Gender:
Male    Female   


Please tick in front of appropriate Choices

  What is your age Group?

Under 30 Years    31-45 Years    46-55 Years    56 + Years Years   


  What is your Qualification?
Below Higher Secondar    Higher Secondary    Graduate    Post Graduate or above


  Your Marital Status
Single    Married    Other

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  Please specify your post tax income (per annum)
Less than Rs. 3 Lakhs    Between Rs. 3-7 Lakhs    Between Rs. 7-10 Lakhs    Between Rs. 10-20 Lakhs    Above Rs. 20 Lakhs


  Number of dependants you support financially (other than yourself)
None    1-2    3-4    More than 4


  What percentage of your income do you manage to save?
Less than 10%    Between 10% to 25%    Between 26% and 50%    Over 50%


  Do you own a house property?
Yes    No   


  What is the size of your emergency fund?
I have not created an emergency fund
Between 1 to 3 months of average monthly expense
Between 4 to 6 months of average monthly expense
More than 6 months of average monthly expense


  Expected expenditure on your life goals (Like daughter’s marriage, house property etc) in next 5 Years is
Less than 3 times your annual post tax income
Less than 5 times your annual post tax income
Less than 7 times your annual post tax income
More than 7 times your annual post tax income


  Number of Years left to retirement
Less than 5 Years    Between 5 to 10 years    Between 10 to 20 years    More than 20 Years


  Do you expect to maintain your current living standard after retirement?
Strongly agree    Agree    No opinion    Disagree    Strongly disagree


  Do you expect your income to
Increase substantially     Stay ahead of inflation    Drop due to inflation or other factors


  If you win Rs. 50,00,000 in a Raffle/contest, would you
Spend the entire amount    Invest in FDs    Invest in stocks for a long term    Indulge in short term speculation


  You have saved a long while to buy an expensive car. A week before you buy the car, you lose your job. Would you:
Postpone your purchase
Buy a new but not the expensive one you saved for
Go ahead with your purchase plan and buy the same car
Buy the same car and go on a one week vacation to celebrate the new purchase


  If the value of your investments drop by 10% in a year would you immediately switch to all cash
Strongly agree    Agree    No opinion    Disagree    Strongly disagree


  You prefer having your savings in the bank and do not mind a return of 4.5%
Strongly agree    Agree    No opinion    Disagree    Strongly disagree


   While making an investment, I plan to hold the investment for
< 1 year    1-3 years    3-5 years    > 5 years


  I would invest in a mutual fund based on
Random decision    Conversation with friends, co worker or a relative    Self research    Research by professionals


   When it comes to investing, how do you rate your financial quotient on a scale of 1-10
1-2    3-4    5-6    > 7-8    > 9-10


  Which of the following portfolios would you like to invest in
Low risk / low return portfolio
Low to mod risk / low to mod return portfolio
Moderate risk / moderate return portfolio
Mod to high risk / mod to high return portfolio
High risk / high return portfolio


   What would you prefer?
Aggressive capital appreciation
Invest more for capital appreciation than current income
Invest in a balance manner (Capital appreciation & current income)
Invest for generating current income
I would not invest, rather redeem my investments to meet short term goals


Fixed (Yearly Expenses) Rs. Variable (Yearly Expenses) Rs.
Housing & Household Operations Transportation
Food (Groceries) Recreation
Health & Medical Care Clothing
Utilities All Other
Other    
SUB TOTAL SUB TOTAL
       

   Retirement and Financial Independence Planning Concepts (if applicable)

Amount you are contributing towards financial independence each Year  
     
Year if applicable, at what age would you like to be financially independent/ retired  
     
Through what age are might you want to live on investments and pensions  
     
How much monthly income, in today’s Rupee, would you be comfortable with?  
     


    Liabilities (Debts)

Mortgage or loan Interest rate % Payment/month Balance Due
       


    Life and Health Insurance

Name Type Benefits Amounts & Limits Annual Premium