| 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]] |
| 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]] |
| Children, Grandchildren and Dependants | |||||||
|---|---|---|---|---|---|---|---|
| Name: | [[depname1]] | Date of birth: | [[depdob1]] | Relationship: | [[deprel1]] | ||
| Name: | [[depname2]] | Date of birth: | [[depdob2]] | Relationship: | [[deprel2]] | ||
| Name: | [[depname3]] | Date of birth: | [[depdob3]] | Relationship: | [[deprel3]] | ||
| Name: | [[depname4]] | Date of birth: | [[depdob4]] | Relationship: | [[deprel4]] | ||
| Name: | [[depname5]] | Date of birth: | [[depdob5]] | Relationship: | [[deprel5]] | ||
| Health | Self | Partner |
|---|---|---|
| General State of Health: | [[healthSelf]] | [[healthPartner]] |
| Details of any medical conditions: | [[healthcondSelf]] | [[healthcondPartner]] |
| Income Details | Self | Partner |
|---|---|---|
| Occupation: | [[occupationSelf]] | [[occupationPartner]] |
| Share / Salaried Partner: | [[sharesalariedSelf]] | [[sharesalariedPartner]] |
| Firm Name: | [[firmnameSelf]] | [[firmnamePartner]] |
| Profit share / salary: | $[[profitshareSelf]] | $[[profitsharePartner]] |
| Bi-monthly draw: | $[[bimonthlydrawSelf]] | $[[bimonthlydrawPartner]] |
| Total Gross Income: | £[[grossincomeSelf]] | £[[grossincomePartner]] |
| Average Monthly Expenditure: | £[[averageexpenditureSelf]] | £[[averageexpenditurePartner]] |
| Property | Value | Ownership | Mortgage | Rental Income |
|---|---|---|---|---|
| [[propertyName1]] | £[[propertyValue1]] | [[propertyOwnership1]] | £[[propertyMortgage1]] | £[[propertyRental1]] |
| [[propertyName2]] | £[[propertyValue2]] | [[propertyOwnership2]] | £[[propertyMortgage2]] | £[[propertyRental2]] |
| [[propertyName3]] | £[[propertyValue3]] | [[propertyOwnership3]] | £[[propertyMortgage3]] | £[[propertyRental3]] |
| [[propertyName4]] | £[[propertyValue4]] | [[propertyOwnership4]] | £[[propertyMortgage4]] | £[[propertyRental4]] |
| [[propertyName5]] | £[[propertyValue5]] | [[propertyOwnership5]] | £[[propertyMortgage5]] | £[[propertyRental5]] |
| Other Assets | |||
|---|---|---|---|
| Self | Partner | Joint | |
| Private Equity, PEF, DIF: | $[[peSelf]] | $[[pePartner]] | $[[peJoint]] |
| Cash: | £[[cashSelf]] | £[[cashPartner]] | £[[cashJoint]] |
| Stocks & Shares: | £[[stockSelf]] | £[[stockPartner]] | £[[stockJoint]] |
| Pension: | £[[pensionSelf]] | £[[pensionPartner]] | £[[pensionJoint]] |
| Other: | £[[otherSelf]] | £[[otherPartner]] | £[[otherJoint]] |
| ESG | Self | Partner |
|---|---|---|
| Would you like the investments in your portfolio to be selected from a narrow universe which has been screened for Environmental, Social and Governance ('ESG') factors? | [[esgSelf]] | [[esgPartner]] |
| Cover | ||||
|---|---|---|---|---|
| Cover | Type | Self | Partner | Joint |
| [[coverCover1]] | [[coverType1]] | [[covertypeSelf1]] | [[covertypePartner1]] | [[covertypeJoint1]] |
| [[coverCover2]] | [[coverType2]] | [[covertypeSelf2]] | [[covertypePartner2]] | [[covertypeJoint2]] |
| [[coverCover3]] | [[coverType3]] | [[covertypeSelf3]] | [[covertypePartner3]] | [[covertypeJoint3]] |
| [[coverCover4]] | [[coverType4]] | [[covertypeSelf4]] | [[covertypePartner4]] | [[covertypeJoint4]] |
| Debt | |||
|---|---|---|---|
| Debt | Self | Partner | Joint |
| [[debtType1]] | [[debtSelf1]] | [[debtPartner1]] | [[debtJoint1]] |
| [[debtType2]] | [[debtSelf2]] | [[debtPartner2]] | [[debtJoint2]] |
| [[debtType3]] | [[debtSelf3]] | [[debtPartner3]] | [[debtJoint3]] |