Financial Planner

Name of Client

Name of Spouse / Others

Name of Adviser

I declare I am authorized to:

Advise / arrange contract of Insurance in respect of Life Policies

Advise / market Collective Investment Schemes

Professional Investment Advisory Services Pte Ltd is an affiliate of Aviva group of companies

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 1 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 1 - PERSONAL INFORMATION
A. Personal Details (This section is compulsory, please complete the entire Section A)
Client Spouse / Others
Title Mr Mrs Mdm Ms Dr Mr Mrs Mdm Ms Dr

Full Name (As in NRIC / Passport) Lakshman

Underline Surname Kumar

Date of Birth 26-05-2019

Nationality Singaporean Singapore PR Singaporean Singapore PR

(Complete Enhanced Customer Due

Diligence Form for Nationals from High Others Others
Risk Countries and Jurisdictions)

NRIC / Passport No ABC12345

FIN No (if applicable)

Residential Address

Contact Details

Home +91 123456789

Office +65 234234234

Mobile +91 987654321

Email abc@[Link]

Marital Status Married Divorced Married Divorced

Single Widowed Single Widowed

Gender Male Female Male Female

Highest Qualification Primary Secondary Primary Secondary

N/O Levels Post Sec/ A Levels/ N/ O Levels Post Sec/ A Levels/
Diploma Diploma
Degree and Above Degree and Above

Language Proficiency

English Malay English Malay

Conversant in Spoken Language Others Others
Mandarin Tamil Mandarin Tamil

English Malay English Malay

Proficient in Written Language Others Others
Mandarin Tamil Mandarin Tamil

Smoker Yes No Yes No

Politically Exposed Person Yes No Yes No

(If yes, complete Enhanced Customer Due Diligence Form)
Politically Exposed Person means: (a) a natural person who is or has been entrusted with prominent public functions whether in Singapore or
a foreign country; (b) immediate family members of such a person; or (c) close associates of such a person. “Prominent public functions”
includes the roles held by a head of state, a head of government, government ministers, senior civil servants, senior judicial or military
officials, senior executives of state owned corporations, and senior political party officials.
B. Employment Details (This section is compulsory, please complete the entire Section B)
Employment Status Full Time Retired Full Time Retired
Part Time Others Part Time Others

Self Employed Self Employed

Employer MR. ABC

Occupation Manager

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 2 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 2 - TRUSTED INDIVIDUAL
It is recommended for you to be accompanied by a Trusted Individual if you belong to one of the following profiles. If you belong to
two or more of the following profiles, it is compulsory for you to be accompanied by a Trusted Individual
(C) (S/O)
Clients who are aged 62 and above
Clients who do not have a minimum of "N" or "O" levels
Clients who cannot communicate, read or write in English

Trusted Individuals Declaration

This form has been explained in CHINESE (language) by Li Keqiang (name of Trusted Individual)

Trusted Individuals details

NRIC Number XYZ123456

Relationship with Client FRIEND

Contact Number +86 1213213132

Signature of Trusted Individual

Trusted Individual has to be an individual whom the client trusts and is between age 18 - 61, has a minimum of “N” or “O” levels and is able
to communicate, read and write in English. Fellow Adviser / Manager cannot be appointed as a Trusted Individual.

Client Declaration

I decline to have a Trusted Individual, despite my Advisers recommendations and will be responsible for the decision to
purchase the product(s) based on my own judgement

Client Signature

SECTION 3 - DEPENDANTS DETAILS

If you do not have any dependants, please indicate "Nil" or "None".

A. Dependants details (Eg. Children, Elderly Relatives, Others)

Name Relationship DOB (DD/MM/YY) Years to support Remarks

Mr. DEP one SON 26-05-2019 4 My son

DAUGHTER DAUGHTER 26-05-2019 5 My daughter

I do not wish to disclose my dependants information and for it to be taken into consideration for needs analysis and
B. recommendations.

Please provide reasons:

cassacascsac

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 3 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 4 - FINANCIAL OBJECTIVES
Tick the following objectives where applicable - HIGH, MEDIUM or LOW
For financial objective(s) which are very important and you would like to address in this financial review, please tick under HIGH (H).
For financial objective(s) which are important and you would like to address in this or future financial reviews please tick MEDIUM (M)
and/or LOW (L).
Client Spouse / Others

A. Protection H M L H M L

Protecting family / assets in the event of death

Providing for critical illnesses

Providing for disability

Providing for long term care / disability income

Providing for hospital, surgical, medical costs

Providing for dependant's protection needs

Client Spouse / Others

B. Wealth Accumulation H M L H M L

Planning for retirement

Providing for children's education

Saving for other purposes

Client Spouse / Others

C. Wealth preservation / Distribution H M L H M L

Supplementary Retirement Scheme (SRS) Planning

Estate planning (e.g. Will, Trusts, CPF Nomination, Lasting power of Attorney)

Client Spouse / Others

D. Others H M L H M L

Notes

Health Declaration
Do you or any applicants have any pre-existing medical conditions?
Yes No

If yes, please specify the medical condition:

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 4 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 5 - INFLOW AND OUTFLOW
This section is compulsory. If you are providing information on Section 5A and 5B, it is not required to tick the box under Section 5C.
A. Monthly Inflow
Client Spouse / Others Client Spouse / Others
Net Employment Income $ $ Dividend Income $ $
Bonus $ $ Rental Income $ $
Other Income $ $
Total Monthly Inflow $ 4567 $
B. Monthly Expenses
Household Personal
Utilities $ $ Mobile / Internet / Cable $ $
Groceries $ $ Food / Dining $ $
Property Tax $ $ Grooming / Shopping $ $
Maid Services $ $ Entertainment $ $
Cash Mortgage $ $ Vacation $ $
Others: $ $ Income Tax $ $
Total Household $ $ Others: $ $
Expenses Total Personal Expenses $ $

