Special Proposal Form

Confidential Questionnaire for

FINANCIAL SECURITY PLANNING Name: (Surname, First Name, MI)____________________________________________ Date:_____________ Please answer the following questions as truthfully as you can. The information you give will become the basis for the financial needs analysis we will provide you afterwards. Rest assured everything disclosed here will be strictly confidential and will only be used to complete the financial needs analysis for you.

FINANCIAL NEEDS: Rank A Education Funding:

Priorities

Ensure that sufficient funds are available to meet the increasing cost of my(our) (future) children’s education.

B

Income Protection:

C D

Retirement Planning: Ensure that I(we) retire in comfort. Investment & Fund Accumulation: Ensure that my(our)

Guarantee that there will be enough money for the daily needs and comfort of my(our) (future) family, even if I(we) am(are) no longer around. money & savings get the best

possible investment growth for my(our) future needs.

E

Living with Impaired Health:

F

Estate Planning:

G

Final Expenses:

Ensure that I(we) and my(our) (future) family are protected from the financial consequences of having a critical illness and disability. Ensure that the assets I(we) have already accumulated AT PRESENT are preserved for my(our) (future) children and heirs. Ensure that there is enough money to take care of my(our) (future) financial obligations I(we) will be leaving behind in the event of my(our) death/s.

FAMILY INFORMATION

You

Your Spouse/Fiancé/Fiancée

Name Date of Birth Home Address Home Phone No. Mobile Phone No. Email Address Occupation Employer/ Name Of Business Phone No. at Work

Dependents:

Name (Actual or Planned)

Date of Birth (Actual or Planned)

Relationship

Current Occupation

Employer or School

FAMILY PLANS ❖ If UNMARRIED: Do you plan to get married in the future? When? ____ years from now. ❖ Do you plan to have (more) children in the future? _____ YES _____ NO ❖ If YES, how many (more) children do you plan to have? _____ When? _____/_____/_____/ CAREER PLANS ❖ Do you foresee your career changing in the near future? In what way, if any? ❖ Do you foresee your (present/future) spouse’s career changing in the near future? In what way, if any? A. EDUCATION FUNDING ❖ Where do you want your (future) children to study in? Child’s Name

Pre-School

Grade School

High School

College/ Course

Post-Grad/ Course

❖ Do you already have any existing savings, education plans, investments, etc. set aside for funding your (future) children’s education? Type of Provision

Current Value, Php

Education Plans Bank Deposits

B. INCOME PROTECTION ❖ How much do you need for basic family expenses (food, shelter, clothing, utilities, etc.) in order to maintain your minimum standard of comfort and/or living? [P

] per month

[P

] per year

❖ How much life insurance do you already have on your life at this time? You: Php________________

Your Spouse: Php___________________

C. RETIREMENT PLANNING ❖ At what age do you plan to retire: You ________

Your spouse _________

❖ Does your employer provide you with retirement benefits? How many months’ salary per Yr of service?

Current Salary, Php

Current Tenure, Yrs

Retirement Age to get the benefit

YOU YOUR SPOUSE

❖ If you were to retire NOW, how much money would you need to maintain the lifestyle you want? [P

] per month

[P

] per year

❖ How much provision for your retirement do you already have at this time? Type of Provision

Current Value, Php

Maturity Year

Pension Plans Bank Deposits

D. INVESTMENT & FUND ACCUMULATION ❖ What and how much major one-time expense are you expecting in the future? Purpose

Amt Needed

Yr Needed

Purpose

Amt Needed

House

P

Car

P

Major Travel

P

Wedding/Debut/etc.

