PAN CARD IS REQUIRED TO CHECK YOUR KYC STATUS, AN ACRONYMFOR “ KNOW YOUR CLIENT “
PAN* ____________
FIRST NAME ___________
MIDDLE NAME __________
LAST NAME ____________
DATE OF BIRTH _________ (DD/MM/YYYY)
GENDER _________
MARITAL STATUS ____________
PHONE ___________
ALTERNATE PHONE _________
OCCUPATION _________
COMPANY/ SELF EMPLOYEED ____________
HOW DID YOU KNOW ABOUT US __________ (INTERNET/FRIEND/HOLDING/OTHER)
ADDRESS ______________
EMAIL-ID _____________
COUNTRY _____________
STATE __________
CITY _____________
PINCODE _________
FAMILY DETAILS
PARTICULAR MEMBER 1 MEMBER 2 MEMBER 3
RELATIONSHIP
NAME
OCCUPATION
DATE OF BIRTH
EMAIL-ID
PHONE NUMBER
INCOME
NAME MONTHLY AMOUNT YEARLY AMOUNT
POST TAX TAKE HOME
SALARY
INCOME FROM INVESTMENT
(DEPOSITS,SECURITIES)
RENTAL INCOME
INTEREST EARN ON SAVING
TOTAL
UTILITIES
NAME MONTHLY AMOUNT YEARLY AMOUNT
ELECTRICITY
GAS
WATER
TELEPHONE
MOBILE
INTERNET
DISH TV
NEWSPAPER
OTHER
TOTAL
HOUSEHOLD
NAME MONTHLY AMOUNT YEARLY AMOUNT
MILK
VEG/NON-VEG/FRUIT
RENT
FUEL
MEDICAL EXPENSE
MONTHLY SOCIETY
MAINTENANCE CHARGES
AUTO MAINTENANCE
EDUCATION
GROCERIES/ SUPPLIES
MAID/COOK/NANNY/DRIVER
PERSONAL CARE( HAIR
CUT/SALON/SPA ETC
PROPERTY TAX
LAUNDRY / DHOBI
GYM EXPENSE
TOTAL
ENTERTAINMENT & TRAVEL
NAME MONTHLY AMOUNT YEARLY AMOUNT
WORK EXPENSE (LUNCH,
COFFEE)
ENTERTAINMENT (MOVIES,
PLAYS ETC.)
DINING OUT
TRAVEL VACATION
HOBBIES
OTHER
TOTAL
MISCELLANEOUS
NAME MONTHLY AMOUNT YEARLY AMOUNT
CLOTHES
GIFTS
CHARITY
FURNITURE
ELECTRONICS
PET CARE
SHOES
OTHER
TOTAL
LOANS & DEBT
NAME BANK LOAN AMOUNT LOAN TENURE EMI (INTEREST)
PERSONAL LOAN
HOME LOAN
BUSINESS LOAN
AUTO LOAN
TWO WHEELER
LOAN
GOLD LOAN
EDUCATION
LOAN
LOAN AGAINST
PROPERTY
CREDIT CARD 1
CREDIT CARD 2
CREDIT CARD 3
CREDIT CARD 4
OTHERS
TOTAL
INSURANCE PAYMENT
NAME COMPANY PRIMIUM POLICY TERM SUM PREMIUM
NAME MODE( CARD/CHEQU (YEARS) ASSURED
E/CASH)
LIFE
INSURANCE
HEALTH
INSURANCE
MEDICLAIM
PLANS
GENERAL
INSURANCE
TOTAL
STOCKS
COMPANY NAME ________
NUMBER OF SHARE _________
SHARE PRICE _____________
MUTUAL FUNDS
FUND NAME ___________
NUMBER OF UNITS _________
NAV ____________
PURCHASE YEAR __________
FUTURE AND OPTIONS
INVESTMENT TYPE:- FUTURE / OPTIONS
ASSET TYPE:- EQUITY / COMODITY / FOREIGN EXCHANGE
ASSET NAME _____________
NO. OF CONTRACTS __________
PURCHASE DATE ______________ (DD/MM/YYYY)
CONTRACT PURCHSE VALUE ____________
CONTRACT MARKET VALUE ________________ AS OF DATE_____________ (DD/MM/YYYY)
SAVING SCHEME
NAME ORG. DIVIDEND AMOUNT ROI TENURE START END FUND
NAME TYPE INVESTED (%) (YEARS) DATE DATE VALUE
(M/Q/H/Y)
FIXED DEPOSIT
RECURRING
DEPOSIT
POST OFFICE
SAVING
