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Site Type
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Client Group ID
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Adviser ID
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Adviser Entry ID
Adviser's People form Entry ID derived from Adviser relationship entry
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Adviser First Name
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Adviser Last Name
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Adviser Roles
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Practice ID
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Practice Name
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Adviser Email
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Primary Client WordPress ID
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Primary Client Entry ID
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Primary Client First Name
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Primary Client Last Name
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Client 2 Entry ID
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Client 2 First Name
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Client 2 Last Name
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Client 2 Email
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Client 2 Mobile
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Entry ID
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Existing Client Intro Message
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Prospective Client Intro Message
Hello, To give us an idea of where you are currently at with your finances and the challenges you’re currently facing, please share some of your information with us using the form attached. If you do not wish to answer, or are unable to, please click "Next" through to the following question. This will really help us to maximise the value of our time together at our meeting and give us a greater understanding of how we can help. If you have any questions, please contact us on (03) 5428 0123. Nixon Financial Services Team
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Shown Fields
Primary Client Intro
Getting Started
Kind regards,
Next
Non-Primary Client Intro
Getting Started
Hi
,
Kind regards,
Next
What is your first name?
*
Let’s start with some personal details
What is your first name?
This field is required.
What is your last name?
*
This field is required.
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Primary Client Email
*
This field is required.
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Primary Client Mobile
*
This field is required.
What is your email?
*
This field is required.
What is your mobile number?
*
This field is required.
What is your date of birth?
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What is your date of birth?
Let’s start with some personal details
, what is your date of birth?
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What is your gender?
Male
Female
Do you have financially dependent children?
If any, please list below. If none, please click next.
First Name
Last Name
Age
What is your housing status?
Boarding
Renting
Own Home
With Parents
What is your address?
Street Address
Address Line 2
City
State
Post Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Country
What are your main reasons for seeking Financial Advice?
What do you think an adviser could help you with?
Select all that apply
Budgeting
Saving for a goal
Planning for retirement
Debt management
Investment advice
Insurance
Superannuation
What about these areas?
Select all that apply
Children's education
Centrelink
Estate Planning
Succession Planning
Reviewing our Financial Structures
Philanthropy, Giving, Volunteering
Do you have a partner?
Yes, Married
Yes, De facto
No
What is your partners first name?
*
Tell us more about your partner
What is your partners first name?
This field is required.
What is
's last name?
*
This field is required.
What is
's email?
What is
's mobile number?
*
This field is required.
What is
's date of birth?
DD
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28
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31
MM
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YYYY
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Hidden
What is
's gender?
Male
Female
How would you rate your current health?
Excellent
Good
Average
Poor
Do you smoke?
Yes
No
How would you rate your current health,
?
Excellent
Good
Average
Poor
Do you smoke,
?
Yes
No
What is your employment status?
Let’s now talk about your employment status
What is your employment status?
Employee
Self-employed
Retired
Not Working
What type of employment do you have?
Permanent full-time
Permanent part-time
Casual
Contract
What is the name of the business?
What is your Job Title?
How much is your annual income excluding tax?
How much is your annual income excluding tax?
What is
's employment status?
Employee
Self-employed
Retired
Not Working
What type of employment does
have?
Permanent full-time
Permanent part-time
Casual
Contract
What is the name of the business
owns or is employed by?
What is your Job Title,
?
How much does
get paid before tax each year?
How much does
get paid before tax each year?
This amount should exclude superannuation.
Do you have a Self Managed Superannuation Fund?
Let’s get clearer about your superannuation and pensions
Do you have a Self Managed Superannuation Fund?
Yes
No
What is the name of your superannuation provider?
What is the estimated balance of your Superannuation?
$0 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000 - $1,000,000
$1,000,000+
What is the estimated balance of your Superannuation?
What is the name of
's superannuation provider?
What is the name of
's superannuation provider?
What is the estimated balance of
's Superannuation?
$0 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000 - $1,000,000
$1,000,000+
What is the estimated balance of
's Superannuation?
What is the estimated balance of
's Superannuation?
$0 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000 - $1,000,000
$1,000,000+
What is the estimated balance of
's Superannuation?
Do you have a pension?
Yes
No
How much are you receiving every fortnight from your pension?
How much are you receiving every fortnight from your pension?
$200 - $5,000
$5,001 - $10,000
$10,001 - $15,000
Do you have any personal insurances?
This can include Life/Death, Total and Permanent Disability (TPD), Trauma/Critical Illness or Income Protection. Often you will have some insurance in your superannuation account.
Yes
No
Not sure
Does
have any personal insurances?
This can include Life/Death, Total and Permanent Disability (TPD), Trauma/Critical Illness or Income Protection. Often you will have some insurance in your superannuation account.
Yes
No
Not sure
Hidden
How much money do you have left after all your expenses each week?
Now let's talk about your expenses
How much money do you have left after all your expenses each week?
What is the approximate total amount you're saving per month?
What cash or property assets do you have?
Let’s get clearer about your assets
What cash or property assets do you have? Select all that apply
Savings Account
Investment Property
Term Deposit
Own Home
Offset Account
Holiday Home
What is the estimated value of your Savings Account?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Savings Account?
What is the estimated value of your Savings Account?
Client
Provider
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Offset Account?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Offset Account?
What is the estimated value of your Offset Account?
Client
Provider
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Term Deposit?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Term Deposit?
What is the estimated value of your Term Deposit?
Client
Provider
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Own Home?
$0 - $500,000
$500,000 - $1,000,000
$1,000,000 - $1,500,000
$1,500,000 - $3,000,000
$3,000,000+
What is the estimated value of your Own Home?
What is the estimated value of your Own Home?
Client
Suburb
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Investment Property?
$0 - $500,000
$500,000 - $1,000,000
$1,000,000 - $1,500,000
$1,500,000 - $3,000,000
$3,000,000+
What is the estimated value of your Investment Property?
What is the estimated value of your Investment Property?
Client
Suburb
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Holiday Home?
$0 - $500,000
$500,000 - $1,000,000
$1,000,000 - $1,500,000
$1,500,000 - $3,000,000
$3,000,000+
What is the estimated value of your Holiday Home?
What is the estimated value of your Holiday Home?
Client
Suburb
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What investment or retirement assets do you have?
Please select all that apply
Managed Funds
Shares
Bonds
Account Based Pension
Annuity
Defined Benefit
Other Investments
What is the estimated value of your Managed Funds?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Managed Funds?
What is the estimated value of your Managed Funds?
Client
Provider
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Shares?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Shares?
What is the estimated value of your Shares?
Client
Provider
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Bonds?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Bonds?
What is the estimated value of your Bonds?
Client
Provider
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Account Based Pension?
$0 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000 - $1,000,000
$1,000,000+
What is the estimated value of your Account Based Pension?
What is the estimated value of your Account Based Pension?
Client
Provider
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
What is the estimated value of your Annuity?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Annuity?
What is the estimated value of your Annuity?
Client
Provider
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Defined Benefit?
$0 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000 - $1,000,000
$1,000,000+
What is the estimated value of your Defined Benefit?
What is the estimated value of your Defined Benefit?
Client
Provider
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Other Investments?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Other Investments?
What is the estimated value of your Other Investments?
Client
Provider
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What personal debts do you have?
Now let's talk about your debts
What personal debts do you have? Please select all that apply
Car Loan
Credit Card
Personal Loan
Line of Credit
HECS Loan
Reverse Mortgage
Home Loan
ATO Debt
Loan from Family or Friends
Other Personal Loan
What is the estimated balance of your credit card?
$0 - $10,000
$10,000 - $30,000
$30,000 - $60,000
$30,000 - $100,000
$100,000+
What is the estimated value of your Credit Card?
What is the estimated value of your Credit Card?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Car Loan?
