Client Profile

Private and Confidential

Client 1

______________________________________________________

Client 2

______________________________________________________

Adviser

______________________________________________________

Address

______________________________________________________

Important Notice to Clients

In order for us to provide financial planning advice to you, we need to have a reasonable basis for that advice. The information
requested in this Client Profile is one of the tools we use to establish a basis for the advice we will provide. It is therefore important
for you to complete this document as accurately and fully as possible. Failure to do so could result in advice being provided that is
not appropriate to your individual needs, circumstances and objectives.

GWM Adviser Services Limited

Trading as Garvan Financial Planning
ABN 96 002 071 749
Australian Financial Services Licensee
Registered Office at 105 153 Miller Street North Sydney NSW 2060

Client Profile Version AUG 2005

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Table of Contents
Financial planning and you.............................................................................................................................................4
Your short term goals (within the next 2 years)..............................................................................................................4
Your medium term goals (2 to 5 years away).................................................................................................................4
Your long term goals (more than 5 years away)............................................................................................................4
Your retirement...............................................................................................................................................................5
Your lifestyle in retirement .............................................................................................................................................5
Personal information........................................................................................................................................................6
Dependant family members............................................................................................................................................6
Your current estate planning details...............................................................................................................................7
Your contact details.........................................................................................................................................................7
Your current financial position.......................................................................................................................................8
Income.............................................................................................................................................................................8
Non-financial assets .......................................................................................................................................................8
Your liabilities..................................................................................................................................................................9
Your debt management needs.....................................................................................................................................11
Your current entities......................................................................................................................................................11
Your annual expenditure ..............................................................................................................................................11
Your attitude towards investment risk ........................................................................................................................12
Determining Your Investment Risk Profile....................................................................................................................12
Superannuation details ................................................................................................................................................17
Your financial assets......................................................................................................................................................18
Current personal protection details.............................................................................................................................19
Life and Total & Permanent Disability Insurance.........................................................................................................19
Income Protection.........................................................................................................................................................19
Trauma Cover ..............................................................................................................................................................20
General insurance.........................................................................................................................................................20
Your current advisers....................................................................................................................................................20
Our Acknowledgments..................................................................................................................................................24
Information Release Form ............................................................................................................................................26
Option to Quote Tax File Number

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Financial planning and you

Briefly outline your reasons for seeking financial advice.
1.

_________________________________________________________________________________________

2.

_________________________________________________________________________________________

3.

_________________________________________________________________________________________

Are there any specific issues that are of particular importance to you?
1.

_________________________________________________________________________________________

2.

_________________________________________________________________________________________

3.

_________________________________________________________________________________________

Your short term goals (within the next 2 years)

Holiday, purchase a car, purchase a house, renovations, repay mortgage, insurance, travel, start a family, change jobs

Goals
e.g. Travel around Australia

Start
Date

End
Date

Estimated Costs

Sept 03

Feb 04

$10,000
$
$
$

Your medium term goals (2 to 5 years away)

Purchase a house, repay mortgage, insurance, boost retirement savings, educate children, travel, replace car

Goals

Start
Date

End
Date

Estimated Costs
$
$
$
$

Your long term goals (more than 5 years away)

Purchase a business, purchase a holiday home, asset protection, boost retirement savings, be debt free, financial independence, retire

Goals

Start
Date

End
Date

Estimated Costs
$
$
$
$

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Are there any other issues that we need to take into consideration that may affect you achieving your goals?
e.g. health, job security, aging parents

Briefly detail your past experiences with Financial Planning.

What are your expectations of our services?

Do you require a cash reserve (for emergencies or discretionary spending)?

Yes / No

If so, how much do you require?

Do you have a preference to Ethical Investments?

Yes / No

What is your investment time frame?

0 2 years
2 5 years
5 + years

Your retirement
Client 1

Client 2

What is your planned retirement age?

If you are close to retirement, what is your intended
retirement date?
What amount (in todays dollars) do you need to support
your preferred retirement lifestyle?

Do you intend to leave an inheritance to your dependants?

Your lifestyle in retirement

In addition to your day to day living expenses, please outline the lifestyle activities you wish to pursue in retirement
and estimate the cost in todays dollars.

Lifestyle activity

e.g. Travel every two years

$10,000
$
$
$
Total

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Personal information
Client 1

Client 2

Title
Surname
Given Names
Preferred Name
Date of Birth

Male

Sex

Female

Male

Female

Single Married Defacto

Single Married Defacto

Divorced Separated

Divorced Separated

Widowed Unknown

Widowed Unknown

Yes

Yes

Marital Status/Relationship

Do you have any health issues?