NATIONAL SAVING
SCHEME
INDIRA VIKAS
PATRA
KISAN VIKAS
PATRA
MONTHLY INCOME
SCHEME
PF
PPF
GRATUITY
SUPERANNUATION
NPS
GOVERNMENT
BONDS
CORPORATE
BONDS
INFRA BONDS
NATIONAL SAVING
CERTIFICATE
TOTAL
ALTERNATIVE SCHEME
NAME FUND NAME PURCHASE DATE AMOUNT MARKET VALUE
INVESTED AS OF DATE
(DD/MM/YYYY)
REIT
PE/VC
STRUCTURED
PRODUCTS
ESOP
RSU
TOTAL
CASH
NAME AMOUNT
IN BANK
PERSONAL POSSESSION
HAND LOAN
OTHER SOURSE
TOTAL
PROPERTY, JEWELLERY & OTHER
NAME RESIDENTIAL COMMERCIA VEHICLES JEWELLERY OTHERS
L
PROPERTY
NAME
PROPERTY
SIZE/
WEIGHT.
CURRENT
MAKET
VALUE
TOTAL
CHIT FUNDS
CHIT FUND NAME___________
CHIT START DATE_____________
CHIT VALUE___________
TENURE(MONTHS)___________
MONTHLY PAYMENTS____________
CURRENT VALUE_____________
GOALS
NAME AMOUNT NEEDED GOAL YEAR LOAN REQUIREMENT (%)
HOME
EDUCATION
VEHICLE
CHILD BIRTH
MARRIAGE
BUSINESS
FAMILY SUPPORT
VACATION
EMERGENCY FUND
RETIREMENT FUND
OTHERS
TOTAL
RISK PROFILE QUESTIONNARIES
1) When you think of the word RISK which of the following first comes to mind?
Danger
Opportunity
Uncertainty
Thrill
Cautiousness but not fear
2) Assuming normal market conditions, you expect your investments
To have some stability and make modest profits
To preserve capital at all costs
To greatly exceed returns provided by equity market index
To atleast match returns provided by equity market index
3) Due to lost mail, your car will be without insurance for seven days. What will you do?
Take a ride with friends/family
Take public transport
Drive car carefully and as little as possible
No problem
4) You are on a TV game show and you just answered a question right. You are now entitled for a gift. The
options would you choose?
80% chance of winning 1 crore
10% chance of winning 10 crores
30% chance of winning 3 crores
50% chance of winning 2 crores
5) You have lost 5 lakhs at a casino. How much are you prepared to risk to win Rs. 5 lakhs back?
2,50,000
1,00,000
5,00,000
More than 5,00,000
Nothing more
6) Your attitude towards personal investments recently has inclined towards?
Mostly towards higher risk
Sometimes towards higher risk
Mostly towards lower risk
Sometimes towards lower risk
No changes
7) Which of the following describes your attitude towards your investment?
Prefer investments with little or no fluctuations in value and low levels of risk. I am willing to accept lower rate of returns a
a mix of investments that have a low risk. Small part of portfolio could be directed towards higher risk assets
Balanced portfolio
Emphasis on higher risk
Only high return assets
8) How do you adapt/react to unfavourable financial changes in your life?
