Personal Insurance Needs Analysis

Risk and Insurance Needs Analysis

Your Details
Name*
First Last
Date of Birth*
DD slash MM slash YYYY
Gender*
- Male
- Female
Marital Status*
Email*
Mobile Number*
(including country code)
Employment Status*
Smoking Status*
Health*
Australian Tax Resident*
Insurance Goals and Objectives
What are your goals from your objectives from your personal insurances?
- Repay all my outstanding debts against my family home
- To repay all my investment debts
- Repay the outstanding leases on my cars
- Pay for the private school education of my children
- Provide for cost of care for my children until age 21
- Provide funding for my family to maintain their current lifestyle
- Provide funding for my partner to retire with a comfortable lifestyle
Your Partner's Details
Partner's name*
First Last
Partner's Gender*
- Male
- Female
Partners Date of Birth*
DD slash MM slash YYYY
Partner's Email
Partner's Mobile Number
Partners Employment Status*
Smoking Status*
Health*
Australian Tax Resident*
Residential Address
Residential Address*
Street Address Address Line 2 City State / Province / Region Postcode / Zip Country
Family
Knowing your family situation will enable us to provide personalised advice to your needs.
Do you have any children?*
Name, DOB, and Gender of Each Child
Please add a row for each.
Name Relationship DOB Gender Financially Dependent Until 18 or 21?
Children Education
Understanding your education intention with regards to your children will aid in modeling your budgeting and insurance needs.
If you intend to send your children to childcare, what age will you send them?
How many days a week will they attend childcare?
If you intend to send your children to pre-school, at what ages will you send them?
What type of primary school will you send them to?
What type of secondary school will you send them to?
Do you intend to pay for their university/tertiary education?
What accommodation do you anticipate for you child/children during university/tertiary education?
Monthly Living Expenses
Please provide your monthly living expenses.
Monthly Basic Housing & Property Expenses?
Monthly Communication and Media Expenses?
Monthly Food and Groceries Expenses?
Monthly Recreation and Entertainment Expenses?
Monthly Clothing and Personal Care Expenses?
Monthly Medical and Health Expenses?
Monthly Transport Expenses?
Monthly Education and Childcare Expenses?
Monthly Insurance Expenses?
If renting, what is your weekly rental amount?
Do you have any major expenses other than education, debt or general living expense?
Examples may include major holiday, wedding and child support from previous relationships.
- Yes
- No
What would the annual costs be?
Retirement
Knowing your retirement plans will aid us in modeling you requirements your financial needs
What age would you like to retire?*
What age would your Partner like to retire?*
What lifestyle would you like in retirement?
Estate Planning
Providing details on your Estate Plan will enable us to understand your intention and be aware of this when reviewing interlinking documents.
Do you have a Will?*
- Yes
- No
Has your will been updated in the last 3 years?*
- Yes
- No
Holding Structures
Providing a summary of your holding structures will let us understand you asset and tax planning structures.
Do you have Companies, Partnerships, or Trusts that currently or may hold investments for you and your family?
- Yes
- No
Provide details of Trusts and Companies
Please add a row for each Trust (and its Trustee) or Company that you use to invest or hold assets in.
Trust/Company Name Trustee Name (If applicable to a Trust) Directors Purpose and Assets it Holds.
Debts
Please provide details of your debts.
Do you have any Home, Investment or Business loans?
- Yes
- No
Please provide details on Home or Investment loan(s)
Provider Current Balance ($) Loan Terms (Years) Interest Rate (%) Monthly Repayments ($)
Do you have car loans?
- Yes
- No
Please provide details on your car loan(s)
Provider Current balance ($) Interest rate (%) Balloon payment amount ($) Date balloon due
Do you have any other debt?
- Yes
- No
Please provide details on any other debts, including ATO debts
Creditor/Lender Current balance ($) Monthly Payments($) Interest Only or Interest and Principle
Super Details
Do you have a Self Managed Super Fund (SMSF)?*
- Yes
- No
What is the name of your SMSF?*
Who are the members in the SMSF and their member balance?*
Member Name Member Balance
Do you have multiple superannuation funds?
What retail super fund do you currently use?*
What is the name of your super fund?*
What is the approximate balance of your super fund?*
Does your partner have multiple superannuation funds?
What retail super fund does your partner currently use?*
What is the name of your partners fund?
What is the approximate balance of your partner's super fund?
Assets
What is your current Cash at Bank?*