No

No

If so, please provide details

Occupation
Qualifications

Employment Status

Full Time Part Time Casual

Full Time Part Time Casual

Self Employed Home maker

Self Employed Home maker

Retired Not Employed

Retired Not Employed

Employer
Employer Contact Details
Yes

Do you wish to disclose your Tax File Number to your planner?

No

Note: If you wish to disclosure your Tax File Number, it will be necessary to complete and sign the Option to
Quote Tax File Number document. Refer to Page 27 (Tick if completed)
Are you a smoker?

Yes

No

Yes

No

Private Health Insurance

Yes

No

Yes

No

Hobbies/Personal Interests

Dependant family members

e.g. Parents, Children

Name

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Relationship

Date of Birth

Financially
Dependent?

Yes / No

Yes / No

Yes / No

Yes / No

Support to
Age

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Your current estate planning details

Client 1

Client 2

Yes / No

Yes / No

Date of Will

Last reviewed?

Do you have a valid Will?

Will location
Executor name(s)
Do you have a Power of Attorney?
Do you have an Enduring Power of
Guardianship?
Expected inheritances:

Yes / No

Yes / No

Enduring Other

Enduring Other

Yes / No

Yes / No

Notes
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________

Your contact details

Residential Address

Postal Address
(if different from above)

Tick if same as above

Home Phone
Home E-mail

Client 1

Client 2

Home / Work / Mobile / E-mail

Home / Work / Mobile / E-mail

Mobile
Business Phone
Business Fax
Business E-mail
Preferred Contact

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Your current financial position

Income
Before-tax income

Client 1

Client 2

Salary/wages/earnings

per annum

per annum

Interest/dividends

per annum

per annum

per annum

per annum

per annum

per annum

per annum

per annum

Government support/ Veterans Affairs

e.g. Age Pension

Superannuation pension
Other
e.g. Rental, Family allowance, Child maintenance

Total annual before-tax income

Notes

(Salary packaging details, bonus details, business income, child maintenance)

_____________________________________________________________________________________________
_____________________________________________________________________________________________

Non-financial assets
Owner

Purchase
Date

Amount

Details

Assets
Residential Home

Household Contents

Non-income producing
Real Estate (Holiday Home,
Vacant Land)

Car(s)

Boat/Marine Equipment

Caravan

Collectables/Art/Antiques
or Other Valuables

Total Assets

Notes
_____________________________________________________________________________________________
____________________________________________________________________________________________

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Your liabilities
Loan
Amount
Outstandin
g

Lender
Name

Owner
(Client 1/
Client 2 /
Joint)

Loan
Type
(P&I or I)

Intere
st
Rate

Fixed (F)
or
Variable
(V)

Loan
Term
Remaini
ng

Repaym
ents

Frequen
cy
(F/n or Mth)

Percenta
ge Tax
Deductib
le

Non Tax
Deducti
ble
Principal Home

Car Loan

Personal Loan

Credit Cards

Other

Investment Line of
Credit

Investment Loan

Investment Loan

Other

Tax
Deducti
ble

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Notes
____________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________

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Your debt management needs

Client 1

Client 2

Does your home loan have an offset account or redraw facility?

Yes / No

Yes / No

Are there any fees or charges associated with variations to your loan
repayments?

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

If Yes, please provide details

Have you made extra repayments into your home loan or offset account?
If Yes, how much do you have immediate access to?
Are you able to credit your salary directly into your loan or offset account?
If No, how much extra cash would you be comfortable in using to
pay off your inefficient debt?
What is the interest free period associated with your credit cards?
Do you pay off your credit card within the interest free period?

Your current entities

The following information will provide us with a brief summary of your current entities.

Client 1

Client 2

Do you have a Self Managed Super Fund?

Yes / No

Yes / No

Do you have a Private Company?

Yes / No

Yes / No

Do you have a Trust?

Yes / No

Yes / No

If you answered Yes to any of these questions, please complete the details in the corresponding Supplementary Form:
Self-Managed Superannuation Fund Supplementary Form # 2

(Tick if completed)

Private Company Supplementary Form # 3

(Tick if completed)

Private Trust Supplementary Form # 4

(Tick if completed)

Your annual expenditure

Living Expenses

Entertainment

Mortgage

Housing

Motor Vehicle

Insurances

Other

Total

Do you anticipate any changes in your expenditure over the

next 12 months?