Dependants Transportation
Allowances - Parents $ $ Public Transport $ $
Allowances - Children $ $ Car Insurance $ $
School Fees $ $ Road Tax + Car Servicing $ $
Medical $ $ Parking + Petrol $ $
Others: $ $ Car Loan $ $
Total Dependants $ $ Others: $ $
Expenses Others: $ $
Total Transportation $ $
Expenses

Insurance - Cash premiums Regular Investments - Cash (incl. SRS )

Personal $ $ Unit Trusts $ $
Children $ $ Shares / Stocks $ $
Parents $ $ Endowment $ $
Others: $ $ Others: $ $
Total Premiums (Cash) $ $ Total Cash / SRS $ $

Monthly CPF Info Miscellaneous

Inflow Charity / Tithes $ $
Ordinary Account $ 535345 $ Other Loans: $ $
Special Account $ 345345 $ Others: $ $
Medisave Account $ 12323 $ Others: $ $
Total Inflow $ $ Total Miscellaneous $ $
Outflow Expenses

OA Mortgage $ 345345 $
Total Monthly Outflow $ 4567 $
OA Regular Investments $ $
SA Regular Investments $ 3238 $
MA Outflow $ 123 $ SURPLUS / $ 8765 $
Total Outflow $ $ (SHORTFALL)

CPF Surplus / (Shortfall) $ $ ANNUAL SURPLUS / $ 1234 $

(SHORTFALL)

Are there any factors within the next 12 months which may significantly increase or decrease your current income and expenditure position?
Yes No (If yes, please provide details)

C. I do not wish to disclose my cash flow information and for it to be taken in to consideration for needs analysis and recommendations. Please Provide reasons

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 5 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 6 - ASSETS AND LIABILITIES
This section is compulsory. If you are providing information on Section 6A and 6B, it is not required to tick the box under Section 6C.
A. Assets (Current Market Value)
Client Spouse / Others Client Spouse / Others
Cash/Near Cash Invested Assets
Savings $ $ Unit Trusts $ $
Fixed Deposits $ $ Stock $ $
Others: $ $ ILP $ $
Total Cash/Near Cash: $ $ Bonds $ $
Personal Use Assets Business Interests $ $
Property - Residence $ $ Insurance Endowments $ $
Motor Vehicle(s) $ $ CPF Balance (OA) $ $
Others e.g. (Valuables / $ $ CPF Balance (SA) $ $
Collections)
CPF Medisave (MA) $ $
Total Personal Use Assets $ $
SRS $ $
Property - Investment 1 $ $
Property - Investment 2 $ $
Property - Investment 3 $ $
Others: $ $
Others: $ $
Others: $ $
Total Invested Assets: $ $
Total Assets: $ $

B. Liabilities (Please Indicate Outstanding Amount Owing on Liability)

Short Term Long Term
Credit Card(s) $ $ Mortgage Loan on $ $
Residential Property
Bank Overdraft $ $
Mortgage Loan on $ $
Outstanding Tax $ $
Investment Property 1
Others: $ $
Mortgage Loan on $ $
Others: $ $ Investment Property 2

Others: $ $ Mortgage Loan on $ $

Investment Property 3
Total Short Term Liabilities $ $
Car Loan $ $
Others: $ $
Others: $ $
Others: $ $
Total Long Term Liabilities $ $
Total Liabilities $ 23424 $
NET WORTH $ 45632 $

Are there any factors within the next 12 months that may significantly increase or decrease your net worth?
Yes No (If Yes, please provide details)

C. I do not wish to disclose my assets and liabilities information and for it to be taken into consideration for needs analysis and recommendations. Please
provide reasons:

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 6 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 7 - EXISTING INVESTMENTS AND INSURANCE
This section is compulsory. If you do not have either Investment or Insurance, please indicate "Nil" or "None" in the respective Investment or Insurance sub-sections

[Link] Investments (e.g. Stocks, Bonds, Unit Trusts, Managed Accounts etc)
This sub-section is compulsory. Please indicate "Nil" or "None" if you do not have any existing investments.
*Please provide attachments with similar format, if required.
Investment Amount
Owner Type of Investment Cash / CPF/ SRS Current Value Remarks
(SP / RSP)

Lakshman health cash 1234 2345 Remarks for existing investment details

B. Existing Life / Health Insurance Policies (i.e. CPF Dependants' Protection Scheme, Investment-Linked, Endowment, Income Protection, Hospitalisation, Total Permanent Disability, Whole Life etc)
This sub-section is compulsory.
Please indicate "Nil" or "None" if you do not have any existing insurance.
*Please provide attachments with similar format, if required.
Commencement Sum Assured - Total
Life Company and Type of Sum Assured - Sum Assured -
Owner Life Assured Date Premium & Permanent Maturity / Remarks
Policy Death Critical Illness
(DD/MM/YY) Disability (TPD)

1234 2334 2323

I do not wish to disclose my existing investment and insurance information and for it to be taken into consideration for needs analysis and recommendations.
C.
Please provide reasons:

bhaskar

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 7 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 8 - INVESTMENT RISK PROFILE
The following questions are designed to determine your investment risk profile taking into account your financial needs, circumstances and
objectives. Please indicate your preferences.

