Institutional Assessment Form — IPFS Elite Wealth Management

Assessment Form

Financial Planning Questionnaire

Personal Information

Full Name (Block Letters)

Mail Address

Residential Address

City

State

Pincode

Mobile

Family Details

Category	Name	Age	PAN No
Self
Spouse

Marriage Anniversary

Children Details

Child 1
Child 2

Risk & Estate Assessment

Term Insurance (Self)

Other Insurance (Self)

Term Insurance (Spouse)

Other Insurance (Spouse)

Own a House?

Yes No

Financial Requirement if any (Rs)

Education & Marriage Planning

Category	Current Age	Marriage Req (Rs)	Education Req (Rs)
Child 1
Child 2

Retirement Planning

RETIREMENT: SELF

Retirement Year

Tenure (Years)

Req After Ret (PM)

Corpus Required (Rs)

Present Monthly Exp

RETIREMENT: SPOUSE

Retirement Year

Tenure (Years)

Req After Ret (PM)

Corpus Required (Rs)

Present Monthly Exp

Vacations & Medical Insurance

Domestic Vacation

International Vacation

Medical Insurance Company & Sum Insured

Self
Spouse
Children

Existing Investments (FDR, PPF, NSC etc)

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