Do you feel there is an opportunity to save any additional

funds? If Yes, please provide details.

For a detailed budget planner, please refer to the following Supplementary Form:
Budget Planner Supplementary Form # 5

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(Tick if completed)

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Your attitude towards investment risk

Determining Your Investment Risk Profile
When investing it is important that you consider the level of risk as well as the return on an investment in view of your
circumstances and investment goals. Risk means different things to different investors. For some, investment risk
means the likelihood of a loss of capital, while for others it is the level of volatility of an investment, or the risk of an
asset not producing enough to live on.
This Investment Risk Profile questionnaire has been designed to assist you in making an investment decision. It asks
some questions regarding your goals, time frames and comfort with investments to provide a guide to your investor
profile. Your investor profile then determines a benchmark asset allocation for your investments. Please complete the
questions below by choosing the answer which most closely describes you.

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For how long would you expect most of your money to be invested before you would need to
access it?
Less than 12 months

10

Between 1 and 3 years

20

Between 3 and 5 years

30

Between 5 and 7 years

40

Longer than 7 years

50

1.

Score
2.

If you consider current interest rates what overall level of return (after inflation) do you
reasonably expect to achieve from your investments over the period you wish to invest for?

A reasonable return without losing any capital *

4-6%

3.

Assuming you had no need for capital, how long would you allow a poorly performing
investment to continue before cashing it in (assuming the poor performance was mainly
due to market influences)?
You would cash it in if there was any loss in value* 0
Less than 1 year 10

30

7-9%

10

1-3%

20

40

Over 9%

50

Up to 3 years

20

Up to 10 years

50

4.

How familiar are you with investment markets?

Very little understanding or interest

10

Not very familiar

20

Have had enough experience to understand the importance of diversification

30

I understand that markets may fluctuate and that different market sectors offer different income,
growth and taxation characteristics
I am experienced with all investment classes and understand the various factors that may
influence performance.

40

Up to 5 years

30

Score

Up to 7 years

40
Score

50
Score

5.

There is generally a greater tax efficiency when investing in more volatile investments.
With this in mind, which of the following would you be more comfortable with?

Preferably guaranteed returns, ahead of tax-savings

10

Stable, reliable returns with minimal tax savings

20

Some variability in returns, some tax savings

30

Moderate variability in returns, reasonable tax savings

40

Higher variability but potentially higher returns, maximising tax savings

50
Score

6.

What would your reaction be if six months after placing your investments, you discovered that due
mainly to market conditions your portfolio had decreased in value by 20%?

Horror Security of your capital is critical and you do not intend to take risks.*

10

You would cut your losses and transfer your funds to more secure investment sectors.

20

You would be concerned, but would wait to see if the investments improve.

30

This
was a risk
you understood
Client
Profile
Version
AUG 2005 you would leave your investments in place expecting

performance to improve.
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You would invest more funds to take advantage of the lower unit/share prices expecting future

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40

* If you have answered this question and your total profile score is greater than 100 (Very Conservative Investor) then detail in the notes
below your preference for a greater return against your preference for the protection of your investment capital.

Notes
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

Benchmark
Asset mix**

Investor Profile
Very Conservative Cash (0-100 Points)
May be suitable for investors with a short-term investment horizon or a very low tolerance for risk,
seeking a return similar to cash rates.

100% Cash

Conservative Fixed Interest (101-140 Points)

May be suitable for investors with an investment horizon of at least 3 years and a low risk tolerance,
seeking higher than cash returns over the investment timeframe.

100% Defensive

Moderately Conservative Capital Stable (141- 170 Points)

May be suitable for investors with an investment horizon of at least 3 years and a low to moderate risk
tolerance, seeking regular income and the opportunity for some growth over the investment
timeframe.

70% Defensive
30% Growth

Moderate Conservative Growth (171-200 Points)

May be suitable for investors with an investment horizon of at least 3-5 years and a moderate risk
tolerance, seeking a mix of income and growth over the investment timeframe from a well-diversified
portfolio. This strategy suits investors aiming for a return higher than what is likely from a portfolio
dominated by defensive assets but who want lower volatility than what a share fund would likely
generate.
Assertive Balanced (201-250 Points)
May be suitable for investors with an investment horizon of at least 5 years and a moderate risk
tolerance, seeking more growth than income over the investment timeframe. This strategy suits
investors aiming for a return higher than what is likely from a more defensive portfolio but who want
lower volatility than what a share fund would likely generate.