For insurance planning excluding ILPs, answer minimally Q1.

For investment planning including ILPs, answer ALL questions. Portfolio 1 Portfolio 2

Name

Purpose All purposes

Score
Portfolio 1 Portfolio 2
1. Please circle the number on the line below indicating your preferred risk / return 1 1
objective.
2 2
Lowest RISK and Highest RISK and 3 3
Lowest potential Highest potential
4 4
RETURN 1 2 3 4 5 RETURN
5 5

2. Investment Time Horizon: What is the expected time frame for your investment?

1 3 years or less 1 1
2 >3 - 5 years 2 2
3 >5 - 7 years 3 3
4 >7 – 10 years 4 4
5 More than 10 years 5 5

3. What is the average annualised gross return you reasonably expect to achieve from your
investment portfolio(s), over a longer term period of at least 10 years?

1 0 - 2% 1 1
2 >2 - 4% 2 2
3 >4 - 6% 3 3
4 >6 - 8% 4 4
5 More than 8% 5 5

4. In your opinion, what percentage drop in the major market indices (e.g. STI, Dow Jones,
NASDAQ, S&P, etc) would you consider as a severe crisis?

1 -10% 1 1
2 -20% 2 2
3 -30% 3 3
4 -45% 4 4
5 -60% 5 5

5. If stock markets have dropped by at least 20% in its value over a year, how will you
potentially respond?

1 I would probably be very upset and sell off all my investments 1 1

2 I would be upset and will only sell off those with little or no losses
2 2
I would not be happy but will keep my investments in the hope of a
3 3 3
recovery
4 I would think it is a good buying opportunity and buy cautiously 4 4
5 I would think it is a great buying opportunity and buy aggressively 5 5

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 8 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 8 - INVESTMENT RISK PROFILE

6. The following chart shows the possible range of values for five different investments of $100,000 after
one year. Which investment would you be most comfortable in owning? Score

Portfolio 1 Portfolio 2

1 1

2 2

3 3

4 4

5 5

Insurance and
Insurance Only Score Investment Score Client Investment
Score
(Q1 only) (Q1 to Q6) Risk Profile

1 6 to 9 Conservative Portfolio 1 Portfolio 2

2 10 to 14 Moderate 5

3 15 to 21 Balanced Investment Risk

Profile
4 22 to 26 Growth

5 27 to 30 Aggressive

Client Investment Risk Profile Choice

(Complete this only if client DISAGREES with the Investment Risk Profile above)

Not withstanding the Investment Risk Profile questionnaire, I hereby declare that my risk profile is

Investment Profile - Portfolio 1

Investment Profile - Portfolio 2

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 9 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 8 - INVESTMENT RISK PROFILE
Your Investment Risk Profile
Conservative - Score 6 to 9
Your investment risk profile suggests that you are able to take on low risk investments. Your main priority is safeguarding your investment
capital. You are prepared to sacrifice higher returns for peace of mind. This indicates that you wish to take a conservative approach towards
investing and the recommended asset allocation strategy would range between 80% to 90% products with risk = 1 (Developed Govt Fixed
Income) and 10% to 20% products with risk = 5 (Regional or Single Country Equities).

PORTFOLIO RISK ALLOCATION:

Less than or equal to (<) 1.8

Moderate – Score 10 to 14
Your investment risk profile suggests that you have some understanding of investment markets and their behaviour. You do not wish to see all
your capital eroded away by taxes and inflation and you are prepared to take short- to medium-term risk in order to gain longer-term capital
growth. This indicates that you wish to have a moderate approach towards investing and the recommended asset allocation strategy would
range between 60% to 70% products with risk = 1 (Developed Govt Fixed Income) and 30% to 40% products with risk = 5 (Regional or Single
Country Equities).

PORTFOLIO RISK ALLOCATION:

More than (>) 1.8 and less than or equal to (<) 2.6

Balanced – Score 15 to 21
Your investment risk profile suggests that you are seeking a greater growth component in your investment portfolio to help protect your capital
from the eroding effect of taxes and inflation. While you remain cautious towards taking high levels of risk, your general understanding of
investment markets enable you to feel comfortable with some short- to medium-term risk. Your priority is consistent capital growth with some
income to smoothen out any volatility in your returns. This indicates that you wish to have a balanced approach towards investing and the
recommended asset allocation strategy would range between 40% to 50% products with risk = 1 (Developed Govt Fixed Income) and 50% to
60% products with risk = 5 (Regional or Single Country Equities).

PORTFOLIO RISK ALLOCATION:

More than (>) 2.6 and less than or equal to (<) 3.4

Growth – Score 22 to 26
Your investment risk profile suggests that you are an investor who understands the movement of the investment markets. You are most
interested in maximising the value of your investments(s) through long-term capital growth, although you do not wish to make imbalanced
investment decisions. You are comfortable with short- to medium-term volatility from your portfolio to maximise the potential for long-term capital
growth. This indicates that you wish to have an assertive approach towards investing and the recommended asset allocation strategy would
range between 20% to 30% products with risk = 1 (Developed Govt Fixed Income) and 70% to 80% products with risk = 5 (Regional or Single
Country Equities).

