: N

Held by: N N Name of Attorney: N

Fact Finding Sheet

September 2012

2. YOUR CASH FLOW STATEMENT A.CASH INFLOW Gross Annual Employment Income Gross Annual Employment Bonus EPF from Employer Sub total (less EPF of employee) (less EPF of employer) Net annual income and bonus Annual Interest Income Annual Rental Income Annual Dividends Sale of Assets Borrowings Other Income YOU SPOUSE COMBINED

TOTAL INFLOW

Fact Finding Sheet

September 2012

B. CASH OUTFLOW Home Utilities (e.g. water, gas, rental, TV license, others) Vehicles (e.g. Vehicle installment, insurance, road tax & others) Family & personal Life (e.g. Food, clothing, domestic help, child expenses, medical & dental, Income tax) Luxury (e.g. Holidays, clubs) Loan Repayment (e.g. Home mortgage, personal/student loans) Savings & Investment (e.g. Cash savings, Insurance premiums, investment) Tax Payable Other Expenses

YOU

SPOUSE

COMBINED

TOTAL OUTFLOW

C. NET CASH FLOW TOTAL INFLOW less OUTFLOW

YOU

SPOUSE

COMBINED

Do you plan or are there factors within 12 months, which may significantly increase or decrease your current income and expenditure position. (E.g. An inheritance or borrowing money for investment or purchase of a holiday home. etc.)

Fact Finding Sheet

September 2012

3. YOUR NET WORTH STATEMENT ASSETS Cash Assets: Savings Accounts Current Account Fixed Deposit Life Insurances Cash Value Others Total Cash Assets YOU SPOUSE COMBINED

Invested Assets: Equities (Stocks & Shares) Bonds/Fixed income Securities Unit Trust Investment-linked policies EPF Other Retirement Account Balance Others Total Invested Assets

Personal Use Assets: Owner occupied Residential property Home Furnishings Cars Jewelry/Collections Others Total personal Use Assets TOTAL ASSETS

Fact Finding Sheet

September 2012

3. YOUR NET WORTH STATEMENT

Current outstandi ng Balance (RM)

LIABILITIES

Interest %

YOU (RM)

Spouse (RM)

Joint (RM)

Mthly Repayme nt (RM)

Current Liabilities: Credit Cards Overdraft Income tax payable Other Bank Loans Others Total Current liabilities

Long-Term Liabilities: Residential Home Loan Investment Property Car loan Repayment Hire purchase Home renovation Loan Family/Personal Loan Others Total long-term Liabilities TOTAL LIABILITIES Net Worth

Fact Finding Sheet 4. YOUR FINANCIAL GOALS AND OBJECTIVES 4. YOUR FINANCIAL GOALS AND OBJECTIVES Short Term (Less Than 3 years)

September 2012

Estimated Costs

Medium Term (3 7 years)

Estimated Costs

Long Term (More Than 7 years)

Estimated Costs

Fact Finding Sheet 4. YOUR FINANCIAL GOALS AND OBJECTIVES YOUR PERSONAL PRIORITIES Rank your personal priorities starting from 1 as top most priority
YOU

September 2012

SPOUSE Ranking

PERSONAL PRIORITIES
Ranking

Providing for family in the event of death Providing for you and your family in the event of disability Providing for long-term medical care (major illness) Providing for hospital and surgical benefits Debt management / loan cancellation Saving for short term (e.g. deposit for home, car) Saving for medium term (e.g. early mortgage repayment) Funding your childrens tertiary education Funding for a comfortable retirement Planning for possible Estate Duty Taxes

Fact Finding Sheet YOUR FINANCIAL GOALS AND OBJECTIVES YOUR RISK PROFILE 1. What is your Investment time horizon? a. I plan to hold my investment portfolio for the next 1 year b. I plan to hold my investment portfolio for the next 5 years c. I plan to leave my money for 10 years or more 2. When you hear unexpected, adverse or bad financial news, you a. Never over react b. Rarely over react c. Always over react

