Client Profile Questionnaire Confidential Client Profile This following financial profile is designed to enable your adviser to offer the most suitable advice for your circumstances using the information provided. All information is treated in strict confidence, and held in accordance with the UK Data Protection Act 1998. Prior to agreeing to become a client of AXIS Strategy Consultants you will be issued with our client agreement, which incorporates our Terms of Business and Key Facts about our services and their costs. Personal Information Name * Address Country Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombi Comoros Congo (Brazzaville) Congo Costa Rica Cote d\'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (Timor Timur) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia, The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepa Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Telephone / Mobile Number * Email * What is your date of birth? * What is your nationality? * Occupation * Employer name & address Country Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombi Comoros Congo (Brazzaville) Congo Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (Timor Timur) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia, The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepa Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Dependents Name Age Gender Male Female Male Female Male Female Is there a need to financially support your dependents now or in the future? Your Income Annual Income & Currency Self Partner GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Annual Bonus / Commission Self Partner GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Other Income Your Monthly Expenditure GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Monthly Disposable Income Self Partner GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Personal Balance Sheet (Assets & Liabilities) Current Assets Current/Deposit Account(s) Self / Partner / Joint Bank / Institution Value Currency Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Other Account(s) Self / Partner / Joint Bank / Institution Value Currency Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Fixed Assets (Property) Principle Residence Self / Partner / Joint Property Value Outstanding Mortgage Currency Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Investment Property Self / Partner / Joint Property Value Outstanding Mortgage Currency Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Medium - Long Term Assets Direct Equity Holdings Self / Partner / Joint Bank(s) / Institution(s) Total Value Currency Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Insurance Bonds Self / Partner / Joint Bank(s) / Institution(s) Total Value Currency Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Unit Trusts / Investment Trusts / Mutual Funds Self / Partner / Joint Bank(s) / Institution(s) Total Value Currency Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Regular Savings / Education Plans / Retirement Schemes Self / Partner / Joint Bank(s) / Institution(s) Total Value Currency Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Self Partner Joint GBP EUR USD AED AUD CAD CHF CNY HKD JPY MXN NZD QAR SAR Retirement Details When are you planning to retire? I am already retired Within 24 months Between 2 and 10 years time Between 11 and 15 years time Between 16 and 20 years time Between 21 and 25 years time In more than 25 years time Which country are you planning to retire in? Country Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombi Comoros Congo (Brazzaville) Congo Costa Rica Cote d\'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor (Timor Timur) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia, The Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepa Netherlands New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Yemen Zambia Zimbabwe Details on existing UK Pension Schemes? Pension Provider Type of Pension Approximate Value Less than £75,000 Between £76,000 - £200,000 Between £201,000 - £500,000 Between £501,000 - £1,000,000 Greater than £1,000,000 Less than £75,000 Between £76,000 - £200,000 Between £201,000 - £500,000 Between £501,000 - £1,000,000 Greater than £1,000,000 Less than £75,000 Between £76,000 - £200,000 Between £201,000 - £500,000 Between £501,000 - £1,000,000 Greater than £1,000,000