PORTFOLIO RISK ALLOCATION:

More than (>) 3.4 and less than or equal to (<) 4.2

Aggressive - Score 27 to 30
Your investment risk profile suggests that you are prepared to sacrifice your investment capital in pursuit of highest long-term potential capital
growth. You have a good understanding of the behaviour of investment markets and you are interested in negating the effects of taxation and
inflation. This indicates that you wish to have an aggressive approach towards investing and the recommended asset allocation strategy would
range between 0% to 10% products with risk = 1 (Developed Govt Fixed Income) and 90% to 100% products with risk = 5 (Regional or Single
Country Equities).

PORTFOLIO RISK ALLOCATION:

More than (>) 4.2 and less than or equal to (<) 5.0

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 10 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 9 - CUSTOMER KNOWLEDGE ASSESSMENT
It is important to find out if you have the knowledge or investment experience to understand the risk and features of unlisted "Specified Investment Products"
(SIP) which include Investment-Linked Policies (ILP)s, unit trusts or similar products. This assessment, known as the Customer Knowledge Assessment
(CKA), helps to assess your knowledge or investment experience before a solution(s) is / are offered to you. The accuracy or completeness of the information
provided may affect the suitability of the recommendations made. A copy of the form will be submitted to the relevant investment platform when necessary.
By proceeding to provide this information, you have given consent to the collection, use and disclosure of this information.

Part 1 : Knowledge Acquired Client Spouse / Others

Educational Qualifications
Yes No Yes No
1. Do you have a diploma or higher qualification in any of the following fields?

(C) (S/O) (C) (S/O) (C) (S/O)

Accountancy Actuarial Science Economics
Capital Markets Commerce Financial Planning
Finance Financial Engineering Business / Business Admin / Business
Management / Business Studies
Computational Finance Insurance
Please also specify the full name of the Education Institution(s) in which the above qualification(s) were obtained and any other relevant information:

Client: Spouse / Others:

Singapore Institute of technology

2. Do you possess any professional finance-related qualifications? Yes No Yes No

(e.g. AFP / AWP / CFP, AFC / ChFC, ACCA, CLU, CFA / CAIA, CPA / CA, FRM / PRM, CISI)
If yes, please specify the full name of the qualification(s), Education Institution(s) in which the qualification(s) were obtained and any other relevant information:

Client: Spouse / Others:

Investment Experience
3. Have you made at least 6 transactions in the following unlisted “Specified Yes No Yes No
Investment Products” in the past 3 years?
(C) (S/O)
Collective Investment Schemes (CIS) (e.g. Unit Trusts)
Investment-Linked Policies (ILP). includes intra-fund switches
If yes, please specify the full name of the Financial Institution(s) where the transactions were carried out and any other relevant information:

Client: Spouse / Others:

Work Experience
4. Do you have a minimum of 3 continuous years of working experience* in the Yes No Yes No
preceding 10 years involving the following fields?
(C) (S/O)

Development / Structuring / Management / Sale / Trading / Research / Analysis of Investment Products

Provision of training on Investment Products

Accountancy, Actuarial Science, Treasury, Financial Risk Management and Legal work in financial areas
* Provision of general support functions in the above mentioned areas such as operations, HR, corporate services and IT will not be
considered as relevant experience.
Please also specify the full name of the business organisation(s) where the above work experience was obtained and any other relevant
information:

Client: Spouse / Others:

Aviva

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 11 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 9 - CUSTOMER KNOWLEDGE ASSESSMENT
PART 2 : Outcome of CKA

Based on the guidelines prescribed by the Monetary Authority of Singapore (MAS), if any of the above response is "Yes", you are deemed to have the
relevant investment knowledge and / or experience for the purpose of this assessment.
Client Spouse / Others
You are assessed to have acquired the relevant knowledge and / or experience to
understand and purchase "Specified Investment Products".
You are assessed not to have acquired the relevant knowledge and / or experience to
understand and purchase "Specified Investment Products".

Note 1: In the event of a joint investment, both clients will be deemed to have not fulfilled the criteria in the CKA if one of them is assessed
not to have possessed the knowledge or experience in an unlisted Specified Investment Product.

I declare the above information provided to be correct and understand that any inaccurate or incomplete information provided
by me may affect the outcome of the CKA.
The personal information gathered here by the adviser, including the statement(s) and other [Link] provided by you, is for the purpose
of providing you, the client, with suitable financial recommendations and will be kept confidential.

Client Acknowledgement of CKA Outcome

I acknowledge that
I have been given a clear explanation of the objectives for the Customer Knowledge Assessment (CKA);

I have answered all the relevant questions to the best of my knowledge

I understand and agree with the outcome of the Client Knowledge Assessment.

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 12 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 10A - NEEDS ANALYSIS (PROTECTION)

[Link] the Event of Death

Client Spouse / Others
Income
Monthly needs for dependants $ monthly $ monthly
Annual amount (pmt) $ annually $ annually
Number of years required (n) years years
Inflation-adjusted rate of return from investments (%) (i)
(A) Funds required to provide income (pv) $ $

Liabilities
Outstanding mortgage $ $
Debt (Loans, Credit cards, Overdraft, etc.) $ $
Funds required for dependants’ education (tertiary, etc) $ $
Final expenses (Medical, Taxes, Funeral, etc.) $ $
Others: $ $
(B) Funds required to settle liabilities $ $

(A + B) = (C) Total funds required $ $

Existing Resources Allocated (Current Values)

Life insurance coverage $ $
Cash assets (Savings, Fixed Deposits, etc.) $ $
CPF $ $
Investments (Bonds, Unit Trusts, Shares, etc.) $ $
Others: $ $
(D) Total $ $