Very easily
Somewhat easily
Somewhat uneasily
Very uneasily
9) If the market has fallen 40% over last 6 months would you
Sell all current investments
Sell part of current investment to invest into more stable, secure avenues
Invest more funds to lower purchase price
Status quo
10) Have you ever invested a large sum in a risky investment mainly for the thrill of seeing whether it went
No
Rarely
Somewhat frequently
Very frequently
11) Find below the potential yearly returns for five different portfolios ( Portfolio A to Portfolio E). Which P
Portfolio type Year 1 Year 2 Year 3 Year 4 Year 5
Portfolio-A -14% -8% 21% 12% 24%
Portfolio-B 10% -3% 12% 12% 10%
Portfolio-C 30% -26% -16% 38% -10%
Portfolio-D -5% 15% -10% 12% 16%
Portfolio-E 8% 9% 7% 5% 9%
12) How much of your portfolio has been acquired based on recommendations from your friends during a
None
Less than 20%
Less than 30%
Less than 50%
Less than 75%
13) How familiar are you with investment matters?
No Clue
Basic Understanding of Banking Products
Basic Understanding of Banking Products & Mutual Funds
Basic Understanding of Banking Products, Equities and Mutual Funds
Very familiar. Use research and other investment info on my own
14) How would you consider your understanding of financial investments and markets as?
Lacking
Minimal
Inadequate
Adequate
Superior
15) What is Risk v/s Reward?
Increased Risk decreases the Reward
Risk and Reward do not go together
Less Risk increases the possibility of Reward
Increased Risk Increases possibility of Greater Reward
16) Which of the following describes your current stage in life?
Single with few financial burdens. Ready to accumulate wealth for future short term as well as long term needs
Couple without children. Establish a home. Expecting to or already have a high purchase rate of household and consume
and childcare costs and maintain only small cash balances
Mature family. In your peak earning years. Children grown up. Starting to think of retirement years
Retired
17) You have invested all your savings in the stock markets. The markets have suddenly started to crash.
portfolio?
6 Months
1 year
2 years
3 years
Less than 3 months
18) Which of the following describes your objective of investing?
You have an investment horizon of more than 5 years. You understand investment markets are mainly investing for grow
nearing retirement, have surplus funds to invest and are aiming to accumulate long term wealth from a balanced portfolio
You have a lumpsum and are uncertain about suitable investment options
Investing for retirement
You have specific obectives over next 5 years for which you are setting money aside
You want a regular income stream and protection of your capital
19) Choose one of the following attributes
Capital preservation
Reasonable Growth
Low volatility
Inflation protection
Aggresive growth
Tax efficiency
Leverage for Growth
20) Desired time horizon for portfolio?
0-1 years (Immediate Term)
1-3 years (Short Term)
3-7 Years (Medium Term)
8+ Years (Long Term)
TAX
GROSS INCOME
Name
Income From Salaries (per annum)
Basic Salary
DA
HRA (click checkbox If you are staying in a metro city)
Children(s) Education
LTA (click checkbox If you are claiming for the current year)
Other Allowances
Bonus
Income From House Properties
Rental Income
GROSS INCOME
Name
Income from other source
Interest from savings ( FD, RD etc.)
Interest from bonds
Others
HOME DEDUCTION
Name
Deduction Under Section 24B
Interest on Housing Loan (click checkbox If possession is taken)
Deduction Under Section 80C
Principal Loan Repayment ( Housing Loan )
Rent for HRA
Mention the rent claimed for HRA
Deduction Under Section 80EE
Remaining Interest on Housing Loan
Rent claimed under section 80GG
Mentioned the rent claimed for section 80GG
80D DEDUCTION
Name
Medical Insurance Premium for Self
Medical Insurance Premium for Parents
Preventive Health Checkup
OTHER DEDUCTION
Name
Deduction Under Section 80G
OTHER DEDUCTION
Name
Eligible Donations
Deduction Under Section 80 CCG
Investments in RGESS
Deduction Under Section 80DDB
Medical Treatment ( Specified Disease only )
Deduction Under Section 80DD
Medical Treatment / Insurance of handicapped Dependencies
Deduction Under Section 80CCD
NPS
Deduction Under Section 80E
Repayment of Loan of higher Self education
ADVICE
GOAL ADVICE
RISK ADVICE
TAX ADVICE
INVESTMENT ADVICE