Do you (and your partner if applicable) own any real estate?*
Including real estate that may be mortgaged or owned outright in your own names or through your holding structures.
- Yes
- No
Please provide details of any real estate you, your partner or any companies and trusts you control own*
Real Estate Address Owner Weekly Rental (If Applicable) Estimated Value
What is value of your (and your partners if applicable) home contents value?*
Do you have a car(s)?*
- Yes
- No
Please provide details for each car that you own:
Rego Number Year Vehicle Make and Model Owner Estimated value
Do you have shares in (A) any companies or (B) other major assets?
- Yes
- No
Please provide details:
Asset Name Owner Total Value
Income Estimate
Understanding your income enables us to provide advice on budgeting, wealth creation, debt and insurance.
What is your annual fixed salary (gross pre-tax)?*
What is your annual bonus income (gross pre-tax)?
What is your annual regular overtime income?
What is your annual rental income?
What is your annual dividends/investment income (grossed up for franking credits)?
What is your annual trust distribution/other income?
What is your annual government assistance income?
Do you expect this to change in the future?
- Yes
- No
Please comment on any changes you are expecting
What is your employer's name?*
What is your job title?
Does this require a specific qualification?
Number of years worked in this occupation?
Partner's Income Estimate
Do you know your partner's income details?
- Yes
- No, please email and contact my partner to verify
What is your annual partner's base income?*
(if none, enter 0)
What is your partner's annual bonus income?
(if none, enter 0)
What is your partner's annual regular overtime income?
(if none, enter 0)
What is your partner's annual rental income?
(if none, enter 0)
What is your partner's annual Dividend/Investment Income, or Trust/Other Income?
(if none, enter 0)
Do you expect this to change in the future?
- Yes
- No
What do you expect to change?
What is the name of your partner's employer?*
What is your partner's job title?
Does this require a specific qualification?
Number of years worked in this occupation?
Self Employed
Business name
ABN
Type of business
Accountant's name
Accountant's phone number
What is your shareholding of the business?
(Please enter a percentage.)
In the last financial year, what was the Net Profit Before Tax for your self employed entity?
(optional)
Life, Permanent Disability or Trauma Insurances
Do you have Life, Permanent Disability or Trauma Insurance?
- Yes, please refer to the below details.
- Unsure
- No.
Who is the Life and Permanent Disability Insurance provider?
Please provide the Life Insurance Coverage Amount.
Please provide the Total Permanent Disability Insurance Coverage Amount.
Please provide the Trauma Insurance Coverage Amount.
If you passed away how many days domestic support would your partner need (i.e. gardening, caring for children)?
Does your partner have Life, Permanent Disability or Trauma Insurance?
- Yes, please refer to the below details.
- Unsure
- No.
Who is your partner's Life and Permanent Disability Insurance provider?
Please provide your partner's Life Insurance Coverage Amount.
Please provide your partner's Total Permanent Disability Coverage Amount.
Please provide your partner's Trauma Insurance Coverage Amount.
If your partner passed away how many days domestic support would you need (i.e. gardening, caring for children)?
Income Protection Insurance
Do you have Income Protection Insurance?
- Yes, please refer to the below details.
- Unsure
- No.
Who is your income protection provider?
Please provide the Income Protection Coverage Amount.
Is it held in your super?
- Yes
- No
- Don't know
Does your partner have Income Protection Insurance?
- Yes, please refer to the below details.
- Unsure
- No.
Who is your partner's income protection insurance provider?
Please provide your partner's Income Protection Coverage Amount.
Is it held within their super?
- Yes
- No
- Don't know
Health Insurance
Do you have private health insurance?
- Yes, please refer to the below details
- No
Who is your health insurance with?
What health coverage do you have?
- Basic
- Full Coverage
- + Hospital
- + Medical Services & General
- + Pharmaceutical Benefits
- + Ambulance
What is your health insurance monthly premium?
Have you and your partner (if applicable) held continuous private health insurance since your 31st birthday?
- Yes
- No, I have not held since my 31st birthday
- No, I have never held private health insurance
Personal Life Insurance Pre-Assessment Information
Potential Insurance Benefits you wish to apply for or have reviewed?
- Life Cover
- Total and Permanent Disability Cover
- Trauma Cover
- Income Protection
- Business Expenses
Occupation
Time in current role? (years)
What percentage of time is spent doing manual labour? (%)