(D - C) = Surplus / (Shortfall) $ $
Notes

2. In the Event of a Critical Illness

Client Spouse / Others
Critical Illness Needs
Monthly needs required for living expenses and / or dependants $ monthly $ monthly
Annual amount (pmt) $ annually $ annually
Number of years required (n) years years
Funds required (pv) $ $
Lump sum required for treatment of illness $ $
Others: $ $
(A) Total critical illness needs $ $
Existing Resources Allocated (Current Values)
Life insurance coverage $ $
Cash assets (Savings, Fixed Deposits, etc.) $ $
Others: $ $
(B) Total $ $

(B - A) = Surplus / (Shortfall) $ $
Notes

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 13 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 10A - NEEDS ANALYSIS (PROTECTION)

3. In the Event of Disability

Client Spouse / Others
Income
Monthly needs for living expenses and / or dependants $ monthly $ monthly
Annual amount (pmt) $ annually $ annually
Number of years required (n) years years
Inflation-adjusted rate of return from investments (%) (i)
(A) Funds required to provide income (pv) $ $

Expenses
Provision for medical expenses $ $
Others: $ $
(B) Total Expenses $ $

(A + B) = (C) Total funds required $ $

Existing Resources Allocated (Current Values)

Existing total permanent disability (TPD) payout $ $
Existing disability income benefit payout (total) $ $
Others: $ $
(D) Total funds available $ $

(D - C) = Surplus / (Shortfall) $ $
Notes

4. In the Event of Disability (Long Term Care / Disability Income)

Client Spouse / Others

(A) Monthly needs required $ monthly $ monthly

Preferred benefit payout period (years) years years
(B) Current monthly benefits $ $

(B - A) = Surplus / (Shortfall) $ $
Notes

5. In the Event of Hospitalisation / Medical Expenses

Client Spouse / Others

What is the preferred hospital type and ward? Private Private
Government / Restructured Government /
A B1 B2/C A B1 B2/C
Provision for Deductible and / or Co-Insurance?
Deductible Deductible

Co-Insurance Co-Insurance
Existing type of hospital plan cover?

Insurer name and plan type?

Do you require coverage for outpatient treatment expenses? Yes No Yes No

Notes

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 14 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 10A - NEEDS ANALYSIS (PROTECTION)

6. Planning for Dependants Protection

Dependant(s)

Name of Dependant:

A. In the Event of Hospitalisation

Preferred hospital type? Private or Government /
Restructured?

Provision for deductible? Yes No Yes No Yes No Yes No

Provision for co-insurance? Yes No Yes No Yes No Yes No

Existing type of hospital plan cover? (Insurer name
and plan type)

B. In the Event of Critical Illness

Total Funds Required $ $ $ $

Less existing resources (if any) $ $ $ $

Surplus / (Shortfall) $ $ $ $

C. In the Event of Disability

Annual expenses (pmt) $ $ $ $

Years to provide for (n)

Net rate of return (inflation adjusted) (i)

(A) Capital Sum Required (pv) $ $ $ $

(B) Medical Expenses $ $ $ $

(A + B) = Total Funds Required $ $ $ $

Less existing resources (if any) $ $ $ $

Surplus / (Shortfall) $ $ $ $

D. In the Event of Death

Final expenses $ $ $ $

Loans (e.g. education loan etc) $ $ $ $

Others: $ $ $ $

Total Cash Needs: $ $ $ $

Less existing resources (if any) $ $ $ $

Surplus / (Shortfall) $ $ $ $

Notes

Important Note to Adviser

Fact find should always be completed on the proposer. In the case of adult child(ren) paying for parents' Eldershield and Eldershield
supplements, fact find should be completed on the parents i.e. the proposer.

SETTING THE PROFESSIONAL STANDARD FOR FINANCIAL ADVICE IN SINGAPORE 15 of 25

Co. Reg. No. 200106346Z | FA Licence No. FA000008-4 Financial Planner - Version 2.6
SECTION 10B - NEEDS ANALYSIS (ACCUMULATION)

7. Planning for Retirement

Client Spouse / Others
Desired retirement age
Number of years to retirement (n) years years
Desired Monthly Retirement Income in Today's Value (pv) $ monthly $ monthly
Assumed inflation rate, (%) (i)
Desired monthly retirement income (fv) $ monthly $ monthly
Annual amount $ annually $ annually
Inflation adjustment investment rate after retirement, (%) (i)
Number of years to provide for retirement (n1) years years

(A) Funds Required at Retirement Age $ $

(B) Remaining Liabilities at Retirement (if any) $ $
(A) + (B) = (C) Total Retirement fund Needed $ $
Existing Resources Allocated for Retirement
ROI(%)
(Projected Values)
Life insurance cash value $ $
Cash assets (Savings, Fixed Deposits, etc.) $ $
Investments (Bonds, Unit Trusts, Shares, etc.) $ $
Others: $ $
(D) Funds Available at Retirement Age (fv) $ $

(D) - (C) = Surplus / (Shortfall) at Retirement $ $

Notes

8. Planning for Children's Tertiary Education

Name of child

Number of years to university (n) years years

Current annual cost of tertiary education (Tuition + Allowances) (pv) $ annually $ annually
Education inflation rate (i)
Course duration (years)
(A) Funds Required (fv) $ $
Existing Resources Allocated for Children's Education
ROI(%)
(Projected Values)
Life insurance cash value $ $
Cash assets (Savings, Fixed Deposits, etc.) $ $
Investments (Bonds, Unit Trusts, Shares, etc.) $ $
Others: $ $
(B) Funds Available $ $

