Section A: Summary of information used

         Section B: Summary of client’s needs

Need

            Needs

Needs addressed

Risk profile

Funds

            quantified

(Y/ N or Partial)

(Specify profile)

            recommended

Life

Disability

Trauma

Savings

Investment

Retirement

Other

1.

2.

3.

         Section C: Products evaluated

Company

Life Cover

Disability

 - Type DISA

Trauma

Investment

Other

…………………..

Premium &

Frequency

Escalation &

Cover Growth

Term

Owner

Life Assured

Beneficiaries

Client Signature:

Broker Signature:

Client Name:

Broker Name:

Date:

Date:

         Section E: Selection of financial product(s)

(ensure an explanation is given if all needs identified in Section B are not

addressed and / or where client’s fund choice does not match his /her risk profile)

Product selected:

Funds selected:

Reason for selection:

Product selected:

Funds selected:

Reason for selection:

Details and reasons for alternative products selected by the client:

         Section F: Needs Analysis

The essence of any Financial Advisor’s business is objective and comprehensive financial planning.  At the core of this lies defining you personal objectives and financial goals, obtaining information about your personal and financial situation, product experience, conducting a thorough analysis, and then developing strategies designed to help you towards reaching these goals.

A comprehensive financial need analysis should include planning for life cover, retirement, savings, investment, medical and risk benefits. The analysis would include aspects such as the material terms and conditions, tax implications, liquidity, investment returns, costs, and a comparison of different products that may be appropriate. Provided sufficient time and information is available, a needs analysis will accurately identify and effectively address any needs or shortfalls.

Please note that my financial planning process and current legislation requires that a financial analysis must be conducted prior to furnishing you with financial advice. However if I am currently unable to conduct a comprehensive analysis for you, either due to insufficient time or information, or due to you only having a specific need to be addressed, then I would like to invite you to provide me with instructions to conduct a more comprehensive analysis at your earliest convenience. 

Should you not understand any aspect of the advice furnished or products recommended, please advise me immediately so that I can clarify any uncertainties.

The analysis and advice is based on a set of assumptions, including the current tax regime and legislation, growth rates, the rate of inflation and that the information provided is correct.  Any financial plan must always be viewed against the background of current financial realities and possible future developments.  The figures should be used for illustrative purposes only and should not be regarded as guarantees of any nature, unless they are a specific term or condition of the financial product.  It is critical that you understand the impact that the rates and assumptions could have on the result of this analysis and ultimately the realization of your financial goals.

         Section F: Client Declaration

         (Please note that it is of utmost importance that you read this section carefully and understand it fully.  All blocks must be correctly marked)

Yes

No

1.     I confirm that the disclosures required by the FAIS Act and the Policyholder Protection Rules (PPR) has been made available to me and that I received a copy of the Statutory Notice.

2.     I confirm that, where the Financial Advisor was unable to do an analysis because all the information was not provided, or there was not sufficient time, or I only required a specific need to be addressed:

a.     I clearly understand that there may be limitations on the appropriateness of the advice provided, and

b.    I will take particular care whether the advice is appropriate considering my financial objectives and current financial position.

3.     I understand the importance and contents of Section F detailed above.

4.     I confirm that all required documents were fully completed prior to my signing them.

5.     The quotation(s) for the product(s) selected was shown to me and the principal terms and conditions explained to me.  I have been informed and understand all costs, charges, penalties, liquidity limitations and tax implications, where applicable.  I understand the risks / guarantees (or absence thereof) associated with the products and or underlying funds selected.

6.     I confirm that the Financial Advisor has made enquiries to ascertain whether the product(s) selected constitute replacements, and I have been informed of the consequences of replacement.

7.     I confirm that the analysis, where applicable, was based on information supplied and that the Financial Advisor has taken reasonable steps to obtain the appropriate information.  I further understand that the accuracy of the analysis is dependant on the information obtained or provided.

Client Signature:

Broker Signature:

Client Name:

Broker Name:

Date:

Date: