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SAPPHIRE.
Many facets of life.
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One cutting edge solution for all your financial needs.
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All information collected in this financial review will be held in strict confidence.
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Name of Client 1 : sasd dasd sasd dasd sasd dasd sasd dasd sasd dasd sasd dasd sasd dasd
Name of Client 2 :
Date of Review : 09/03/2017
Name of Aviva Financial

Adviser's Representative
(AFA Representative) : N.A
MAS Representative No. : N.A
AFA Representative Code : N.A
Handphone : N.A
Email Address : N.A
Personal Finanacial
Record_AFA_v2.0_Oct2016
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Personal Financial Record_AFA_v2.0_Oct2016
Aviva Financial Advisers Pte Ltd 51 Cuppage Road, #03-08/09/10, Singapore 229469 T: +65 6827 7988 Website: www.avivafa.com.sg Page 3 of 30
Company Reg No. 200005578H
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STEP 1: LETS GET TO KNOW YOU
(*These fields are compulsory)
DETAILS CLIENT 1 CLIENT 2

Salutation Mr Mrs Mdm Miss Dr Mr Mrs Mdm Miss Dr
Family Name* sasd dasd sasd dasd sasd dasd sasd N.A
Given Name* sasd dasd sasd dasd sasd dasd sasd N.A
Gender Male Female Male Female
Smoker No Yes No Yes
Marital Status Single Married Widowed Single Married Widowed

Separated Divorced Separated Divorced
NRIC / Passport Number* 845213679 N.A

Date of Birth (DD/MM/YYYY)* 05/05/1990 N.A
Age 27 N.A
Email Address sasd dasd sasd dasd sasd dasd sasd N.A
Contact Number* (HP) +65 54621382 (HP) N.A
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(At least one)
(O) N.A (O) N.A
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(H) N.A (H) N.A
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Residential Address* 364 Cong Hoa
Singapore City
Singapore
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Occupation* N.A N.A

Name and Address sasd dasd sasd dasd sasd dasd sasd N.A
of Employer*
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N.A N.A
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Nature of Business Accounting /Finance Involved in production/ Accounting /Finance Involved in production/
distribution of military distribution of military
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Casino/Other types Casino/Other types

of gaming/ gambling products of gaming/ gambling products
operations Money Service Business operations Money Service Business
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Consulting Professional Services Consulting Professional Services

Research & Research &
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Engineering Engineering
Development Development
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Executive/ Executive/
Sales/Marketing/ Sales/Marketing/
Management Management
Advertising Advertising
Government/Military Government/Military
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Others, please specify: Others, please specify:
Annual Income 0 N.A
Employment Status* Full time Part time Self Employed Full time Part time Self Employed
Not Employed Retired Not Employed Retired
Others: Others:
Highest Education Level* Primary Primary

Secondary Secondary
GCE 'N' or 'O' Level Certificate or GCE 'N' or 'O' Level Certificate or
Equivalent Academic Qualification Equivalent Academic Qualification
Pre-Tertiary Pre-Tertiary
Tertiary and above Tertiary and above
Language Proficiency* Proficient in spoken English Yes No Proficient in spoken English Yes No
Proficient in written English Yes No Proficient in written English Yes No
STEP 1: LETS GET TO KNOW YOU (continued)
For Accident & Health policy application, please complete this section for dependant(s) if the policy owners dependant(s) is/are the life insured.
CLIENTS ACCOMPANIMENT
Would you like to be accompanied by a Trusted Individual? Yes No
If Yes, please complete the details below:
Name of Trusted Individual Relationship to Client NRIC Number
N.A N.A N.A
Note: A Trusted Individual? is a person who is/has:
(i) At least aged 18;
(ii) At least GCE N or O Level Certificate, or equivalent academic qualification;
(iii) Proficient in spoken or written English; and
It is recommended for you to be accompanied by a Trusted Individual if you belong to any two of the following profile:
(i) 62 years of age or older;
(ii) Not proficient in spoken or written English
YOUR LOVED ONE'S DETAILS (DEPENDANTS)
Would you like your dependant(s) to be taken into consideration for the Needs Analysis and Recommendation(s)? Yes No
Date of Birth Income (if Years to

Family Name Given Name Gender Relationship Occupation
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(DD/MM/YYYY) applicable) Support
sasd dasd sasd dasd ava sasd dasd sasd sasd dasd sasd Actor/Actress - No Stunt
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Male 12/12/2015 Work 0 20
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STEP 2 : LETS ESTABLISH YOUR FINANCIAL GOALS

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Note: This is a summary of financial goals. Please tick those that you want to address.
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WEALTH PROTECTION GOALS

Dependent Dependent Dependent Dependent Dependent
Financial Goals Client 1 Client 2
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Income Protection Upon Death

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Disability Planning
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Critical Illness Planning

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Hospital & Surgical Expenses
Long-term Care Planning
WEALTH ACCUMULATION GOALS

Dependent Dependent Dependent Dependent Dependent
Financial Goals Client 1 Client 2
1 2 3 4 5
Retirement Planning
Medium / Long-term Investments
Education Funding
Others: N.A
STEP 3 : LETS DETERMINE YOUR CURRENT FINANCIAL POSITION
CASH FLOW
Would you like your cash flow to be taken into consideration for the Needs Analysis and Recommendation(s)?
Client 1 Yes No. Please state reason: sasd dasd sasd dasd sasd dasd sasd dasd sasd dasd sasd dasd
sasd dasd sasd dasd sasd dasd sasd dasd sasd dasd sasd dasd
sasd dasd sasdj
Client 2 Yes No. Please state reason: N.A
ANNUAL INCOME Client 1 Client 2 Dependant Dependant Dependant Dependant Dependant

1 2 3 4 5
Annual Income 0 N.A 0 N.A N.A N.A N.A
Less: Employees CPF Contribution 0 N.A 0 N.A N.A N.A N.A
A. Net Annual Income 0 N.A 0 N.A N.A N.A N.A
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B. Other Income 0 N.A 0 N.A N.A N.A N.A
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C. TOTAL TAKE-HOME INCOME ( A + B ) 0 N.A 0 N.A N.A N.A N.A
ANNUAL EXPENSES Client 1 Client 2 Dependant

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Dependant
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Dependant
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Dependant
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Fixed (e.g. loans, insurance) 0 N.A N.A N.A N.A N.A N.A
Personal (e.g. meals, communications, transport) 0 N.A N.A N.A N.A N.A N.A
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Family (e.g. groceries, utilities, allowance to parents) 0 N.A N.A N.A N.A N.A N.A
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Lifestyle (e.g. entertainment, vacations, luxuries) 0 N.A N.A N.A N.A N.A N.A
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Others 0 N.A N.A N.A N.A N.A N.A

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D. TOTAL ANNUAL EXPENSES 0 N.A 0 N.A N.A N.A N.A

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NET CASH FLOW ( C D ) 0 N.A 0 N.A N.A N.A N.A

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Do you have any plans or are there any factors within the next 12 months that may significantly increase or decrease your net cash flow? Please specify:
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Client 1 No Yes. Please specify: N.A
Client 2 No Yes. Please specify: N.A
Dependant 1 No Yes. Please specify: N.A

STEP 3 : LETS DETERMINE YOUR CURRENT FINANCIAL POSITION (continued)
BALANCE SHEET
Would you like your assets and liabilities to be taken into consideration for the Needs Analysis and Recommendation(s)?
RETURN ON Dependant Dependant Dependant Dependant Dependant

ASSETS Client 1 Client 2
INVESTMENT* (%) 1 2 3 4 5
Car 0 620,000 N.A 0 N.A N.A N.A N.A

Cash 0 0 N.A 0 N.A N.A N.A N.A
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CPF - Ordinary Account 2.5 0 N.A 0 N.A N.A N.A N.A
1
CPF - Special Account 4 0 N.A 0 N.A N.A N.A N.A
1
CPF - Medisave 0 0 N.A 0 N.A N.A N.A N.A
Property 0 0 N.A 0 N.A N.A N.A N.A
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SRS 0.5 0 N.A 0 N.A N.A N.A N.A
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Stocks / Shares 0 0 N.A 0 N.A N.A N.A N.A
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Unit Trusts / ILPs 0 0 N.A 0 N.A N.A N.A N.A
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Others 0 0 N.A o 0 N.A N.A N.A N.A
A. TOTAL ASSETS 620,000 N.A 0 N.A N.A N.A N.A

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LIABILITIES Client 1 Client 2 Dependant Dependant Dependant Dependant Dependant

1 2 3 4 5
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Car Loan 0 N.A 542000 N.A N.A N.A N.A

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Mortgage 0 N.A 0 N.A N.A N.A N.A

Overdrafts 0 N.A 0 N.A N.A N.A N.A
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Others 0 N.A 0 N.A N.A N.A N.A

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B. TOTAL LIABILITIES 0 N.A 542000 N.A N.A N.A N.A

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NET WORTH ( A B ) 620,000 N.A -542000 N.A N.A N.A N.A

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BUDGET
Source of Funds Annual Amount ($) Single Amount ($)
Cash 30,000 N.A

CPF - Ordinary Account N.A 22,500
CPF - Special Account 1,200 N.A
CPF - Medisave N.A N.A
SRS N.A N.A
Is the budget you set aside a substantial* portion of your assets or surplus? If 'Yes', please provide justification
No Yes Please
If the answer is 'Yes', you may encounter a potential risk in future of not being able to continue paying your premiums.
*Budget is considered substantial if it is more than 50% assets or surplus.
* Based on client's estimated expectations

1 2 3
CPF: Central Provident SRS: Supplementary Retirement ILPs: Investment-Linked Insurance
YOUR EXISTING INSURANCE AND INVESTMENT DETAILS
Would you like your existing insurance and investment portfolio to be taken into consideration for the Needs Analysis and Recommendation(s)?
Client 1 Yes No. Please state reason: sasd dasd sasd dasd sasd dasd sasd dasd sasd dasd
Dependant(s) Yes No. Please state reason: sasd dasd sasd dasd sasd dasd sasd dasd sasd dasd
EXISTING LIFE / HEALTH INSURANCE POLICIES

Name of Type of Sum Assured
4
Year Policy Premium
Name of Insured* (Compulsory) Company Policy
Issued Term (Yearly) Death TPD
1
CI
2
Acc / H & S
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Total 0 0 0 0
HEALTH CONDITION
Do you or any applicant have any medical condition which requires regular attention from a doctor in a clinic or hospital?
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Client 1 No Yes. If Yes, what is this medical condition? N.A
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Client 2 No Yes. If Yes, what is this medical condition?
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Dependant 1 No Yes. If Yes, what is this medical condition?
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Dependant 2 No Yes. If Yes, what is this medical condition? N.A

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EXISTING INVESTMENTS
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Name of Owner Type of Investment Source of Funds

Investment Amount
(e.g. Stocks, Bonds, Unit Trusts, Managed Account) (Cash / CPF / SRS)
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Additional notes: (if any)

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TPD - Total and Permanent Dability CI - Critical Illness Acc / H & S - Accident / Hospitalisation and Surgical To indicate at least one type of Sum Assured
The following risk tolerance questionnaire is designed to measure an individual's ability (time horizon) and willingness (risk tolerance) to accept uncertainties in
investment performance. Total score recommends the most appropriate risk profile.
RISK PROFILE
Time Horizon Client 1 Client 2
1. How long will you be able to hold your investment account (without making any withdrawals)?
a. Less than 2 years a a
b. 2 years b b
c. 3 to 4 years c c
d. 5 to 7 years d d
e. 8 to 10 years e e
f. 11 years or more f f
2. Once you begin withdrawing money from your invesment account, how long do you expect the withdrawals
to last?
a. I plan to take a lump sum a a
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b. 1 to 4 years b b
c. 5 to 7 years c c
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d. 8 to 10 years d d
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e. 11 years or more e e
Risk Tolerance
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3. Which of the following choices best reflects your attitude toward inflation and risk?
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a) Avoid loss, even though I may only keep pace with inflation. a a
b) Earn slightly more than inflation, while taking on a low level of risk. b b
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c) Increase my portfolio's value. Therefore, I am willing to accept short-term losses, but I am not c c
comfortable with extreme performance shifts that may be experienced in the most aggressive
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investment options.
d) Maximise my portfolio value and I am willing to take on more extreme levels of risk and performance d d
shifts in my portfolio to achieve this.
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4. The table below presents a hypothetical 'worst case loss', 'expected value', and 'best case gain' of five
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sample portfolios over a one-year period with an initial $100,000 investment.

Which portfolio would you prefer to hold?
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Hypothetical Expected Hypothetical

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Best Case ($) Value ($) Worst Case ($)

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Porfolio 1 118,472 105,367 88,699 a) Portfolio 1 a) Portfolio 1
Porfolio 2 123,434 106,504 85,564 b) Portfolio 2 b) Portfolio 2
Porfolio 3 129,825 107,770 81,455 c) Portfolio 3 c) Portfolio 3
Porfolio 4 134,886 108,574 78,073 d) Portfolio 4 d) Portfolio 4
Porfolio 5 140,098 109,384 74,791 e) Portfolio 5 e) Portfolio 5
5. Investing involves a trade-off between risk and return. Which statement best describes your investment
goals?
a. Protect the value of my account. a a

In order to minimise the chance for loss, I am willing to accept the lower long-term returns provided by
conservative investments.
b. Keep risk to a minimum while trying to achieve slightly higher returns than the returns provided b b
by investment that are more conservative.
c. Focus more on the long-term investment returns. c c
Long-term growth is equally as important as managing portfolio risk.
d. Maximise long-term investment returns. d d

I am willing to accept large and sometimes dramatic short-term fluctuations in the value of my
investments.
RISK PROFILE
Client 1 Client 2
6. Historically, markets have experienced downturns, both short-term and prolonged, followed by market
recoveries. Suppose you owned a well-diversified portfolio that fell by 20% (i.e. $1,000 initial investment
would now be worth $800) over a short period, consistent with the overall market. Assuming you still have
10 years until you begin withdrawals, how would you react?
a) I would not change my portfolio. a a
b) I would wait at least one year before changing to options that are more conservative. b b
c) I would wait at least three months before changing to options that are more conservative. c c
d) I would immediately change to options that are more conservative. d d
7. The following graph shows the hypothetical best and worst results of five sample portfolios over a
one-year holding period. Note that the portfolio with the highest upside also has the largest downside.
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Which of these portfolios would you
prefer to hold?
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a) Portfolio 1 a) Portfolio 1
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c) Portfolio 3 c) Portfolio 3
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d) Portfolio 4 d) Portfolio 4
e) Portfolio 5 e) Portfolio 5
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8. I am comfortable with investments that may frequently experience large declines in value if there is a
potential for higher returns. Does this describe you?
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a) Strongly disagree a a
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b) Disagree b b
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c) Somewhat agree c c
d) Agree d d
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e) Strongly agree e e
CLIENT 1
TIME HORIZON AND RISK AVERSION SCORE
TIME HORIZON SCORE RISK AVERSION SCORE
Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8
A 0 0 0 0 0 16 17 0
B 1 2 6 4 5 10 13 5
C 3 4 11 8 10 5 9 9
D 7 5 17 12 17 0 5 13
E 9 6 17 0 16
F 11
TOTAL SCORE 4 70
SUMMARY SCORING GRIDS

RISK AVERSION TIME HORIZON SCORE
Score 1-2 3-5 6-7 8 - 10 11+
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0 - 14 C C C C C
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15 - 35 C MC MC MC MC
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36 - 64 C MC M M M
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65 - 83 C MC M MA MA
84 - 100 C MC M MA A
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CLIENT 2
TIME HORIZON AND RISK AVERSION SCORE
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TIME HORIZON SCORE RISK AVERSION SCORE

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Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8
A 0 0 0 0 0 16 17 0
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B 1 2 6 4 5 10 13 5
C 3 4 11 8 10 5 9 9
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D 7 5 17 12 17 0 5 13
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TOTAL SCORE N.A N.A
SUMMARY SCORING GRIDS

RISK AVERSION TIME HORIZON SCORE
Score 1-2 3-5 6-7 8 - 10 11+
0 - 14 C C C C C
15 - 35 C MC MC MC MC
36 - 64 C MC M M M
65 - 83 C MC M MA MA
84 - 100 C MC M MA A
*Note: If you have a time horizon score of zero, even the most conservative product may not be an appropriate option. You should speak to your AFA Representative
before making your selection.
C - Conservative MC- Moderately-Conservative M - Moderate MA - Moderately-Aggressive A - Aggressive
NOTE: The information, data, analyses and opinions ("Information") contained herein: (1) include the proprietary information of Morningstar; (2) may not be copied or
redistributed except as specifically authorised; (3) do not constitute investment advice; (4) are provided solely for informational purposes; and (5) are not warranted to be
complete, accurate or timely. Morningstar is not responsible for any trading decisions, damages or other losses related to the Information or its use. Please verify all of the
Information before using it and don't make any investment decisions except upon the advice of a professional financial adviser. The Information is designed to help
professional financial advisers in selecting an appropriate portfolio, if any, for their client. Any use of this information outside of its design is the responsibility of the
professional financial adviser, not Morningstar. Past performance is no guarantee of future results. The value and income derived from investments may go down as well as up.
STEP 4 : CUSTOMER KNOWLEDGE ASSESSMENT (CKA)
CKA
The Customer Knowledge Assessment is a simple questionnaire where we require you to furnish us with information pertaining to your education qualifications,
investment experience and working experience. The purpose of the assessment is to assess whether you possess the relevant knowledge or experience to
understand the features and associated risk of an unlisted Specified Investment Product, such as Collective Investment Scheme (CIS) or Investment-Linked Policy
(ILP). You will need to satisfy just one of the 3 criteria in order to fulfill or pass? the Customer Knowledge Assessment.
If you pass? the Customer Knowledge Assessment, you are assessed to possess relevant knowledge or experience; you may proceed with the purchase of an ILP
or a unit in a CIS for a period of one year from the date of the assessment.
If you fail? the Customer Knowledge Assessment, you are assessed not to possess relevant knowledge or experience. If you intend to proceed with the transaction,
your AFA Representative will provide advice on whether the ILP or a unit in a CIS is suitable for you, taking into account your investment objectives, financial situation
and particular needs.
Regardless of the outcome of the assessment, in the event you do not wish to receive advice or accept your AFA Representatives recommendations concerning the
Investment product, (i) it is your responsibility to ensure the suitability of the CIS or ILP selected and (ii) you will not be able to rely on Section 27 of the Financial
Advisers Act (Cap 110) to file a civil claim in the event you allege you have suffered a loss and (iii) your request to transact in the CIS or ILP will be subjected to the
companys senior managements review and approval.
Please note that any inaccurate or incomplete information provided by you may affect the outcome of your Customer Knowledge Assessment and the suitability of the
product recommended, if any.
Client 1 Client 2
1. Investment Experience
Have you traded six or more transactions in investment- No Yes No Yes
Linked Products and/or unit trusts in the last three years?
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Please specify the full name of the Financial Institution(s)
where the transactions were carried out and any other
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relevant information.
2. Education Experience and/or Professional
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Finance-Related Qualifications
Do you have any of the following qualification? No Yes No Yes
a) Diploma or higher qualification in the following:
Accountancy Li
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Actuarial Science
Business/Business Administration/
Business Management/ Business Studies
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Capital Markets
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Commerce
Economics
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Finance/Financial Engineering
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Financial Planning/Insurance
Computational Finance
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Please also specify the full name of the Education