(B) - (A) = Surplus / (Shortfall) $ $

Notes

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SECTION 10B - NEEDS ANALYSIS (ACCUMULATION)

9. Savings for Other Purposes

Client Spouse / Others

Purpose
(A) Target Amount $ $
Years to target (n) years years
Current savings and investments (pv) $ $
Estimated rate of return (%) (i)
(B) Future Value of Current Savings and Investments (fv) $ $

(B - A) = Surplus / (Shortfall) $ $

Notes

SECTION 11 - AFFORDABILITY
Please indicate the amount that is within your affordability to set aside for your objectives and whether the amount is a substantial
portion of your assets and income.
As a guide, the amount that you are willing to invest should not be more than 50% of your total assets or 20% of your total monthly
inflow. It is also recommended that you should also set aside 3 to 6 months of your monthly outflow for emergency purposes.

Client Spouse / Others

Funds Annual Single Substantial Annual Single Substantial

Amount Amount Amount Amount Amount Amount

Cash $ $ Yes No $ $ Yes No

CPF Ordinary account $ $ Yes No $ $ Yes No

CPF Special account $ $ Yes No $ $ Yes No

CPF Medisave account $ $ Yes No $ $ Yes No

Supplementary Retirement Scheme $ $ Yes No $ $ Yes No

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SECTION 12 - ADVICE AND RECOMMENDATIONS
Basis of Recommendations (Complete this section for Life & Health Advice)
Attach additional copy only if the space given below is insufficient.

Plan(s) Recommended (including the name of #For

Insurance Provider and additional add-on riders,if Sum Premium Frequency Settlement Client's
any) Assured Mode Choice

#Y=Yourself, S=Spouse, J=Joint, C=Child, P=Parent

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SECTION 12 - ADVICE AND RECOMMENDATIONS
Basis of Recommendations (Complete this section for Life & Health Advice)
Attach additional copy only if the space given below is insufficient.

Invested Platform (iFast / Frequency #For Client's Choice

Action Fund(s) Recommended Amount Navigator)

Portfolio 1
Buy
Switch

Portfolio 2
Buy
Switch

Portfolio 3
Buy
Switch

Portfolio 4
Buy
Switch

#Y=Yourself, S=Spouse, J=Joint, C=Child, P=Parent

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SECTION 12 - ADVICE AND RECOMMENDATIONS
Basis of Recommendations

Please elaborate on the following points (where applicable)

How does the product feature & benefits meets client's
What are the reasons for switching / replacement of products?
financial objectives and needs?
How does the product fit client's risk profile and time How does the product meet client's financial situation?

horizon? Has affordability and liquidity of the client been assessed?

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SECTION 12 - ADVICE AND RECOMMENDATIONS

What are the risks, disadvantages and limitations of the products and recommendations?

What are the products fees & charges?

What are the reasons for deviations? Eg Premium more than client's affordability (Refer to Section 11). Funds risk class is higher than
client's risk profile (Refer to Section 8).

Additional Notes

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SECTION 13 - SWITCHING / REPLACEMENT OF POLICY
1. Are you switching / replacing in full or in part any existing or recently terminated collective investment scheme or insurance policy,
whether purchased from PIAS or other Financial Institution?
Yes No
If "Yes", please proceed to the next question. Your Adviser should provide the reasons in detail, in Basis of Recommendation (for
replacement of CIS, life and health policy(ies)).
If "No", please proceed to Section 14.
2. Did your Adviser recommend that you switch / replace in full or in part any collective investment scheme or insurance policy, whether
purchased from PIAS or other financial advisers?
Yes No
3. Did the Adviser provide the basis of the recommendation and inform you of the transaction costs and / or possible disadvantages
listed below?
Incurring transaction costs without gaining any real benefit from the switch / replacement
The new investment product / insurance plan may offer a lower level of benefit at a higher cost or at the same cost, or offer the same
level of benefit at a higher cost
Incurring penalties for terminating the existing investment products / insurance plans
The new investment product / insurance plan may be less suitable and the terms and conditions may differ
I may not be insurable at standard terms
Loss I may incur as a result
I may be entitled to free fund switching, if any.
Yes No
4. I hereby confirm that I wish to proceed with the switch / replacement notwithstanding that the fees, charges or disadvantages that
may arise could outweigh any potential benefits.
Yes No

SECTION 14 - CLIENT ACKNOWLEDGEMENT AND DECLARATION

1. I acknowledge receipt and I have read and understood the following documents (where applicable)

Important Notice To Client

Financial Planner Form
Copy of the cover page, product summary, policy illustration, bundled product disclosure document and product
highlights sheet (if applicable) in respect of the life policy.
Prospectus / Profile Statement including a supplementary prospectus or supplementary profile statement and Product Highlight Sheet
(if applicable) in respect of the collective investment scheme
High Conviction List - Cash SRS/CPFOA SRS (if applicable)
PIAS Model Portfolio factsheet(s) (if applicable)
I have been directed to the following guides available online (if applicable)
Your Guide to Life Insurance ([Link]
Your Guide to Investment-Linked Insurance Plans ([Link]
Your Guide to Participating Policies ([Link]
Your Guide to Health Insurance ([Link]
2. Investment Risk and Disclosure (where applicable)
I understand and acknowledge that I have been given a clear explanation on the possible investment risk involved. The value of a
Collective Investment Scheme (“CIS”) may rise or fall and the potential returns are non-guaranteed. I may lose some or all of my
investment depending on the performance of the underlying securities of which performance factors include, without limitation, market
risks, fluctuations in interest rates, foreign exchange rates and political instability.
I acknowledge that before I invest in the recommended CIS, I am aware of the nature and objective of the product, details of the product
provider, the product’s intended investment time horizon, the liquidity and the commitment level required for the product and the
expected level of risk tolerance of the client. I am aware that there may be a price difference between the order placement date and the
trade execution date.
I am advised to refer to the fund’s prospectus and product highlights sheet for more information and I should not invest in the product if I
do not understand or I am not comfortable with such risks. I understand and acknowledge that PIAS and its representatives shall not be
held responsible and liable for any market performance of the investments.

