SimWealth Get to Know You Form

Contact Details
Mobile*
Work number
Email*
Enter Email Confirm Email
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Banking Details
*Optional (Not a requirement)
Name of Bank
Account Holder's Name
Account Number
Branch Name
Branch Code

Assets, Liabilities, Equity/Net-worth
Saving, Investments and Policies
Investment/Policy Name Contributions Current Market Value

Please provide a list of all the intangible/financial assets you have.
Employee Benefits
Policy/Investment Contribution Current Market Value

Please kindly indicate any benefits you receive from your employer. i.e Pension/Provident fund, group life cover
Assets
Type of Asset Acquisition Date Assessed/Fair Value Acquisition Cost Repayment Amount Outstanding Capital
Liabilities
Type of Credit Name of Creditor Repayments Outstanding Balance Interest %
Gross Income
Income (Salary/Property/Business) Source of Income (Employment/Rental) Amount before tax
Monthly expenses
Expense Amount

You may exclude payments made to creditors and capital assets
Disposable Income
Income Amount

Please indicate your disposable income after taking into account all your expenses. i.e (All income less all expenses).

Personal Details

Name of Institution	Qualification	Obtained/Progress

Name of Employer	Occupation	Industry

Name and Surname	Relationship	Date of Birth	Special Provisions

Investment/Policy Name	Contributions	Current Market Value