Financial Questionnaire
STRICTLY PRIVATE & CONFIDENTIAL

Private Client(s):

Consultant: Matt Wagener

Briggs Murray Financial Planning & Wealth ManagementLtd

111 Buckingham Palace Road, London, SW1W 0SR

Financial Conduct Authority (FCA) No 773229

SECTION 1: Personal Details

SELF / PARTNER
Name
Relationship Status
Address / Address if different
Telephone:
Home / Work / Mobile
Email:
Home / Work
Date of Birth
National Insurance No.
Residence / Domicile / Nationality / / / / / /
State of health (please detail in Section 9) / Good /Some Issues/Problems / Good /Some Issues/Problems
Smoker (how many cigarettes/day?)
Children (even if not dependant)
-Name(s)
-Age or DOB
-Dependant

SECTION 2: Employment and Other Income

SELF / PARTNER
Employment Status
Occupation
Length of Service
Gross annual salary/earnings / £ pa / £ pa
Benefits in Kind / £ pa / £ pa
Bonus/commission/overtime / £ pa / £ pa
Investment Income / £ pa / £ pa
Pension Income / £ pa / £ pa
Rental Income / £ pa / £ pa
Total GrossIncome / £ pa / £ pa
Maximum rate of tax / % / %
Is there a company pension? / Yes / No / Yes / No
- Have you joined? / Yes / No / Yes / No

SECTION 3: Main Monthly Outgoings

An total figure is acceptable if preferred to itemisation

SELF / PARTNER
Mortgage Payments
Home Insurance
Council Tax
Electricity
Gas
Water
Mobile telephone
TV/Internet/Telephone package
Subscriptions to clubs etc
Food
Public transport
Car running costs
School Fees
Entertainment
Holidays
Credit Cards
Other Insurances
Regular Savings
Pension Contributions (net)
Other outgoings:
Estimated TotalOutgoings:

SECTION 4: Assets & Liabilities (excl. Pensions)

SELF / JOINT / PARTNER
Residential Home - Value
Less – Mortgage(s)
1. Residential Home - Equity
Other Properties – Value
Less - Mortgages
2. Other Properties – Equity
Bank/B.S – Current Accounts
Bank/B.S – Deposit Accounts
Other Cash Equivalents (ISAs)
Less – Debt (cards etc.)
3. Net Cash
Collective Investments (1)
Equities
Gilts, corporate bonds (2)
House Contents & Cars
Other Investments
4. Net Investments
5. Est. Net Worth (1+2+3+4)
  1. For example, unit trusts, investment trusts, OEICs, investment bonds. 2. Directly held, not in a fund

SECTION 5: Pension Arrangements

*NRA = Normal Retirement Age

Plan 1 / SELF / PARTNER
Type (Occupational – defined benefits (DB)/defined contributions (DC). Personal pension. AVC. Other)
Active or “frozen”
Pension provider/employer
Current Value
Estimated Annual Pension (DB)
Plan normal retirement age
Additional info
Plan 2 / SELF / PARTNER
Type (Occupational – defined benefits (DB)/defined contributions (DC). Personal pension. AVC. Other)
Active or “frozen”
Pension provider/Employer
Current Value
Estimated Annual Pension (DB)
Plan normal retirement age
Additional info

Please detail any other pension plans in a Section 10

SECTION 6: Life Assurance & Protection

Enter Sum Assured / Premium: / SELF / PARTNER / JOINT
Employer’s Death In Service
Employer’s PHI
Employer’s PMI
Individual Term Assurance
Individual Critical Illness
Individual PHI
Individual PMI
Other
Other
Other

SECTION 7: For Defined Benefit Transfer Advice

Overview - Points to Consider

We have outlined below some common reasons why membersof defined benefit schemes may choose to transfer out of their scheme.

Please rate each statement below on a 1-10 scale.

1 = not a reason to consider a transfer
10 = major reason to consider a transfer

Reason for considering a transfer out

Potential for a higher tax free cash amount
Increased flexibility on how to structure retirement benefits
Potential for a higher pension/retirement income
Increased flexibility on how to invest retirement funds
Enables early retirement
More suitable death benefits for spouse / family
Can benefit from enhanced annuity rates
Wish to have all retirement benefits in one place
Have a need for additional income
Risk of failure of the Scheme and/or employer
Generous CETV offer
Ill health issues
Inheritance Tax / Succession planning
No dependents
Describe your views on the importance of:Death benefits/leaving wealth to your spouse/children etc.
Versus
A secure income - with limitations to pass on family wealth.
Please explain why flexibility in how you draw your pension is important?
(e.g. the ability to stop, start, reduce or increase your pension drawdown amounts. The ability to take a lump sum and defer pension income.)

Do you require an immediate lump sum payment?

How much?

For what purpose?

Do you require income from outset?

How much?

SECTION 8: Additional Relevant Information

Preferred retirement age(s) Self: Partner:
Expected changes in circumstances (inheritance, family changes, employment, income etc.):
I/We have valid up to date wills: Yes / No Yes / No

SECTION 9: Aims & Objectives

SECTION 10: Further Details

The information about your personal and financial circumstances that you have supplied in this Financial Questionnairehas been requested so that we may assess your circumstances and provide appropriate financial advice. You need to be aware of the basis on which this information is held, and we request that you read and sign acceptance of the following:

THE DATA PROTECTION ACT OF 1998

The information that we hold about you will be held on computer and/or paper files.

This information will be used to administer your application, to deal with queries and to bring to your attention additional services and products that may be of benefit to you.

The information that you give us may be disclosed to third parties such as: product providers and credit reference agencies for the purpose of processing your application(s); to our Regulators the Financial Conduct Authority; and to our compliance advisers. It will also enable further services to be provided to you, so that your details can be best matched with the services available.

You may ask us not to contact you about additional services and products by writing to us at:

Briggs Murray Financial Planning & Wealth Management Ltd

111 Buckingham Palace Road

London

SW1W 0SR

DECLARATION

I confirm that I have provided this information on the understanding that it will be used in the strictest confidence and that it does not place me/us under any obligation to take up any recommendations which may be made.

I/We have read the client financial information form carefully before signing it. Should there be any significant changes to my/our financial goals or circumstances in the future, I/we undertake to contact my/our adviser to provide details so that and my/our need for advice can be reviewed.

I/We have read and understood the terms stated above and agree to be bound by them.

I/We have been given a copy of Briggs Murray Financial Planning & Wealth Management Ltd Disclosure Document.

Signature(s)

Client: ______Date: ______

Spouse/Partner: ______Date:______

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