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SECTION 14 - CLIENT ACKNOWLEDGEMENT AND DECLARATION
3. Payer's Source of Funds

Salary Financial Investments Inheritance

Business Income Insurance Benefits Family Gifts
Compensation or remuneration Retirement Assets
Others (specify):

Third Party Payment

For third party payment please complete the following fields and provide a copy of third payer's identification document ([Link]/Passport etc.)

Name: NRIC/Passport NO: Relationship to Payer

Reason: Nationality & Residency

4. Payer's Source of Wealth

Salary Financial Investments Inheritance

Business Income Insurance Benefits Family Gifts
Compensation or remuneration Retirement Assets
Others (specify): (e.g. one time receipts, sale of properties etc.)
5. Tax Declaration
I declare that, to the best of my knowledge, I have not committed or been convicted of any serious tax crime
If otherwise, please provide more information in the box below.

6. Personal Data Notice and Consent Clause

a. I understand, acknowledge and consent to PIAS processing, collecting and using my personal data provided by me in this form and
from time to time, to PIAS and disclosing my personal data to Permitted Parties for the following Purposes:
i) administering, servicing or dealing with the financial advisory services provided by PIAS (including processing my applications for
financial products);
ii) managing with my financial products that I have purchased pursuant to the financial advisory services provided by PIAS;
iii) observing any legal, governmental or regulatory requirements of any relevant jurisdiction (including any disclosure or notification
requirements to which PIAS is subject to);
iv) carrying out due diligence, monitoring or other screening activities in accordance with PIAS’ legal or regulatory obligations or risk
management procedures; and
v) providing me with marketing, advertising and promotional information, materials and / or documents relating the financial advisory
services provided by PIAS (including the financial products of PIAS’ business partners and product providers) that PIAS may be
selling, marketing, offering or promoting (whether such products or services exist now or are created in the future) which in the
opinion of PIAS may be of interest or benefit to me, by way of postal mail and electronic transmission to my email and postal
address(es).* For withdrawal of consent for marketing via email and/ or postal mail, please contact PIAS Data Protection Officer for
more information at dataprotection@[Link]
b. (Please tick the box if you wish to provide your consent)
By ticking the box, I hereby consent to PIAS providing me with marketing, advertising and promotional information, materials and / or
documents relating the financial advisory services provided by PIAS (including the financial products of PIAS’ business partners and
product providers) that PIAS may be selling, marketing, offering or promoting (whether such products or services exist now or are
created in the future) which in the opinion of PIAS may be of interest or benefit to me, by way of telephone calls, SMS / MMS and
facsimile to me, to the telephone number(s) provided by me to PIAS in this form and any other telephone number(s) provided by me to
PIAS from time to time.
I understand that if my consent is not provided, PIAS will be unable to provide me with such marketing and promotional information
using such modes of communication.*
c. I hereby represent and warrant that I am the user and / or subscriber of all the telephone number(s) provided by me to PIAS from time
to time (including without limitation the telephone number(s) provided by me to PIAS in this consent form and on all other forms, or
documents from time to time), and that I have read and understood PIAS’ Personal Data Notice and Consent Policy and the
above provisions.
d. I represent and warrant that for any personal data of my dependant(s) that I disclose to PIAS, that I am validly acting on behalf of my
dependant(s) and that, prior to disclosing my dependant(s)' personal data to PIAS, I have informed my dependant(s) that their personal
data will be disclosed to, and obtained the consent from my dependant(s) for their personal data to be disclosed to, PIAS so that PIAS
can process, collect and use my dependant(s)' personal data for one or more of the Purposes and PIAS can disclose my dependant(s)'
personal data to the Permitted Parties for one or more of the Purposes.

* For details about PIAS' Personal Data Notice and Consent Policy, please visit [Link]

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SECTION 14 - CLIENT ACKNOWLEDGEMENT AND DECLARATION
7. Customer Knowledge Assessment Declaration
Note: In the event of a joint investment, both clients will be deemed to have not fulfiled the criteria in the CKA if one of them is assessed not
to have possessed the knowledge or experience in an unlisted Specified Investment Product.

IMPORTANT NOTICE TO CLIENTS

Please note that should you choose to proceed with the investment after being advised that the product/s is / are not suitable for you, you will not
be able to rely on section 27 of Financial Advisers Act (FAA) to file a civil claim should you suffer a loss in future.

I acknowledge that I have been given a clear explanation of the objectives for CKA, as well as understand and agree with the outcome
of the CKA.