$0 - $10,000
$10,000 - $30,000
$30,000 - $60,000
$30,000 - $100,000
$100,000+
What is the estimated value of your Car Loan?
What is the estimated value of your Car Loan?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Personal Loan?
$0 - $10,000
$10,000 - $30,000
$30,000 - $60,000
$30,000 - $100,000
$100,000+
What is the estimated value of your Personal Loan?
What is the estimated value of your Personal Loan?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your HECS Loan?
$0 - $10,000
$10,000 - $30,000
$30,000 - $60,000
$30,000 - $100,000
$100,000+
What is the estimated value of your HECS Loan?
What is the estimated value of your HECS Loan?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Line of Credit?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Line of Credit?
What is the estimated value of your Line of Credit?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Home Loan?
$0 - $250,000
$250,000 - $500,000
$500,000 - $1,000,000
$1,000,000 - $1,500,000
$1,500,000+
What is the estimated value of your Home Loan?
What is the estimated value of your Home Loan?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Reverse Mortgage?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Reverse Mortgage?
What is the estimated value of your Reverse Mortgage?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Loan from Family or Friends?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Loan from Family or Friends?
What is the estimated value of your Loan from Family or Friends?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your ATO Debt?
$0 - $10,000
$10,000 - $30,000
$30,000 - $60,000
$30,000 - $100,000
$100,000+
What is the estimated value of your ATO Debt?
What is the estimated value of your ATO Debt?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Other Personal Loan?
$0 - $10,000
$10,000 - $30,000
$30,000 - $60,000
$30,000 - $100,000
$100,000+
What is the estimated value of your Other Personal Loan?
What is the estimated value of your Other Personal Loan?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What investment or business debts do you have?
Please select all that apply
Investment Property Loan
Lease
SMSF Loan
Hire Purchase
Margin Loan
Overdraft
Business Loan
Other Investment Loan
Other Business Loan
What is the estimated value of your Investment Property Loan?
$0 - $250,000
$250,000 - $500,000
$500,000 - $1,000,000
$1,000,000 - $1,500,000
$1,500,000+
What is the estimated value of your Investment Property Loan?
What is the estimated value of your Investment Property Loan?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your SMSF Loan?
$0 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000 - $1,000,000
$1,000,000+
What is the estimated value of your SMSF Loan?
What is the estimated value of your SMSF Loan?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Margin Loan?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Margin Loan?
What is the estimated value of your Margin Loan?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Business Loan?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Business Loan?
What is the estimated value of your Business Loan?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Lease?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Lease?
What is the estimated value of your Lease?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Hire Purchase?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Hire Purchase?
What is the estimated value of your Hire Purchase?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Overdraft?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Overdraft?
What is the estimated value of your Overdraft?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Other Investment Loan?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Other Investment Loan?
What is the estimated value of your Other Investment Loan?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
What is the estimated value of your Other Business Loan?
$0 - $20,000
$20,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000+
What is the estimated value of your Other Business Loan?
What is the estimated value of your Other Business Loan?
Client
Lender
Amount
{input_field_17}{input_field_24}
{input_field_19}{input_field_25}
Joint
Hidden
What income do you earn?
Who
Employer
Role
Salary or Wages
Super %
Primary Client
Client 2
Superannuation is normally paid at 9.5% of salary.
Do you have a Will?
Some final questions
Do you have a will?
Yes
No
Select from the below if you have a special power of attorneys
Enduring power of attorney
General power of attorney
Medical power of attorney
Cascading power of attorney
Mutual power of attorney
Limited power of attorney
Do you have a power of guardianship?
Yes
No
Do you have any of the following entities?
Please select all that apply
Company
Trust
Partnership
Sole Trader Business
Notes
Write down also anything that worries you at the moment
Hidden
Do you want to activate the Mini Fact Find consent fields for your clients?
Yes
No
Hidden
Consent text record
Hidden
Consent checkbox label
Acknowledgement Terms
.
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