Do you participate in any hazardous activities (sky diving, motor racing, football)?
- No
- Yes
If yes, please provide details:
How many hours do you work per week?
Do you intend to change occupation in the next 12 months?
- No
- Yes
If yes, please provide details:
If you become disabled and unable to work, will any of your income (from any source) continue? (For example, sick leave, directors fees, salary, commission, exiting salary continuance insurance, ongoing profit share from a business etc.)
- No
- Yes
If yes, please provide details:
Do you participate in any pastimes, pursuits or sports?
Please tick all that apply
- Underwater diving
- Football
- Motor sports (car, bike, boat racing etc)
- Water sports
- Aviation activities (parachuting, hang gliding, flying planes etc)
- Abseiling
- Rock/Mountain climbing
- None
Are you a permanent resident of Australia?
- Yes
- No
Have you booked an overseas holiday in the next 12 months?
- No
- Yes
If yes, please provide details:
What is your height? (cm)
What is your weight? (kg)
Have you smoked tobacco or used any nicotine-based substance in the past 12 months?
- No
- Yes
If yes, please provide details of type, frequency and last used:
Do you drink alcohol?
- No
- Yes
If yes, please provide details of standard drinks per week?
Have any of your immediate blood relatives (parents, brothers or sisters) suffered any of the following conditions?
- Heart disease, heart attach or stroke
- Breast or ovarian cancer
- Melanoma
- Diabetes
- Bowel Cancer
- Familial Polyposis (FAP)
- Multiple Sclerosis
- Parkinson's disease
- Rheumatoid arthritis
- Haemochromatosis
- Muscular dystrophy
- Polycystic Kidney Disease (PCKD)
- Huntington's disease
- Motor neurone disease
- Any other cancer not listed above
- Any other hereditary disorder
- No
If any, Include family member, condition type, age condition commenced
Have you ever had, or been told that you had, or ever sought advice or treatment from a doctor, conseller or other health professional for any of the following?
Please tick all that apply
- Stress, anxiety, depression or other mentional health disorder
- High blood pressure
- High choresterol
- Asthma
- Skin cancer, tumour, skin lesion, mole or cyst
- Back or nexk strain/sprain/pain, sciatica, whiplash, spondylitis or any other back/neck/spinal problem
- Any bone/joint fractures, muscle, ligament or tendon injuries, gout, arthritis or osteoporosis
- No
If any, detail each condition and timing:
Have you ever had, or been told that you had, or ever sought advice or treatment from a doctor, conseller or other health professional for any of the following?
Please tick all that apply
- Any skin condition
- any blood conditions
- any disease/disorder of the eyes
- any disease/disorder of the ears
- any heart conditions
- any respiratory conditions
- any gastrointestinal conditions
- diabetes
- thyrois conditions
- cancer or tumours
- HIV
- Hepatitis
- No
If any, detail each condition and timing:
Have you ever, or do you now have, any other disabilioty, illness, injury or symptom not already advised?
- No
- Yes
If any, detail each condition and timing:
Have you in the last 5 years taken any drug/tablet, or medication (including illicit drugs) not already advised?
- No
- Yes
If any, detail each condition and timing:
Do you intend to seek any medical advice, test, investigation or treatment (including surgery)?
- No
- Yes
If any, detail each condition and timing:
Females Only - Have you ever had or been advisd to have treatment for any breat lump, abnormal cervical smear or abnormal vaginal bleeding?
- No
- Yes
If any, detail each condition and timing:
Have you ever had an insurance application declined or modified?
- Yes
- No
Your Partner's Personal Information
Partner's height (in cm)
Partner's weight (in kg)
How would you describe your partner's health
- Excellent
- Good
- Average
- Poor
Has your partner smoked in the last 12 months?
- Yes
- No
Is there a history of any particular illness in your partner's immediate family (cancer, diabetes, heart conditions, genetic disorders)?
- Yes
- No
Has your partner been treated for any medical conditions over the past 5 years?
- Yes
- No
Does your partner take medication?
- Yes
- No
Please provide details on your partner's medication:
Has your partner ever had an insurance application declined or modified?
- Yes
- No
Does your partner participate in any hazardous activities (sky diving, motor racing, football)?
- Yes
- No
Other Comments
Is there anything else you'd like to discuss?
Supporting Documents Request List
If you do not authorise Cashel House to collect the supporting documents please provide the requested documents below.
Cashel Supporting Document Collection Instructions
Please attach a copy of your latest Super Statement
This can be obtained from your superannuation fund online, or is normally posted to you in August each year.
Drop files here or