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Institution(s) in which the above qualification(s) were

obtained and any other relevant information.
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b) Professional finance-related qualifications No Yes No Yes

Chartered Financial Analyst (CFA)
Association of Chartered Certified Accountants (ACCA)
Chartered Institute of Securities & Investment (CISI)
Chartered Alternative Investment Analyst (CAIA)
Certified Financial Technician (CFTe)
Financial Risk Manager (FRM)
Chartered Financial Consultant (ChFC)

Associate Financial Planner (AFP)
Chartered Financial Planner (CFP)
Associate Wealth Planner (AWP)
Please specify the full name of the Education Institution(s)

in which the above qualification(s) were obtained and any
other relevant information.
STEP 4 : CUSTOMER KNOWLEDGE ASSESSMENT (CKA) (continued)
CKA
Client 1 Client 2
3. Working Experience
Do you have a minimum of three continuous years of No Yes No Yes
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relevant work experience in the preceding ten years in the
following areas:
Development/Structuring/Management/Sale/Trading/
Analysis/Research of Investment Products
Provision of training in investment products
Accountancy
Actuarial Science
Treasury or Financial Risk Management Activities
Legal work in relevant financial areas
Please also specify the full name of the business

organisation(s) where the above work experience was
obtained and any other relevant information.
1 Support functions in the above-mentioned areas that are administrative or clerial in nature (for example: Operations, Human Resources, Corporate Services and
IT) will not be considered as relevant experience.
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OUTCOME OF CKA
Based on the guidelines prescribed by the Monetary Authority of Singapore (MAS), if any of the above Client 1 Client 2
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responses is 'Yes', you are deemed to have the relevant investment knowledge and/or experience for the
purposes of this assessment.
You are assessed
TO HAVE PASSED the relevant knowledge and/or experience to understand and purchase "Specified Li
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Investment Products".
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NOT TO HAVE PASSED the relevant knowledge and/or experience to understand and purchase "Specified
Investment Products".
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YOUR ACKNOWLEDGEMENT ON CKA OUTCOME

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I acknowledge that
I have been given a clear explanation of the objectives for the Customer Knowledge Assessment (CKA);
I have answered all the relevant questions to the best of my knowledge;
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I understand and agree with the outcome of the Client Knowledge Assessment
Please TICK and ACKNOWLEDGE as appropriate Client 1 Client 2

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PASS CKA (Valid for 1 year)

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I understand that I have PASSED the CKA assessment and I DO NOT WISH to receive any advice offered
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by my AFA Representative. I understand that by choosing not to receive any advice, I will not be able
to rely on section 27 of the Financial Advisers Act (FAA) to file a civil claim in the event of a loss.
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I understand that I have PASSED the CKA assessment and WISH to receive advice offered to me by
my Adviser Based on the assessment of the suitability of the investment product, I have been advised that:
The investment product/s that I intend to invest in is/are SUITABLE for me, and I would like to PROCEED
with the investment
The investment product/s that I intend to invest in is/are NOT SUITABLE for me, and I would like to
PROCEED with the investment
DID NOT PASS CKA (A fresh CKA is required for every transaction)
I understand that I DID NOT PASS the CKA assessment and I WISH TO PROCEED with my investment.
I understand that I will need to receive advice from my AFA Representative, who will assess and advise
me on the suitability of the investment product for my investment. Based on the assessment of the
suitability of the investment product, I have advised that:

The investment product/s that I intend to invest in is/are SUITABLE for me, and I would like to PROCEED
with the investment
The investment product/s that I intend to invest in is/are NOT SUITABLE for me, but I choose to PROCEED
with the investment*.
*To be submitted together with the Senior Management's Approval Form.
STEP 4 : CUSTOMER KNOWLEDGE ASSESSMENT (CKA) (continued)
SECTION 27, FINANCIAL ADVISERS ACT - EXTRACT

Recommendations by licensed financial adviser
27. - (1) No licensed financial adviser shall make a recommendation with respect to any investment product to a person who may reasonably be expected to rely
on the recommendation if the licensee does not have a reasonable basis for making the recommendation to the person.
(2) For the purposes of subsection (1), a licensed financial adviser does not have a reasonable basis for making a recommendation to a person unless -
(a) he has, for the purposes of ascertaining that the recommendation is appropriate, having regard to the information possessed by him concerning the
investment objectives, financial situation and particular needs of the person, given such consideration to, and conducted such investigation of, the subject-
matter of the recommendation as is reasonable in all the circumstances; and
(b) the recommendation is based on the consideration and investigation referred to in paragraph (a).
(3) Where - (a) a licensee, in making a recommendation to a person, contravenes subsection (1);
(b) the person, in reliance on the recommendation, does a particular act, or refrains from doing a particular act;
(c) it is reasonable, having regard to the recommendation and all other relevant circumstances, for the person to do that act, or to refrain from doing that
act, as the case may be, in reliance on the recommendation; and
(d) the person suffers loss or damage as a result of doing that act, or refraining from doing that act, as the case may be, then, without prejudice to any
other remedy available to that person, the licensed financial adviser is liable to pay damages to that person in respect of that loss or damage.
(4) In this section, a reference to the making of a recommendation is a reference to the making of a recommendation expressly or by implication.
(5) This section shall not apply to any licensed financial adviser or class of licensed financial advisers in such circumstances or under such conditions as may
be prescribed.
STEP 5 : LET'S ANALYSE YOUR FINANCIAL GOALS

For Accident & Health policy application, please complete this section for dependant(s) if the policy owner's dependent(s)' is/are the life insured.
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INCOME PROTECTION UPON DEATH
Dependant Dependant Dependant Dependant Dependant
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Client 1 Client 2
1 2 3 4 5
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Annual Cash Need (PMT) 210,000 N.A
Years to Support
35 N.A
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Cash Need (n)
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Net Rate of Return

(adjusted for inflation) (i) N.A N.A
A. CAPITAL SUM
REQUIRED (PVAD) 1,117,533 N.A
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N.A N.A
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Final Expenses
Emergency Fund N.A N.A

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Mortage N.A N.A

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Personal Debts N.A N.A

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Others N.A N.A

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B. TOTAL CASH
OUTFLOW 304,320 N.A
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TOTAL ( A + B ) 1,421,853 N.A

Less: Existing Insurance
Coverage on
Death
Less: Existing Resources
(if any) 0 N.A
Net amount required 1,346,653 N.A
Additional notes: sasd dasd N.A

STEP 5: LET'S ANALYSE YOUR FINANCIAL GOALS
For Accident & Health policy application, please complete this section for dependant(s) if the oplicy owner's dependent(s)' is/are the life insured.

DISABILITY PLANNING
Client 2 Dependant Dependant Dependant Dependant Dependant
Client 1
1 2 3 4 5
Annual Cash
Need (PMT) 1,245,000 N.A N.A N.A N.A N.A N.A
Years to Support
Cash Need (n) 7 N.A N.A N.A N.A N.A N.A
Net Rate of Return
(adjusted for inflation) (i) N.A N.A N.A N.A N.A N.A N.A
A. CAPITAL SUM
REQUIRED (PVAD) 8,662,988 N.A N.A N.A N.A N.A N.A
Medical Expenses N.A N.A N.A N.A N.A N.A N.A

B. TOTAL CASH
OUTFLOW
750,000 N.A N.A N.A N.A N.A N.A
TOTAL ( A + B ) 9,412,988 N.A N.A N.A N.A N.A N.A

Coverage on N.A N.A N.A N.A N.A N.A N.A
Disability
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Less: Existing Resources
(if any) 0 N.A N.A N.A N.A N.A N.A
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Net amount required 9,037,788 N.A N.A N.A N.A N.A N.A
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sasd dasd
Additional notes: N.A N.A N.A N.A N.A N.A
sasd dasd
sasd dasd
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sasd dasd
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sasd dasd
sasd dasd CRITICAL ILLNESS PLANNING
sasd dasd Dependant Dependant Dependant Dependant Dependant
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Client 1 Client 2
sasd dasd 1 2 3 4 5
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Annual Cash sasd dasd

Need (PMT) 535,200
sasd dasd N.A N.A N.A N.A N.A N.A
Years to Support sasd dasd
23 N.A N.A N.A N.A N.A N.A
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Cash Need (n) sasd dasd

Net Rate of Return sasd dasdN.A N.A N.A N.A
N.A N.A N.A
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(adjusted for inflation) (i) sasd dasd

A. CAPITAL SUM sasd dasd
5,805,742 N.A N.A N.A N.A N.A N.A
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REQUIRED (PVAD)
sasd dasd
sasd dasd
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Medical Expenses N.A N.A N.A N.A N.A N.A N.A

sasd dasd
B. TOTAL CASH
sasd dasd
352,000 N.A N.A N.A N.A N.A N.A
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OUTFLOW
sasd dasd
TOTAL ( A + B ) 6,157,742
sasd dasd N.A N.A N.A N.A N.A N.A
Less: Existing Insurance sasd dasd
Coverage on sasd dasdN.A N.A N.A N.A N.A N.A N.A
Disability sasd dasd
Less: Existing Resources sasdj
(if any)
Additional notes: sasd dasd N.A N.A N.A N.A N.A N.A
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
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STEP 5: LET'S ANALYSE YOUR FINANCIAL GOALS (continued)
For Accident & Health policy application, please complete this section for dependant(s) if the oplicy owner's dependent(s)' is/are the life insured.

HOSPITAL & SURGICAL EXPENSES
Client 1 Client 2
1 2 3 4 5
Type of Hospital Choice Private N.A N.A N.A N.A N.A N.A
Choice of Class Ward 1 B N.A N.A N.A N.A N.A N.A
Existing Hospital Cover:

sasd dasd
N.A N.A N.A N.A N.A N.A
sasd dasd
sasd dasd
1. Name of Existing Plan N.A N.A N.A N.A N.A N.A
sasd dasd
2. Type of Hospital Choice Public N.A N.A N.A N.A N.A N.A
1
3. Type of Class Ward
C N.A N.A N.A N.A N.A N.A
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sasd dasd
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sasd dasd
sasd dasd
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sasd dasd
sasd dasd
sasd dasd
sasd dasd Li
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sasd dasd
-N
sasd dasd
sasd dasd
sasd dasd
O
sasd dasd
EM
sasd dasd
sasd dasd
sasd dasd
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sasd dasd
sasd dasd
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sasd dasd
sasd dasd
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sasd dasd
sasd dasd
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sasd dasd
sasd dasd
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sasd dasd
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(*) Circle where appropriate
1
A: Any standard ward of a Private Hospital B: Any standard ward of a Public Hospital C: Any 4-bed (B1) standard ward of a Public Hospital
D: Any 6-bed (B2) standard ward of a Public Hospital
LONG-TERM CARE PLANNING
Client 1 Client 2
1 2 3 4 5
Desired Monthly
Cash Payout 510,000 N.A N.A N.A N.A N.A N.A
Maximum Payout
Period 12 N.A N.A N.A N.A N.A N.A

Benefit Payout 453,200 N.A N.A N.A N.A N.A N.A
Net amount required 56,800 N.A N.A N.A N.A N.A N.A
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
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sasd dasd
sasd dasd
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sasd dasd
sasd dasd
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sasd dasd
sasd dasd
sasd dasd
sasd dasd Li
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sasd dasd
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sasd dasd
sasd dasd
sasd dasd
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sasd dasd
sasd dasd
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STEP 5 : LET'S ANALYSE YOUR FINANCIAL GOALS (continued)
WEALTH ACCUMULATION GOALS

RETIREMENT PLANNING
Client 1 Client 2 Dependant Dependant Dependant Dependant Dependant
Expected Retirement Age 33 N.A N.A N.A N.A N.A N.A

Number of Years to Retirement (n) 66 N.A N.A N.A N.A N.A N.A
EITHER Income Method of
(Tick )
Annual Income (PV) N.A N.A N.A N.A N.A N.A N.A
Rate of Income Increment (%) (i) N.A N.A N.A N.A N.A N.A N.A
Income at Retirement Age (FV) 0 N.A N.A N.A N.A N.A N.A
(%) of Income Required at N.A N.A N.A N.A N.A N.A N.A
Income required at
Retirement (PMT)
Expense Method of Calculation
OR
(Tick )
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Retirement Expenses (in 720,000 N.A N.A N.A N.A N.A
N.A
today's value) (PV)
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Inflation Rate (%) (i) 5 N.A N.A N.A N.A N.A N.A
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Expenses at Retirement 18,022,96
(FV, 5
Years to Receive Retirement
35 N.A N.A Li N.A N.A N.A N.A
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Income (n)
-N
Net Rate of Return (adjusted

for inflation) (i)
N.A N.A N.A N.A N.A N.A N.A
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Cash Need at Retirement Age 375,546,8

(PVAD) 57
EM
Less: Future Value of Existing

Resources for Retirement
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(Assets for Retirement *

ROI ) 1
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sasd dasd
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MEDIUM / LONG-TERM INVESTMENTS / OTHERS

Client 1 Client 2 Dependant Dependant 2 Dependant Dependant Dependant
Objective of Goal 462,000 N.A N.A N.A N.A N.A N.A

Goal Description sasd dasd N.A N.A N.A N.A N.A N.A
Years to Reach Goal 5 N.A N.A N.A N.A N.A N.A
Less: Existing Resources for Goal *
ROI 1
Net amount required

462,000 N.A N.A N.A N.A N.A N.A
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasd dasd
sasdj
1 ROI - Return On Investment
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STEP 5 : LET'S ANALYSE YOUR FINANCIAL GOALS (continued)
"WEALTH ACCUMULATION GOALS"

"EDUCATION FUNDING"
Child 1 Child 2 Child 3
Name N.A N.A N.A
Years to Tertiary Education (n) N.A N.A N.A
No. of Years of Study (n) N.A N.A N.A
Annual Tuition Fees (PV) N.A N.A N.A
Education Inflation Rate (in %) (i) N.A N.A N.A
Future Value of Annual Tuition Fees (FV) N.A N.A N.A
A. TOTAL TUITION FEES N.A N.A N.A
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Annual Living Costs (PV) N.A N.A N.A
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Inflation Rate (in %) (i) N.A N.A N.A
Li
Future Value of Annual Living Costs (FV) N.A
o N.A N.A
B. TOTAL LIVING COSTS N.A N.A N.A

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TOTAL EDUCATION FUNDING (A + B) N.A N.A N.A

O
Less: Future Value of Existing Resources for Education

1
(Total Assets for Education * Gross ROI ) N.A N.A N.A
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Net amount required N.A N.A N.A

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Additional notes:
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- Child 1: N.A
- Child 2: N.A
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- Child 3: N.A
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1
ROI Return On Investment
STEP 6: LETS TAKE ACTION AND IMPLEMENT YOUR FINANCIAL PLAN
BASIS OF RECOMMENDATION
Client's Objective(s)
Client's concern, investment objectives, shortfall amount ($), time horizon, investment risk profile, where applicable
vxcv
Plans Recommendation
Full name of plan and rider, duration, sum assured ($), premium ($)/frequency, fund name(s), investment amount and respective risk classification, where
applicable
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Name of Policy Owner/ Full name of Sum Policy Premium Payment Client's choice
Life Assured Plans and rider (s) Assured ($) Term ($) Frequency
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asd asdas 54,000 10 3430000 Yearly
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Applicable for recommendations on Investment-Linked Plans/Collective Investment Schemes Products
Note: For Investment-Linked Plans, please state the Fund Name, Investment Amount and Fund's Risk Category
Fund Name Investment Amount ($)
Li Fund's risk category Client's choice
o
0
-N
Applicable for Switching of Fund(s)

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Switch from Account Switch to Account No.: Client's choice

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Name of Fund to be Switch Out Amount $ or % Name of Fund to be Switch Into Amount $ or %
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Plans Recommended and Reasons

D
State how the plan meets client's need(s)

State and explain features and benefits relating to the product sold
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Affordability, considerations before purchasing (where applicable), remaining shortfall (if any)
N.A
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STEP 6 : LETS TAKE ACTION AND IMPLEMENT YOUR FINANCIAL PLAN (continued)
BASIS OF RECOMMENDATION
Fees and Charges / Risks / Disadvantages of Plans
Sales charges, ongoing charges
State the risks and disadvantages for the recommended plans AND the attached riders based on client's circumstances
State free look / cancellation period
sdffsd
Reasons for Deviation(s)

Reasons for any deviation from Client's profile, objectives and / or representative's recommendations (where applicable)
Premiums deviate from Client's budget
Fund (s) recommended (e.g. ILP sub-fund) deviate from Client's risk profile
Deviation of Sum Assured from calculated shortfall
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Deviation of Policy Term from client's Time Horizon
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Client's choice of plan(s) / fund(s) differs from representative's recommended plan(s) / fund(s)
Premium payment term exceeds Client's intended retirement age
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N.A
Li
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-N
O
Other Choices by Client (To complete if client's choices is different from Representative's recommendation)
EM
State full name of plan and rider, duration, sum assured ($), premium ($)/frequency, fund name(s), investment amount and respective risk
clarification, where applicable.
D
Name of Policy Owner/ Full name of Sum Policy Premium Payment

Life Assured Plan and rider Assured Term ($) Frequency
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Applicable for Investment-Linked Plans/Collective Investment Schemes Products

Note: For Investment-Linked Plans, please state the Fund Name, Investment Amount and Fund's Risk Category
Si
Fund Name Investment Amount ($) Fund's Risk Category
Applicable for Switching of Fund(s)

Switch from Account Switch from Account
Name of Fund to be Switched Out Amount $ or % Name of Fund to be Switched Into Amount $ or %
null null
CLIENT'S DECLARATION AND ACKNOWLEDGEMENT
WITHDRAWAL / SURRENDER or TERMINATION
Have you previously withdrawn / surrendered / terminated, in part or in full any existing unit trust / life / health insurance policy (including attached riders)
within the last 12 months for regular premium purchase (or 120 days for single premium purchase)?
No
Yes. Please state reasons:
REPLACEMENT OF POLICY
Do you intend to purchase this product to replace in part or full any existing or recently terminated insurance policy / health insurance policy or
investment product?
No
Yes, If 'Yes", please complete sections below.
CLIENT'S DECLARATION ON POLICY REPLACEMENT (LIFE)
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No Yes
Is the replacement of policy advised by the Aviva Financial Adviser Representative?
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My/Our Aviva Financial Adviser Representative has explained the following to my/our satisfaction in the event a replacement of policy should take place.
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a) I/We may incur transaction costs without gaining any real benefit from the replacement.
b) I/We may incur penalties for terminating any of my/our existing policies.
c) I/We may not be insurable at standard terms.

Li
o
d) The replacement plan may offer a lower level of benefit at a higher cost or same cost, or offer the same level of benefit at a higher cost.
-N
e) The replacement plan may be less suitable and the terms and conditions may differ.
f) There may be other options available besides policy replacement (e.g. free switching facilities for investment policy).
O
CLIENT'S DECLARATION ON SWITCHING OF FUNDS (CIS ONLY)

EM
Please ensure that your appointed Representative completes the "Applicable for Switching Fund(s)" section under "Basis of Recommendation" on
page 21 and/or page 22.
No Yes
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Is the switching of funds advised by your Aviva Financial Adviser Representative?

My / Our Aviva Financial Adviser Representative has explained the following to my/our satisfaction in the event a replacement of policy should take place.
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a) I / We have been informed by my/our appointed Representative on whether I am / we are entitled to free switching, if any.
b) I / We have been advised on the disadvantages of switching which may include the following:
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The new fund(s) may offer a different level of risks and returns;
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The new fund(s) may be less suitable;
I / We may incur losses as a result of this switch.

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CLIENT'S DECLARATION AND ACKNOWLEDGEMENT (continued)
I/We understand that the above recommendation(s) is/are based on the facts furnished in this Personal Financial Record; and any incomplete or inaccurate
information provided by me/us may affect the suitability of the recommendations made. If I/we choose not to provide information requested or accept the Aviva
Financial Adviser Representative's recommendations, then it is my/our responsibility to ensure the suitability of the product(s) selected. I/We take the responsibility to
ensure that the product(s) is/are suitable for my/our financial needs and objectives, and the budget amount is affordable and sustainable.
Where life insurance products are concerned, I/we understand that insurance policies are long term commitments and early termination may result in a cash value
that is less than the total premiums paid.
Where investment-linked funds/collective investment schemes and participating plans are concerned, I/we understand and agree that neither Aviva Financial
Advisers nor Aviva Financial Adviser Representative can guarantee the capital and performance of any of the investment-linked funds/collective investment schemes
and/or participating plans and that nothing herein contained constitutes the same. Aviva Financial Advisers nor Aviva Financial Adviser Representative cannot be
held responsible in any way whatsoever for the performance of the investment-linked funds/collective investment schemes and/or participating plans I/we have
chosen to purchase.
Where collective investment schemes are concerned, I/we understand that they are not investment-linked plans and do not provide any insurance cover.
(Tick where applicable)

I/We have been assessed to fulfill or "pass" my/our Customer Knowledgement Assessment and I/we confirm that I/we do not wish to receive advice
concerning the investment product from my/our Aviva Financial Adviser Representative. I/We am/are aware that I/we am/are not able to rely on Section 27 of
the Financial Advisers Act (Cap 110) to file a civil claim against my/our Aviva Financial Adviser Representative or Aviva Financial Advisers Pte Ltd.
I/We acknowledged that I/we failed the Customer Knowledge Assessment and I/we confirm that I/we do not wish to receive advice concerning the investment
product from my/our Aviva Financial Adviser Representative. I/We am/are aware that i/we am/are not able to rely on Section 27 of the Financial Advisers Act
(Cap 110) to file a civil claim against my/our Aviva Financial Adviser Representative or Aviva Financial Advisers Pte Ltd.
The Aviva Financial Adviser Representative has explained to me/us in detail the recommendations made and I/we agree do not agree
with the proposed recommendation(s).
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Remarks:
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I/We acknowledge that my/our Aviva Financial Adviser Representative has explained the contents, including all the Notes within the document and furnished
me/us with the following documents:
o
Aviva Financial Advisers Personal Financial Record (copy of this completed and endorsed document) and
-N
Where applicable:
Benefit Illustrations Product Highlight Sheet

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Product Summary Fund Summary (Selected Funds)

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Your Guide to Life Insurance Prospectus (For Collective Investment Scheme)
Your Guide to Health Insurance and Infographic "Evaluating

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Navigator Terms and Conditions

My health Insurance Coverage"
Navigator Schedule - Fund Investments
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Your Guide to Investment-Linked Insurance Plans

D
Where replacement or switching of my existing investment portfolio, I/we are fully aware that I/we may incur fees and charges as a result of the disposal of, or
reduction in interest in, an existing investment portfolio and the acquisition of, or increase in interest in, a new investment policy or product. I/we have carefully
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considered the fees, charges or disadvantages that may arise from a Switch could outweigh any potential benefits and hereby declare that any decision I/we
make in relation to purchasing the new policy or plan is based solely on my/our own decisions. I/we will obtain my/our own advice on the tax implications
and/or any ancillary implications in relation to the application of this policy or plan.
Si
On behalf of my family members and myself, consent to Aviva Financial Advisers (and other Aviva's group companies) for collecting, using and/or disclosing
my/our personal data to perform financial needs analysis and planning, including providing financial advice, product recommendation and reviews of my
financial plans.
DECLARATION OF BENEFICIAL OWNERSHIP

For avoidance of doubt, completion of this section is not a nomination of beneficiary(ies) under the Policy.
Are there any beneficial owners in relation to this policy?
Yes No
If "Yes", please provide the beneficial owner(s) information and submit a copy of their identify Card/Passport.
Beneficial Owner Name: Identify Card/Passport No.: Relationship to Assured:
"Beneficial Owner" means the natural person who ultimately owns or controls a customer or the natural person on whose behalf a transaction is conducted or business relations are
established and includes any person who exercises ultimate effective control over a legal person or legal arrangement.
CLIENT'S DECLARATION AND ACKNOWLEDGEMENT (continued)
DECLARATION OF POLITICALLY EXPOSED PERSON (PEP)

Are the Assured or any immediate family member of the Beneficial Owner # previously or currently entrusted with prominent public functions* in Singapore or
foreign country; or a close associate** of one who is/was entrusted with prominent public functions in Singapore or a foreign country?
Yes No
If "Yes", please provide details:
Name of Person previously or currently entrusted with prominent public functions:
Relationship of the person listed above to Assured:
#
"Beneficial Owner" means the natural person who ultimately owns or controls a customer or the natural person on whose behalf a transaction is conducted or business relations are
established and includes any person who exercises ultimate effective control over a legal person or legal arrangement.
* "Prominent public functions" includes the roles held by a head of state, a head of government, government ministers, senior civil servants or public servants, senior judicial or military
officials, senior executives of state owned corporations, senior political party officials, members of the legislature and senior management of international organisations.
** "Close associate" means a natural person who is closely connected to a politically exposed person, either socially or professionally
TAX DECLARATION
I declare that, to be best of my knowledge, I have not committed or been convicted of any serious tax crimes
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Please provide details below if you HAVE committed or been convicted of serious tax crimes
ns
ce
Li
o
-N
rd
3 PARTY PAYMENT DECLARATION
O
To complete if the payor is not the policyholder.

EM
Particulars of Payor
(Note: A copy of the NRIC / Passport of Payor is required to be attached to this form)
Name of Payor
D
NRIC / Passport / Business Registration No. of Payor

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Occupation of Payor
Contact No, of Payor
D
Relationship of Payor and Client(s)

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Reason for 3rd party payment

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Signature of Client 1: Signature of Client 2:
09/03/2017 03:09
Date (DD/MM/YYYY): Date (DD/MM/YYYY):

09/03/2017 09/03/2017
REPRESENTATIVE'S DECLARATION AND ENDORSEMENT
REPRESENTATIVE'S DECLARATION ON POLICY REPLACEMENT / SWITCHING OFFUNDS

I have explained to the client the possible disadvantages of policy replacement, including any fees and charges, change in level of benefits, and where
applicable, informed him/her of other options available besides policy replacement.
I have also explained the basis for policy replacement / switching of funds and why the replacement of policy / switching of funds is suitable for the client below:
ADDITIONAL INFORMATION BY AVIVA FINANCIAL ADVISER REPRESENTATIVE

Is the proposer/life to be assured related to you?
Yes (Please specify relationship to you):
No
AVIVA FINANCIAL ADVISER REPRESENTATIVE'S DECLARATION

1. The recommendation(s) made by me is/are based on the above needs analysis which has taken into account the information disclosed by the Client
e!
in the Personal Financial Record.
2. The information provided to me in this Personal Financial Record is strictly confidential and is only to be used for the purpose of fact-finding as part
ns
of the process of recommending suitable insurance products and unit trusts and shall not be used for any other purposes.
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3. Client is a "Selected Client"
Signature of Aviva Financial Adviser Representative: Date (DD/MM/YYYY):

09/03/2017
Li
o
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09/03/2017 03:09
O
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DECLARATION AND ENDORSEMENT (FOR PRODUCT PROVIDERS)
Please complete and submit this form to the product provider(s).
CLIENT'S DETAILS
Client's Name: (please underline surname) NRIC / Passport Number:
DECLARATION BY AFA REPRESENTATIVE
The recommendation(s) made by me is/are based on the above needs analysis which has taken into account the informantion disclosed by the Client in the
Sapphire Form. The information provided to me in this Sapphire Form is strictly confidential and is only to be used for the purpose of fact-finding as part of the
process of recommending suitable insurance products and unit trusts and shall not be used for any other purposes.
Name of AFA Representative: AFA Representative Code:
Signature of AFA Representative: Date (DD/MM/YYYY):
09/03/2017
09/03/2017 03:10
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ACKNOWLEDGEMENT BY CLIENT
ns
I/We understand that the above recommendation(s) is/are based on the facts furnished in the Sapphire Form; and any incomplete or inaccurate information
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provided by me/us may affect the suitability of the recommendations made. If I/we choose not to provide information requested or accept my AFA Representative's
recommendations, then it is my/our responsibility to ensure the suitability of the product(s) selected.
The AFA Representative has explained to me/us in detail the recommendations made and I/we
recommendation(s).
Li agree do not agree* with the proposed
o
Remark:
-N
O
Signature of Client 1: Signature of Client 2:

EM
D
09/03/2017 03:10
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Date (DD/MM/YYYY): Date (DD/MM/YYYY):
09/03/2017 09/03/2017
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Aviva Financial Advisers Pte Ltd

51 Cuppage Road, #03-08/09/10, Singapore
Tel: (65) 6827 7988
www.avivafa.com.sg

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SAPPHIRE.

Many facets of life.

Date of Review : 09/03/2017

Name of Aviva Financial

MAS Representative No. : N.A

AFA Representative Code : N.A

Email Address : N.A

Personal Financial Record_AFA_v2.0_Oct2016

DETAILS CLIENT 1 CLIENT 2

Smoker No Yes No Yes

Marital Status Single Married Widowed Single Married Widowed

NRIC / Passport Number* 845213679 N.A

Occupation* N.A N.A

Casino/Other types Casino/Other types

Consulting Professional Services Consulting Professional Services

Others, please specify: Others, please specify:

Annual Income 0 N.A

Highest Education Level* Primary Primary

Tertiary and above Tertiary and above

Proficient in written English Yes No Proficient in written English Yes No

YOUR LOVED ONE'S DETAILS (DEPENDANTS)

Date of Birth Income (if Years to

STEP 2 : LETS ESTABLISH YOUR FINANCIAL GOALS

WEALTH PROTECTION GOALS

Income Protection Upon Death

Critical Illness Planning

Hospital & Surgical Expenses

Long-term Care Planning

WEALTH ACCUMULATION GOALS

Medium / Long-term Investments

Client 2 Yes No. Please state reason: N.A

ANNUAL INCOME Client 1 Client 2 Dependant Dependant Dependant Dependant Dependant

Annual Income 0 N.A 0 N.A N.A N.A N.A

Less: Employees CPF Contribution 0 N.A 0 N.A N.A N.A N.A

A. Net Annual Income 0 N.A 0 N.A N.A N.A N.A

ANNUAL EXPENSES Client 1 Client 2 Dependant

Others 0 N.A N.A N.A N.A N.A N.A

D. TOTAL ANNUAL EXPENSES 0 N.A 0 N.A N.A N.A N.A

NET CASH FLOW ( C D ) 0 N.A 0 N.A N.A N.A N.A

Client 1 No Yes. Please specify: N.A

Client 2 No Yes. Please specify: N.A

Dependant 1 No Yes. Please specify: N.A

Dependant 2 No Yes. Please specify: N.A

Dependant 3 No Yes. Please specify: N.A

Dependant 4 No Yes. Please specify: N.A

Dependant 5 No Yes. Please specify: N.A

Client 1 Yes No. Please state reason: N.A

Client 2 Yes No. Please state reason: N.A

RETURN ON Dependant Dependant Dependant Dependant Dependant

Car 0 620,000 N.A 0 N.A N.A N.A N.A

A. TOTAL ASSETS 620,000 N.A 0 N.A N.A N.A N.A

LIABILITIES Client 1 Client 2 Dependant Dependant Dependant Dependant Dependant

Car Loan 0 N.A 542000 N.A N.A N.A N.A

Mortgage 0 N.A 0 N.A N.A N.A N.A

Others 0 N.A 0 N.A N.A N.A N.A

B. TOTAL LIABILITIES 0 N.A 542000 N.A N.A N.A N.A

NET WORTH ( A B ) 620,000 N.A -542000 N.A N.A N.A N.A

Source of Funds Annual Amount ($) Single Amount ($)

Cash 30,000 N.A

SRS N.A N.A

* Based on client's estimated expectations

YOUR EXISTING INSURANCE AND INVESTMENT DETAILS

Client 2 Yes No. Please state reason: N.A