50% Defensive
50% Growth

30% Defensive
70% Growth

Moderately Aggressive Growth (251- 300 Points)

May be suitable for investors with an investment horizon of at least 5-7 years and a moderate to high
risk tolerance, seeking a high exposure to growth assets.

15% Defensive
85% Growth

Aggressive Share (301-350 Points)

May be suitable for investors with an investment horizon of at least 7 years and high risk tolerance,
comfortable with a share portfolio dominated by Australian and international shares.

100% Growth

** This demonstrates the benchmark Defensive/Growth asset mix for each investor profile. Defensive assets, such as cash and fixed interest are
expected to grow at a slower rate over the longer term but are expected to experience less volatility. Growth assets, such as property and shares
have historically grown at a rate greater than inflation over time and usually produce higher returns than defensive assets but can also
demonstrate greater volatility in the short term.

Acknowledgement
I/ we hereby acknowledge that the concept of risk has been explained and that the above Investor profile is consistent with
my/our risk requirements and profile.
Client 1Signed:

_____________________________

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Dated:

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Client 2Signed:

_____________________________

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Dated:

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Superannuation details
Superannuation
Fund

Owner
Client 1 /
Client 2

Current
Account
Balance

Policy
Number

Investment
Type (1)

Exit Fees

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

(1) Select from the following: Cap Guaranteed / Cap Stable / Balanced / Growth / Aust & Intl Shares

Insurance (held in Super)

Client 1

Client 2

Death Cover

TPD

$____________ benefit period ______

$____________ benefit period ______

Waiting period ___________________

Waiting period ___________________

Client 1

Client 2

Income Protection/Salary
Continuance/ Temporary Disability
In which fund(s) is this insurance
cover held?

Contribution Details

Accumulation Superannuation Funds

Contributions (Per Annum)

$________ SGC ( ___% x $______ )

$________ SGC ( ___% x $______ )

$________ Salary Sacrifice ( ___%)

$________ Salary Sacrifice ( ___%)

$________ Post-tax

$________ Post-tax

To which fund (s) are these

contributions made each year?
(Earliest) Eligible service date

Defined Benefit
Funds
Current Multiple (Defined Benefit fund)
Accrual Rate
Member Contribution
For a more detailed Superannuation collection form, refer to:
Superannuation Details Supplementary Form # 6

(Tick if completed)

PLEASE PROVIDE A COPY OF YOUR MOST RECENT STATEMENT(S).

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Your financial assets

Enter all existing investments including cash and bank accounts, managed funds, shares, debentures, term deposits, insurance bonds, and friendly society bonds. Do not
include the principal home. Use a Supplementary Form for superannuation or retirement income stream products (see list below).

Investment Description

Owner
(Client 1 / Client 2 /
Joint)

Units/
No. of
Share
s

Current
Value

Purchase
Price

Date
Purchased

Growt
h
%

Percent
Frank
age to
ed
Redeem
Realloca
%
te

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

Yes / No

PLEASE PROVIDE A COPY OF YOUR MOST RECENT STATEMENT(S).

Supplementary Forms
Allocated Pensions/Term Allocated Pensions Supplementary Form # 7

(Tick if completed)

Fixed Term or Lifetime Annuities/Pensions Supplementary Form # 8

(Tick if completed)

Commutations Supplementary Form # 9

(Tick if completed)

Investment Property Supplementary Form # 10

(Tick if completed)

Reasonable Benefit Limits Supplementary Form # 11

(Tick if completed)

Termination Payments Supplementary Form # 12

(Tick if completed)

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e
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Current personal protection details

Life and Total & Permanent Disability Insurance
Yes No

Do you have Life and TPD cover?

Client 1

Client 2

Insurer
Policy Owner
Policy Type
Policy Number
Date of Commencement
Total Premium

/
per

- Life

- TPD

Current Withdrawal Value

Current Account Balance

Total Death Benefit

Sum Insured

/
per

Nominated Beneficiaries
Own

Own Occupation or Any

Any

Own

Any

Loading/Exclusions

Income Protection
Yes

Do you have Income Protection?

