Financial Needs Analysis
Syllabis Financial Needs Analysis
Full Name
Personal Information
Email Address
Personal Information
Telephone Number
Personal Information
Personal Information:
Your age?
0-17
18-25
26-35
36-45
46-55
56-65
66-75
76-85
86-95
96+
Please Select
Your gender?
Male
Female
Gender Neutral
Other
I'd prefer not to say
Please Select
What is your relationship status?
Single
In a relationship
Married
Divorced
Divorced and remarried
Please Select
For your current place of residence.
I own the house, apartment or townhouse I stay in
I am renting to stay in my current place of residence.
I am staying at my current place of residence for free, but I don't own it.
I am staying with my parents.
Please Select
How many dependents do you have? This could be children, relatives, friends or loved ones that are dependent on you with regard to finances.
0
1
2
3
4+
Please Select
Please select all financial/insurance products you currently have.
Retirement Annuity
Life Insurance
Insurance
Disability Cover
Severe Illness Cover
Income Protection
Funeral Cover
Go Cover
Credit Life Cover
Health Solutions
Short Term Insurance
Please Select
Do you have an updated will?
Yes
No
I have a will but it has not been updated in a long time.
Please Select
On a scale of 1 to 10, how dangerous is your daily life? (factors effecting this could be your mode of transport, your occupation, your residential area, etc...)
1
2
3
4
5
6
7
8
9
10
Please Select
Do you suffer from any major disabilities?
Yes
No
Please Select
Do you suffer from any chronic or major illnesses.
Yes
No
Please Select
I exercise roughly once
a day.
a week.
every two weeks.
once a month.
I don't really exercise.
Please Select
Financial Information:
What is your highest academic qualification?
Grade 1-11
NSC certificate
Diploma
Degree
Post-graduate degree
Please Select
Your primary occupation?
Personal Information
How many sources of income do you have?
0
1
2
3
4+
Please Select
What is your monthly income?
How much of your monthly income can be classified as disposable income?
Do you currently have a financial planner?
Yes
No
Please Select
What are your current financial goals?
Starting a savings account.
Saving in order to buy a house. (Or some other large purchase)
Saving in order to cover your children's futures.
Better management of your finances as a whole.
Paying off your current debt.
Saving up for my own retirement.
Build up my credit score.
Currently I am satisfied with the state of my finances and don't have any financial goals at the moment.
Start building up more sources of income.
Do you currently have someone who does your taxes/finances for you?
Yes, I have an accountant.
No, I am in charge of dealing with all my finances/taxes.
Other
Please Select
Please provide us with an estimate of the value of all your assets.
Have you made any investments?
No
Yes, my investments are worth less than a R1 000.
Yes, my investments are worth less than a R10 000.
Yes, my investments are worth less than a R100 000.
Yes, my investments are worth less than a R1 000 000.
Yes, my investments are worth more than R1 000 000.
Please Select
Please specify the type of Investment.
Investments for growth.
International Investments
Education Planning
Shares Trading
Tax Free Savings
Please Select
For how long have you been investing?
Less than one month.
Less than 6 months.
Less than a year.
Less than 3 years.
Longer than 3 years.
Please Select
How well prepared are you for financial emergencies?
I have enough money saved up for any major financial emergencies.
I am prepared for minor financial emergencies.
I have assets that I can sell if I encounter a financial emergency.
I am not prepared at all.
I have insurance that should cover the majority of financial emergencies I might encounter.
Please Select
Do you currently have any outstanding debt?
No
Yes, less than R1000
Yes, less than R10 000
Yes, less than R100 000
Yes, less than R500 000
Yes, less than R1 000 000
Yes, more than R1 000 000
No option selected.
At what age do you plan on retiring?
Do you currently have a savings plan for your retirement?
Yes
No
Please Select
From the options below, please select how satisfied you are with your current financial situation.
Extremely satisfied
Satisfied
Neutral
Dissatisfied
Extremely dissatisfied
Please Select
If you are dissatisfied or extremely dissatisfied with your current financial situation, please specify what about your current financial situation you dissatisfied with.
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