Name: *
D O
B: Date
01
02 03
04 05
06 07
08 09
10 11
12 13
14 15
16 17
18 19
20 21
22 23
24 25
26 27
28 29
30 31
Month January
February March April
May June July
August September October November December
Year
1930 1931
1932 1933 1934
1935 1936 1937
1938 1939 1940
1941 1942 1943
1944 1945 1946
1947 1948 1949
1950 1951 1952
1953 1954 1955
1956 1957 1958
1959 1960 1961
1962 1963 1964
1965 1966 1967
1968 1969 1970
1971 1972 1973
1974 1975 1976
1977 1978 1979
1980 1981 1982
1983 1984 1985
1986 1987 1988
1989 1990 1991
1992 1993 1994
1995 1996 1997
1998 1999 2000
2001 2002 2003
2004 2005 2006
Address: *
Phone
Number: STD Code - *
E- Mail
ID: *
How did you
hear about us :
Annual
Income (Avg): 50,000 - 100,000
100,000 - 400,000
400,000 - 600,000
600,000 - 800,000
800,000 -
1,000,000 1,000,000 &
above
Annual
Expenses (Avg): 50,000 - 100,000 100,000 - 400,000 400,000 - 600,000 600,000 - 800,000 800,000 - 1,000,000
1,000,000 &
above
Dependants:
First Dependant:
Second
Dependant:
Third
Dependant:
Fourth
Dependant:
Fifth
Dependant:
Where do you currently invest? (Please tick
against options)
Stocks
Approx Value:
Mutual Fund
Approx Value:
Insurance
Annual Prem.:
Gov. Securities
Approx Value:
Bank Deposits
Approx Value:
Money Lending
Approx Value:
Any other Investments
Approx Value:
Your Risk taking ability
Loans
What is your investment horizon?
No. of
years?
1 yr - 2 yrs 2 yrs
- 3 yrs 3 yrs - 4
yrs 4 yrs - 5 yrs
5 yrs and
above
Minimum
returns that would satisfy
you
5 -
10% 10 - 20% 20 - 30% 30 -
40% 40 - 50% 50% and above
Would you like to be involved in all investment
decisions we take for you or just let us manage it and ask for
regular portfolio updates?
Whether open to profit sharing or Annual
Investment Advisory Fees
Do you wish to invest in Mutual Funds OR
Equities only? Please specify
Whether consulting any other Investment
Advisory company
Are you happy with their services? If not,
please give reasons.
DISCLAIMER