P

Business Capital

P

Others:

P

Yr Needed

❖ Do you want to have an “Emergency Fund?” _____ YES _____ NO ❖ If YES, how much? Php________________ ❖ Do you want to include funds for retirement among the items you want to save for? _______ YES ________NO

E. LIVING WITH IMPAIRED HEALTH ❖ Would swer) o o o o o o

you like to provide for ordinary illness hospitalization funds? (Check applicable anYourself :______Yes Your Spouse :______Yes Child 1_________________ :______Yes Child 2________________ :______Yes Child 3_________________ :______Yes Child 4_________________ :______Yes

______No ______No ______No ______No ______No ______No

❖ How much short-term hospitalization fund would you like to have ready at all times (inclusive of hospital room, medications, medical supplies, doctors’ fees, laboratory expenses, etc.) o ____ Less than Php10,000 o ____ Php10,000 to Php19,999 o ____ Php20,000 to Php34,999 (Minimum recommended for individual) o ____ Php35,000 to Php59,999 (Minimum recommended for family of 4) o ____ Php60,000 to Php79,999 o ____ Php80,000 to Php99,999 o ____ Php100,000 to Php149,999 o ____ Php150,000 or more ❖ How much funds to you want to have for your long-term medical care, health recovery & rehabilitation? (Check the applicable answer) o

o

o

For yourself ▪ ____Php100K to Php249K ▪ ____Php250K to Php499K ▪ ____Php500K to Php999K ▪ ____Php1.0M to Php1.49M

▪

For your spouse/fiancée/fiancé ▪ ____Php100K to Php249K ▪ ____Php250K to Php499K ▪ ____Php500K to Php999K ▪ ____Php1.0M to Php1.49M For your children ▪ ____Php100K to Php249K

▪ ▪ ▪

____Php250K to Php499K

____Php500K to Php999K ____Php1.0M to Php1.49M

____Php1.5M to Php1.99M

▪ ▪ ▪

____Php2.0M to Php2.99M ____Php3.0M to Php4.99M ____Php5.0M and over

▪ ▪ ▪ ▪

____Php1.5M to Php1.99M

▪ ▪ ▪ ▪

____Php1.5M ____Php2.0M ____Php3.0M ____Php5.0M

____Php2.0M to Php2.99M ____Php3.0M to Php4.99M ____Php5.0M and over to Php1.99M to Php2.99M to Php4.99M and over

❖ Do you already have any provision for medical needs? Amount of cover from Health Care Plans, Php YOU YOUR SPOUSE

Critical Illness Funds / Insurance, Php

Disability Funds / Insurance, Php

Others (Including PhilHealth), Php

F. ESTATE PLANNING ❖ In case you or your (future) spouse passed away suddenly, what kind & amount of assets do you have at present that can be converted to or sold for cash in order to meet your (future) family’s needs? Description of Assets Real Estate

Cash Value, P

Remarks

Stocks, Bonds, Warrants

Cash Savings Others Total G. FINAL EXPENSES If either you or your (future) spouse were to pass away tomorrow, how much money will you want to provide for in order to cover: Left-over debts P____________ Final medical bills P____________ Funeral expenses P____________ Legal fees P____________ Others P____________

ADDITIONAL PROVISION FOR FINANCIAL SECURITY Usually, our clients set aside from 8 to 15% of their take-home income for a financial program that solves their needs for financial security (roughly, one or two months’ income every year). Does this make sense for you? ______ Yes ______ No, I prefer to set aside _______% instead. How much are you willing to set aside monthly for your financial security needs? Php_________________

Signed:____________________________________

Date:_________________

Budget Planner Basic Needs: •

Home rental / mortgage

Php

___________

•

Association / condo dues

___________

•

Food & groceries

___________

•

Gas / gasoline / transportation allowance

___________

•

Vehicle maintenance

___________

•

Home maintenance

___________

•

Electricity

___________

•

Water

___________

•

Telephone / mobile phones

___________

•

Cable TV

___________

•

Internet

___________

•

Newspapers / Magazine Subscriptions

___________

•

Househelp / cleaning / laundry service

___________

•

Security service

___________

•

Entertainment / dining out

___________

•

Clothes / apparels / shoes / accessories

___________

•

Medicine / medical care

___________

•

Donations / tithes

___________

•

Personal allowances

___________

•

Miscellaneous

___________

Work-related: •

Transportation & travel

•

Food

___________

•

Representation

___________

•

Office rental

___________

•

Telephone / fax / mobiles / internet

___________

•

Publications

___________

•

Light & water

___________

•

Building dues

___________

•

Security & cleaning services

___________

•

Miscellaneous

___________

Total

Php

Php

___________

___________