Client
PASS CKA
I understand that I have PASSED CKA and I DO NOT WISH to receive any advice offered by my Adviser. I understand that by
choosing not to receive any advice, I will not be able to rely on Section 27 of Financial Advisers Act (FAA) to file a civil
claim in the event of a loss.
I understand that I have PASSED CKA and I WISH to receive advice offered to me by my Adviser. Based on the assessment of the
suitability of the investment product, I have been advised that the investment product/s that I intend to invest in is / are SUITABLE
for me, and I would like to PROCEED with the investment

DID NOT PASS CKA

I understand that I DID NOT PASS CKA and I WISH TO PROCEED with my investment. I understand that I will need to receive advice
from my Adviser, who will assess me on the suitability of the investment product for my investment. Based on the assessment of the
suitability of the investment product, I have been advised that the investment product/s that I intend to invest in is / are SUITABLE for
me, and I would like to PROCEED with the investment.

Spouse / Others
PASS CKA
I understand that I have PASSED CKA and I DO NOT WISH to receive any advice offered by my Adviser. I understand that by
choosing not to receive any advice, I will not be able to rely on Section 27 of Financial Advisers Act (FAA) to file a civil claim
in the event of a loss.
I understand that I have PASSED CKA and WISH to receive advice offered to me by my Adviser. Based on the assessment of the
suitability of the investment product, I have been advised that the investment product/s that I intend to invest in is / are SUITABLE for
me, and I would like to PROCEED with the investment.

DID NOT PASS CKA

I understand that I DID NOT PASS CKA and I WISH TO PROCEED with my investment. I understand that I will need to receive advice
from my Adviser, who will assess me on the suitability of the investment product for my investment. Based on the assessment of the
suitability of the investment product, I have been advised that the investment product/s that I intend to invest in is / are SUITABLE for
me, and I would like to PROCEED with the investment.

Financial Advisers Act Section 27 Extract

Recommendations by licensed financial advisers
1. No licensed financial adviser shall make a recommendation with respect to any investment product to a person who may reasonably be expected to reply on the recommendation if
the licensee does not have a reasonable basis for making recommendation to the person.

2. For the purposes of subsection (1), a licensed financial adviser does not have a reasonable basis for making recommendation to a person unless:
(a) he has, for the purposes of ascertaining that the recommendation is appropriate, having regard to the information possessed by him concerning the investment objectives,
financial situation and particular needs of the person, given such consideration to, and conducted such investigation of, the subject-matter of the recommendation as is reasonable
(b) the recommendation is based on the consideration and investigation referred to in paragraph (a).
3. Where:
(a) a licensee, in making a recommendation to a person, contravenes subsection (1);
(b) the person, in reliance on the recommendation, does a particular act, or refrains from doing a particular act;
(c) it is reasonable, having regard to the recommendation and all other relevant circumstances, for the person to do that act, or to refrain from doing that act, as the case may be, in
reliance on the recommendation; and
(d) the person suffers loss or damage as a result of doing that act, or refraining from doing that act, as the case may be,
4. In this section, a reference to the making of a recommendation is a reference to the making of a recommendation expressly or by implication.
5. This section shall not apply to any licensed financial adviser or class of licensed financial advisers in such circumstances or under such conditions as may be prescribed.

[2/2005]
[SF Bill, Clause 121]

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SECTION 14 - CLIENT ACKNOWLEDGEMENT AND DECLARATION
I acknowledge that

a) The recommendation(s) prepared by my Adviser is / are based on the facts furnished by me in this form, and any incomplete or
inaccurate information provided by me may affect the suitability of the recommendation(s) made. As such, PIAS shall have no
responsibility for any errors and / or omissions
b) In the event I choose not to provide information requested, I am aware that it is my responsibility to ensure the suitability of the
product(s) selected.
c) In the event that this intended transaction is a substantial portion of my assets / income, I am aware and willing to proceed with the
transaction and bear the responsibility of this decision.
d) The Adviser has explained to me in detail the recommendation(s) made and
i) by affirming it with my signature below, I agree to proceed with the proposed recommendation(s) as indicated with tick(s) in
Client’s Choice in Section 12 (Advice and Recommendations);
or
ii) by NOT affirming it with my signature below, I disagree to proceed with the proposed recommendation(s).
e) Beneficial owner is a natural person who contributes to or exercises control over the account(s)/policy(ies). I am the beneficial owner
and have not appointed any natural person to act on my behalf.
If you are not the beneficial owner or have appointed natural person(s) to act on behalf of you, kindly complete the Enhanced Customer
Due Diligence Form.

Signature of Client / Date Signature of Spouse / Others / Date

SECTION 15 - ADVISER'S DECLARATION

I declare that the recommendation(s) made by me is / are based on the above needs analysis which has taken into account the information
disclosed by the client in this form. The information will be treated as confidential and will be used as part of fact find to recommend suitable
investment product(s) and shall not be used for any other purposes without client’s consent.
For Switching / Replacement of Policy (where applicable):
1. I have explained to the client the possible disadvantages of the Switching / Replacement and where applicable, informed him of other
options besides Switching / Replacement.

2. I have also explained the basis for Switching / Replacement and why the Switching / Replacement is suitable for the client as stated in
section 12 (Advice and Recommendations).

Name of Adviser Adviser's Signature Date

SECTION 16 - SUPERVISOR'S REVIEW AND ACKNOWLEDGEMENT

I declare that I have reviewed the information disclosed in this form which relates to the client's priorities and objectives, investment profile,
cash flow and budget, assets and liabilities, insurance portfolio, CKA outcome and the client's acknowledgement.
I agree with the Adviser's needs analysis and recommendation(s).
(If you disagree, please indicate the reasons below and advise on the follow-up action to be taken, where applicable.)
Reason(s) and Follow-up Action

Name of Supervisor Supervisor's Signature Date

Form received by Supervisor on

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