Financial Analyzer — Free Financial Health Check

Personal Information

Let's start with the basics. All information is confidential and used solely for your financial analysis.

Client Details

First Name

Last Name

Date of Birth

Gender

Smoker?

Marital Status

Contact Number

Email Address

Dependants

Number of Children

Youngest Child Age

Other Dependants

Do you have a spouse/partner?

Spouse / Partner Age

Spouse Income / Month

R

Financial Profile

Understanding your income and expenses helps us calculate the right level of cover.

Income

Monthly Gross Income

R

Monthly Net (Take-home) Income

R

Additional Income / Month

R

Employment Type

Monthly Expenses & Liabilities

Bond / Rent

R

Vehicle Finance

R

Credit Cards / Store Accounts

R

Personal Loans

R

School / Tertiary Fees

R

Other Monthly Expenses

R

Assets & Outstanding Debt

Outstanding Bond / Home Loan

R

Total Other Debt (loans, cards)

R

Total Savings / Investments

R

Retirement Savings (RA / Pension)

R

Existing Cover

Tell us what you already have in place. Leave blank if you don't have that cover.

Life & Risk Cover

Life Cover (Death Benefit)

R

Monthly Income Protection

R

Disability Capital (lump sum)

R

Dread Disease / Critical Illness

R

Funeral Cover (self)

R

Current Insurer(s)

Medical Aid

Medical Aid Provider

Monthly Contribution

R

Plan Type

Retirement & Savings

Pension / Provident Fund via Employer

Retirement Annuity

RA Monthly Contribution

R

Other Savings / Unit Trusts

Short-term Assets

List your vehicles and property so we can identify gaps in your short-term cover.

Vehicles

Vehicle Description

Retail / Market Value

R

Currently Insured?

Insurer (if insured)

Property

Do you own property?

Replacement Value of Building

R

Contents Value (estimated)

R

Is your home currently insured?

Additional Risk Exposures

Do you have domestic employees?

Do you run a business from home?

High-value items (jewellery, art, etc)?

R

Do you travel internationally?