September 2012

3. If you have invested in a stock that rose 25% within 3 months after you bough it, you would a. Do nothing or buy more shares b. Sell some shares c. Sell all your shares 4. In case of an emergency, you would have available savings to pay for. a. Less than 3 months living expenses b. 3 to 6 months living expenses c. More than 6 months living expenses 5. Choose the statement that best describes your investment savings goal in relation to inflation a. My savings should be very safe, even if my investment returns do not keep up with inflation b. It is important that the value of my investment grow at the same rate as inflation c. It is important that my investment grow faster than inflation 6. What is the maximum loss of value you could accept in any one-year period on your investment portfolio? a. 0% b. 10% c. 25%

Total Score:

Fact Finding Sheet YOUR FINANCIAL GOALS AND OBJECTIVES SCORING

September 2012

a. = 1 points b. = 2 points c. = 3 points Total Score 6 10 points 11 -15 points 16 18 points Investor profile Low risk Medium risks High risks

YOUR FINANCIAL GOALS AND OBJECTIVES DISCLAIMER We accept no responsibility for giving any recommendation or advice based on the Risk Profile Analysis. The Risk Profile Analysis is structured for hypothetical investors whose characteristics, circumstances and requirement may differ from your own. The Risk profile Analysis is BUT a useful guide.

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Fact Finding Sheet YOUR FINANCIAL GOALS AND OBJECTIVES RETIREMENT PLANNING Retirement Plan What is your desired annual retirement income (in todays Ringgit)? Planned retirement Age? Estimated Life Expectancy FINANCIAL GOALS AND OBJECTIVES TERTIARY PLANNING Estimated Cost of Education (in todays Ringgit): 1 st Child RM 2nd Child RM 3 rd Child RM 4 th Child RM 5 th Child RM in in in in in years years years years years You (RM)

September 2012

Spouse (RM)

Local / Overseas for Local / Overseas for Local / Overseas for Local / Overseas for Local / Overseas for

years years years years years

Available Resource for Tertiary Education 1st Child 2 nd Child 3rd Child 4th Child 5th Child FINANCIAL GOALS AND OBJECTIVES OTHERS 1. Do you, your spouse or children expect to receive an inheritance in the near future? If yes, please provide details: Y N RM RM RM RM RM

2. Other information for consideration (e.g. expected changes to your income or debt level, proposed sales of assets, capital gains tax liability, etc.)

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Fact Finding Sheet FINANCIAL GOALS AND OBJECTIVES ECONOMIC INDEX REQUIRED ASSUMPTIONS: What do you feel is a fair rate of inflation? What is your expected wage (including bonus) growth rate? Either: What % of your current annual income would you need at retirement? Or: What amount, in todays Ringgit would you require during retirement? What would you consider a fair rate of return for the following before retirement? Savings/Current Account Fixed Deposit Traditional Insurance Polices Investment-linked Insurance Policies Stocks/Shares Unit trusts Real Estate EPF Other Retirement Account YOU

September 2012

SPOUSE

What would you consider a fair of return on investment during retirement? What would you consider a fair education inflation rate?

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Fact Finding Sheet FINANCIAL GOALS AND OBJECTIVES EXISTING INSURANCE POLICIES

September 2012

Lets review your existing insurance program (All forms of insurance policies owned by you or provided by the company, e.g. Group benefits, motor car, Mortgage, household contents, investment Linked, Disability, Income protection, hospital. Surgical benefits, including 3rd party child education policies) YOU:
Policy type Incep tion date Basic Sum Assured Riders/ Age Other Benefits Maturi ty date / Age Maturity Amount Cash Value Outsta nding loans Premium/ Annum

SPOUSE:
Policy type Incep tion date Basic Sum Assured Riders/ Age Other Benefits Maturi ty date / Age Maturity Amount Cash Value Outsta nding loans Premium/ Annum

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Fact Finding Sheet FINANCIAL GOALS AND OBJECTIVES GENERAL INFORMATION

September 2012

We need to know of any circumstances that may or may not have in the past affected an application for insurance on your life. Things to consider may include your health, any conditions, any participation in hazardous sports, previous illnesses or accidents, or if you have ever been declined or rated for insurance cover.

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Fact Finding Sheet F INANCIAL GOALS AND OBJECTIVES TAX PLANNING Tax Relief for Resident Individual for Year Assessment 2010 No. 1 2 3 4 5 6 7 8 9 10 11 12 13 Individual Relief Types Self and Dependent Medical expenses for parents Basic supporting equipment Disabled Individual Education Fees (Individual) Medical expenses for serious diseases Complete medical examination Purchase of books, journals, magazines and publications Purchase of personal computer Net saving in SSPN's scheme Purchase of sport equipment for sport activities Subscription fees for broadband registered in the name of the individual Interest expended to finance purchase of residential property. Relief of up to RM10,000 a year for three consecutive years from the first year the interest is paid. Subject to the following conditions: (i) the taxpayer is a Malaysian citizen and a resident; (ii) limited to one residential unit; (iii) the sale and purchase agreement is signed between 10th March 2009 and 31st December 2010; and (iv) the residential property is not rented out. Where: (a) 2 or more individuals are eligible to claim relief for the same property ; and (b) total interest expended by those individuals exceeds the allowable amount for that year. Each individual is allowed an amount of relief for each year based on the following formula: Amount (RM) 9,000 5,000 (Limited) 5,000 (Limited) 6,000 5,000 (Limited) 5,000 (Limited) 500 (Limited) 1,000 (Limited) 3,000 (Limited) 3,000 (Limited) 300 (Limited) 500 (Limited) 10,000 (Limited)

September 2012

You (RM)

Spouse (RM)

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Fact Finding Sheet No. Individual Relief Types AxB C where; A = total interest allowable in the relevant year; B = total interest expended by the relevant individual in the relevant year; C = total interest expended by all the individuals. Husband/Wife/Alimony Payments Disable Wife/Husband Ordinary Child relief Each unmarried child of 18 years and above who is receiving full-time education ("A-Level", certificate, matriculation or preparatory courses). Each unmarried child of 18 years and above that: (i) receiving further education in Malaysia in respect of an award of diploma or higher (excluding matriculation/preparatory courses). (ii) receiving further education outside Malaysia in respect of an award of degree or its equivalent (including Master or Doctorate). (iii) the instruction and educational establishment shall be approved by the relevant government authority. Disabled child Additional exemption of RM4,000 disable child age 18 years old and above, not married and pursuing diplomas or above qualification in Malaysia @ bachelor degree or above outside Malaysia in program and in Higher Education Institute that is accredited by related Government authorities Life insurance and EPF Premium on new annuity scheme or additional premium paid on existing annuity scheme commencing payment from 01/01/2010 (amount exceeding RM1,000 can be claimed together with life insurance premium) Insurance premium for education or medical benefit Amount (RM)

September 2012 You (RM) Spouse (RM)

14 15 16 17

3,000 (Limited) 3,500 1,000 1,000

18

4,000

19

5,000

20 21

6,000 (Limited) 1,000 (Limited)

22

3,000 (Limited)

* For latest tax relief schedule, kindly refer to Inland Revenue Board of Malaysia (www.hasil.org.my).

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Fact Finding Sheet

September 2012

CLIENT ACKNOWLEDGEMENT

Yes (initial Please) The information provided in this form is COMPLETE & ACCURATE to the BEST OF MY KNOWLEDGE Or I have chosen to ONLY DISCLOSE a LIMITED AMOUNT of information shown in this form Or I have CHOSEN & REQUESTED that NO FORMAL ANALYSIS is to be conducted for my circumstance

No (Initial Please)

I understand and acknowledge that by not completing a FACT FINDER, the recommendations given MAY not be accurate and appropriate to my needs and objectives.

Client Signature & name: NRIC No.: Date:

Spouse signature & name: NRIC No.: Dates

FINANCIAL GOALS AND OBJECTIVES ADVISORS DECLARATION I declare that the information provided by me in this Fact Find is confidential and is only to be used for the purpose of fact finding in the process of recommending suitable products and shall not be used for any other purposes. FINANCIAL GOALS AND OBJECTIVES ADDITIONAL INFORMATION

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Fact Finding Sheet

September 2012

DISCLAIMER All information, particulars and data contained herein is confidential and privileged to the intended recipient and/or user only. Such information, particulars and data shall not be used by the intended recipient otherwise than for the purpose expressly and/or impliedly stated by The Malaysian Insurance Institute (MII) and mutually agreed upon by all parties who are privy to the same. If you are not the intended recipient and/or user, you are notified that any use, dissemination, distribution or copying of such information, particulars and data is strictly prohibited. If you have received such information, particulars and data in error, please notify the MII immediately and return the original forthwith.

Clients Signature & Name NRIC No : Date :

Advisors Signature & Name NRIC No : Date :

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