| Self | Partner | |
|---|---|---|
| Surname: | [[surnameSelf]] | [[surnamePartner]] |
| First Name: | [[firstnameSelf]] | [[firstnamePartner]] |
| Title: | [[titleSelf]] | [[titlePartner]] |
| Marital Status: | [[maritalSelf]] | [[maritalPartner]] |
| Address: | [[addressSelf]] | [[addressPartner]] |
| Post code: | [[postcodeSelf]] | [[postcodePartner]] |
| Telephone No. Home: | [[telhomeSelf]] | [[telhomePartner]] |
| Telephone No. Work: | [[telworkSelf]] | [[telworkPartner]] |
| Mobile No.: | [[mobileSelf]] | [[mobilePartner]] |
| Email Address: | [[emailSelf]] | [[emailPartner]] |
| Firm (where you work): | [[firmSelf]] | [[firmPartner]] |
| Date of Birth: | [[dobSelf]] | [[dobPartner]] |
| NI Number: | [[ninumberSelf]] | [[ninumberPartner]] |
| Countries of Citizenship: | [[citizenshipSelf]] | [[citizenshipPartner]] |
| Countries of Residence (for tax purposes): | [[residencetaxSelf]] | [[residencetaxPartner]] |
| Nationalities: | [[nationalitiesSelf]] | [[nationalitiesPartner]] |
| Preferred form of contact: | [[contactprefSelf]] | [[contactprefPartner]] |
| Dependants | |||||||
|---|---|---|---|---|---|---|---|
| Name: | [[depname1]] | Sex: | [[depsex1]] | Date of birth: | [[depdob1]] | Relationship: | [[deprel1]] |
| Name: | [[depname2]] | Sex: | [[depsex2]] | Date of birth: | [[depdob2]] | Relationship: | [[deprel2]] |
| Name: | [[depname3]] | Sex: | [[depsex3]] | Date of birth: | [[depdob3]] | Relationship: | [[deprel3]] |
| Name: | [[depname4]] | Sex: | [[depsex4]] | Date of birth: | [[depdob4]] | Relationship: | [[deprel4]] |
| Name: | [[depname5]] | Sex: | [[depsex5]] | Date of birth: | [[depdob5]] | Relationship: | [[deprel5]] |
| Income Details | Self | Partner |
|---|---|---|
| Occupation: | [[occupationSelf]] | [[occupationPartner]] |
| Employed / Self Employed: | [[employmentSelf]] | [[employmentPartner]] |
| Firm Name: | [[firmnameSelf]] | [[firmnamePartner]] |
| Earned Income / Profit Share: | [[incomeprofitSelf]] | [[incomeprofitPartner]] |
| Other: | [[otherSelf]] | [[otherPartner]] |
| Property | |||
|---|---|---|---|
| Present value: | £[[propertyValue]] | ||
| Ownership: | [[propertyOwnership]] | ||
| Current mortgage: | [[currentMortgage]] | ||
| Other property owned (1): | [[otherProperty1]] | Value: | £[[otherPropertyVal1]] |
| Other property owned (2): | [[otherProperty2]] | Value: | £[[otherPropertyVal2]] |
| Other property owned (3): | [[otherProperty3]] | Value: | £[[otherPropertyVal3]] |
| Other Assets | |||
|---|---|---|---|
| Self | Partner | Joint | |
| Cash: | £[[cashSelf]] | £[[cashPartner]] | £[[cashJoint]] |
| Stocks & Shares: | £[[stockSelf]] | £[[stockPartner]] | £[[stockJoint]] |
| Pension: | £[[pensionSelf]] | £[[pensionPartner]] | £[[pensionJoint]] |
| Other: | £[[otherSelf]] | £[[otherPartner]] | £[[otherJoint]] |
| Client Adviser: | [[clientAdviser]] |