No

Client 1

Client 2

Insurer
Policy Owner
Policy Type
Policy Number
Date of Commencement
Total Premium

/
$

/
per

/
per

Stepped/Level Premium Type

Monthly Benefit

Benefit Period
Waiting Period
Indexed to CPI
Super Guarantee Options

Yes
Yes

No
No

Yes

No

Yes

No

AIDS Exclusion
Loading/Exclusions
PLEASE PROVIDE A COPY OF YOUR MOST RECENT STATEMENT(S).
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Trauma Cover
Do you have Trauma Cover? Yes

No

Client 1

Client 2

Insurer
Policy Owner
Policy Type
Policy Number
Date of Commencement

Total Premium

Sum Insured

/
per

per

Loading/Exclusions
PLEASE PROVIDE A COPY OF YOUR MOST RECENT STATEMENT(S).

Supplementary Forms
Income Protection Supplementary form # 12

(Tick if completed)

Trauma Protection Supplementary Form # 13

(Tick if completed)

Insurance Needs Analysis Supplementary Form # 14

(Tick if completed)

General insurance
Insurer

Policy
Type

Sum
Insured

Premium

Commence Renewal
ment Date
Date

Home

Contents

Vehicle 1

Vehicle 2

Investment/Business
Property

Other (e.g. Professional

indemnity, Business)

Would you be interested in receiving comparative quotes?

Yes/No

Your current advisers

Existing Adviser

Name

Contact Number

Accountant
Solicitor
Stockbroker
Banker
Other:
The Information Release Form attached at the end of this questionnaire will need to be completed to enable us to gain
access to your information, held by any of the above advisers and fund managers. Please note that if there are any
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costs associated with obtaining information from any of the above planners, we will pass these costs onto you as the
client.

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Adviser Notes
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Adviser Notes
_____________________________________________________________________________________________
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_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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Our Acknowledgments
Information in this form
The information provided in this form (Client Profile & Lifestyle Questionnaire Sections A and any supplementary
pages) is complete and accurate to the best of my/our knowledge (except where I/we have indicated that I/we have
chosen not to provide the information).
I/We understand and acknowledge that by either not fully or accurately completing the Client Profile & Lifestyle
Questionnaire Sections A and B and any supplementary pages, any recommendation or advice given by the adviser
in these circumstances may be inappropriate to my/our needs and that I/we risk making a financial commitment to an
investment policy that may be inappropriate for the needs identified.
At my request the areas that I require advice on are:

retirement planning
estate planning
superannuation
investment planning
budgeting
life, trauma insurance and income protection insurance
gearing
direct equities
instalment warrants

Financial Services Guide

I/We have read and understood the Financial Services Guide version __________ prior to obtaining financial planning
services and/or recommendations.

Authority to Adviser
I/We authorise _______________________ of _____________________________ to prepare a Statement of Advice.

Statement of Advice Preparation Fee

The fee for the preparation of the Statement of Advice has been set at $________________ and I/we authorise
___________________ to proceed on this basis.

Authority for current Adviser

I/We authorise _______________________ of _____________________________ to contact any of my/our existing
advisers whose details I/we have provided.

Information and Privacy Agreement

I/We agree that:
1.

Subject to the authorisation of the preparation of a Statement of Advice, I am/we are to receive the following
financial planning services from the adviser named in this Client Profile & LifeStyle Questionnaire [adviser]
and understand that my/our personal information (including any sensitive information such as health
information, membership of professional organisations and sexual preferences and practices [sensitive
information]) is being collected primarily for these purposes:

retirement planning

estate planning

superannuation

investment planning

budgeting

managed investment schemes

life, trauma insurance and income protection insurance

gearing

direct equities

instalment warrants

Client Profile Version AUG 2005

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banking including credit and debit products

arranging for the acquisition and disposal of all relevant products of the type described above; and

an ongoing review service for my/our investment portfolio or life insurance program.

Your adviser will only provide you with advice that your adviser is permitted to offer you.
2.

I/We also consent to the disclosure of my/our personal information (including my/our sensitive information):

to organisations involved in providing my/our adviser with marketing services and to their service providers (for
example posting services), so that my/our adviser may offer me/us products and services that might meet my/our
financial needs; and

to other organisations in connection with the sale or proposed sale of all or part of the advisers business and to
the use of that personal information by those organisations for those purposes.

3.

I/We also consent to the collection of my/our personal information for the purpose of my/our adviser providing
the services stated above. This consent also relates to my/our sensitive information.

3.

If I/we have provided personal information about an individual (such as a partner, dependant, employer, or
accountant) I/we have or will as soon as practicable, provide the individual with a copy of the Privacy
Notification Statement (PNS) that was provided to me/us with the Financial Services Guide and made them
aware that the PNS applies to their personal information that has been collected for the purpose of my
adviser providing me/us with the financial advice I/we have requested.