Max. file size: 2 MB.
Please attach a copy of your partner's latest Super Statement
This can be obtained from your superannuation fund online, or is normally posted to you in August each year.
Drop files here or

Max. file size: 2 MB.
Please attach a copy of your latest Life, TPD, Income Protection and Trauma insurance statements.
These may be contained in your Superannuation statement or should be obtained from your insurance advisor.
Drop files here or

Max. file size: 2 MB.
Please attach a copy of your partner's latest Life, TPD, Income Protection and Trauma insurance statements.
These may be included within you Superannuation statement or available from your insurance advisor.
Drop files here or

Max. file size: 2 MB.
Submit Form
- I authorize Cashel to contact my partner to complete a separate Risk Profile, and provide any missing material including Partner Income Estimates and attachments.
- I agree and accept the Privacy Policy and Acknowledge the Cashel Financial Services Guide and Cashel Credit Guide and Privacy Statement.
- I confirm the answers provided above are true and correct.

Save and Continue Later

Risk and Insurance Needs Analysis

Your Details

Insurance Goals and Objectives

Your Partner's Details

Residential Address

Family

Children Education

Monthly Living Expenses

Retirement

Estate Planning

Holding Structures

Debts

Super Details

Assets

Income Estimate

Partner's Income Estimate

Self Employed

Life, Permanent Disability or Trauma Insurances

Income Protection Insurance

Health Insurance

Personal Life Insurance Pre-Assessment Information

Your Partner's Personal Information

Other Comments

Supporting Documents Request List

Submit Form

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Name	Relationship	DOB	Gender	Financially Dependent Until 18 or 21?

Trust/Company Name	Trustee Name (If applicable to a Trust)	Directors	Purpose and Assets it Holds.

Provider	Current Balance ($)	Loan Terms (Years)	Interest Rate (%)	Monthly Repayments ($)

Creditor/Lender	Current balance ($)	Monthly Payments($)	Interest Only or Interest and Principle

Real Estate Address	Owner	Weekly Rental (If Applicable)	Estimated Value

Provider	Current balance ($)	Interest rate (%)	Balloon payment amount ($)	Date balloon due

Member Name	Member Balance

Rego Number	Year	Vehicle Make and Model	Owner	Estimated value