4.

If I/we have provided sensitive information about someone else, I/we have or will obtain the consent of that
person to that information being collected by my/our adviser and my/our advisers service providers.

Delete any item or consent in paragraphs 1 to 5 above which you do not agree with.

Client 1 Name

Client 1 Signature

Date

Date

Date

Client 2 Name

Client 2 Signature

Adviser Name

Adviser Signature

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Information Release Form

To Whom It May Concern,

I/We,

_________________________________________________________________________________

of

_________________________________________________________________________________

Date of Birth

_________________________________________________________________________________

request that all relevant information on my/our investments, insurances, superannuation, bank accounts or other
financial information be released to:

INCOME SOLUTIONS

on request.

The advisers address and contact number are as follows:

153 Mercer Street, Geelong 3220
(03) 5229 0577

Thank you.

Client 1 Signature

Client 2 Signature

_____/_____/_____

_____/_____/_____

Date

Date

* The adviser certifies that this information will be used only for the preparation of financial planning services for the
aforementioned client

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Option to Quote Tax File Number

Most investment and superannuation application forms request the applicant to provide their Tax File Number (TFN).
As you will be receiving ongoing service from (insert Licensee name) we offer you the option of authorising (insert
Licensee name) to hold your TFN, and/or details of your exemption status, in our records.
The collection, use and disclosure of TFNs are strictly controlled by taxation and superannuation laws and the Privacy
Act. As an authorised representative of (insert Licensee name), (insert Planner name) is authorised to collect TFNs
under the Income Tax Assessment Act 1997.
You are not required to provide us with your TFN and it is not an offence if you choose not to do so.
If you do not provide us with your TFN and you wish to quote your TFN on investment and/or superannuation
application forms, you will need to bring your TFN with you when calling into our office to complete these documents.

Important Information
Investment Bodies
Investment bodies are authorised to collect TFNs under the Income Tax Assessment Act 1997. It is not an offence if
you choose not to provide your TFN to an investment body. However, if you do not quote your TFN, or exemption
status, tax will be deducted from your income distributions at the highest marginal rate.
Some persons/entities are exempted from the TFN quotation arrangements, if the exemption status is notified to the
investment body:

Persons receiving any part of an age, service, widow

pension or other types of qualifying pension/benefit

state type of pension/ benefit

received.

Children under the age of 16, where the investment

is NOT public company share/s and the income will
be less than $420 pa

state age.

Entities not required to lodge income tax returns

state reason not required to

lodge return.

Non-residents

state country of residence.

Superannuation Bodies and Approved Deposit Funds

Superannuation Bodies and Approved Deposit Funds are authorised to collect TFNs under the Superannuation
Industry (Supervision) Act 1993. It is not an offence if you choose not to provide your TFN, however, if you do not
provide your TFN:

you may pay more tax on your superannuation benefit than you have to (you will get a refund at the end of the
financial year in your income tax assessment); and

a surcharge of up to 15% may be payable on contributions made by or for you (the surcharge may not be payable
if you provide your TFN and in some circumstances the surcharge may be reclaimed through the Australian
Taxation Office); and

it may be more difficult to find your superannuation benefits if you change address without notifying your fund, or
to amalgamate any multiple superannuation accounts.

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Your Election
Please tick ONE of the boxes below to indicate your choice of the options available. If you tick boxes 2 or 3, please
record your TFN, and/or exemption status, at the bottom of this page.
1.

2.

3.

I instruct Garvan Financial Planning NOT to hold my Tax File Number in their
records.
I instruct Garvan Financial Planning to hold my Tax File Number in their
records. I authorise Garvan Financial Planning or other recipients approved by
Garvan Financial Planning, to disclose my TFN only to me.
I instruct Garvan Financial Planning to hold my Tax File Number in their
records. I authorise Garvan Financial Planning, or other recipients approved
by Garvan Financial Planning, to disclose my TFN, or exemption status, to me,
the Australian Taxation Office and investment bodies:
Note: Garvan Financial Planning is not permitted to disclose your TFN to
superannuation bodies; Approved Deposit Funds or assistance agencies.

I acknowledge that:

I have read and understood the information above; and

this authority will remain in force until cancelled by me in writing.

If signing under Power of Attorney, I hereby certify that I have not received notice of revocation of that Power.
Full name of individual/entity
Address

Signature

Company Seal
(if applicable)

My Tax File Number is:

My exemption status is (if applicable):

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