Get started - Altitude Wealth Management

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Company

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Depending on your circumstances, an initial consultation fee of up to $330 may apply. We’ll discuss any applicable costs with you before your appointment.

First name*

Last name*

Phone*

Email*

What is your relationship status?

Privacy*

I agree to the privacy policy.

We're a relationship business that is built on referrals from others for the good work that we do. There's a good chance we already know a family member, colleague, or friend of yours.

This is why we take your privacy and the security of your financial information very seriously. So, before we go any further, we'll need you to confirm you understand and accept our Privacy Policy.

Date of birth

Occupation

Residential Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Is your postal address the same as your residential address?*

Yes

Postal Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Do you have any dependants?*

Yes

Name	Date of birth	Relationship to you	Actions

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Which service is of most interest to you?

Retirement planning

Investment advice

Super and SMSFs

Personal insurance

Cashflow and debt

Other advice needs

If other, please specify

How do you feel about your current financial position?

Comfortable

Unsure

Concerned

What best describes why you feel that way?

I'm confident I have enough

I think I’ll be okay but haven’t checked recently

I’m not sure what I’ll need

I don’t think I’ll have enough

What is your personal income from employment?

No employment income

Up to $49,999

$50,000 - $99,999

$100,000 - $149,999

$150,000 - $199,999

$200,000 - $250,000

Over $250,000

I prefer not to say

What other sources of income do you have personally?

Centrelink Pensions or Allowances

Investment income (such as dividends or distributions)

Rental property income

Business income

Non-government pension income (such as an Account Based Pension)

None of the above

Which government payments are you receiving?

Age pension

Disability or Carer pension

Job seeker

Parental leave

Defence force related pension

Other

I'm not receiving any government payments

If other, please provide further information on this income.

Do you have any of the following entities?

Company

Family trust

Self-managed Super Fund (SMSF)

Other

None of the above

If other, please provide details

What's your current residential status?

Homeowner (no mortgage)

Homeowner (with mortgage)

Living free of charge with family/others

Renting

Other

If other, please specify.

What’s the value of your principal place of residence?

If you have a mortgage, how much do you owe?

Do you have any personal insurance?

Yes

Which types of personal insurance do you currently hold?

Life insurance / Term life

Total and Permanent Disability (TPD)

Income protection / Salary continuance

Trauma / Critical illness

Other

Please list the names of any personal insurance providers you have current policies with

What is your approximate total personal superannuation balance?

No superannuation based policies

Up to $249,999

$250,000 - $499,999

$500,000 - $999,999

$1,000,000 or greater

I prefer not to say

Please list the names of any superannuation funds you personally have open.

Don't worry about checking your superannuation. If we know about the fund, we'll check there ourselves.

What is the approximate total balance of your investments outside of property and superannuation?

No investments outside of property or super in my name

Up to $49,999

$50,000 - $99,999

$100,000 - $249,999

$250,000 - $499,999

$500,000 - $1,000,000

Over $1,000,000

I prefer not to say

What is your approximate annual personal expenditure?

$0 - $49,999

$50,000 - $99,999

$100,000 - $149,999

$150,000 - $199,999

$200,000 - $250,000

Over $250,000

I am unsure

I prefer not to say

What types of debt do you hold?

Investment loan

Credit card

Student loan

Other

None of the above

Please provide the current balance(s) of your investment loan(s). If more than one, list each separately.

Please provide the current balance of your student loan.

Please provide your total credit card limit and current balance.

Please describe the debt, balance, and interest rate (if known).

Do you have any of the following investments?

Investment Property

Cash / Term Deposits

Managed Funds

Other

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How many investment properties do you have?

Please provide details.

If other, please specify.

Are you comfortable with us sharing and discussing your own personal financial details with your partner?

Yes

Tick this box to agree and consent to us sharing and discussing your personal financial details with your partner.

Partner's first name*

Partner's last name*

Partner's date of birth

Partner's occupation

Partner's email

Partner's mobile

What is your partner's income from employment?

No employment income

Up to $19,999

$20,000 - $49,999

$50,000 - $99,999

$100,000 - $149,999

$150,000 - $199,999

$200,000 - $250,000

Over $250,000

I prefer not to say

What other sources of income does your partner have?

Centrelink Pensions or Allowances

Investment income (such as dividends or distributions)

Rental property income

Business income

Non-government pension income (such as an Account Based Pension)

None of the above

Is your partner receiving any government payments?

Age pension

Disability or Carer pension

Job seeker

Parental leave

Defence force related pension

Other

I'm not receiving any government payments

If other, please provide further information on this income.

What is your partner's approximate total superannuation balance?

No superannuation based policies in my partner's name

Up to $249,999

$250,000 - $499,999

$500,000 - $999,999

$1,000,000 or greater

I prefer not to say

Please list the names of any superannuation funds your partner has open.

Don't worry about checking your superannuation. If we know about the fund, we'll check there ourselves.

Does your partner have any personal insurance?

Yes

Which types of personal insurance does your partner currently hold?

Life insurance / Term life

Total and Permanent Disability (TPD)

Income protection / Salary continuance

Trauma / Critical illness

Other

Please list the names of any personal insurance providers your partner has current policies with

Do you and your partner have any of the following investments?

Investment Property

Cash / Term Deposits

Managed Funds

Other

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How many investment properties do you and your partner have?

Please provide the current balance(s) of you and your partner's investment loan(s). If more than one, list each separately.

Please provide details.

If other, please specify.

What is your approximate combined total balance of your investments outside of property and superannuation?

Include assets in your name, your partners name, and any jointly held assets.

No investments outside of property or super

Up to $49,999

$50,000 - $99,999

$100,000 - $249,999

$250,000 - $499,999

$500,000 - $1,000,000

Over $1,000,000

I prefer not to say

What is your approximate annual household expenditure?

$0 - $49,999

$50,000 - $99,999

$100,000 - $149,999

$150,000 - $199,999

$200,000 - $250,000

Over $250,000

I am unsure

I prefer not to say

Have you engaged with a financial adviser before?

I currently have a financial adviser but am searching for someone new

I have previously seen a financial adviser

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Do you have a preferred adviser in mind?

Anything else you would like us to know?

We like doing our homework. So, please tell us as much (or as little) as you like about yourself, what you're challenges are, ways you think we may be able to help, or anything else that we might like to know.

Finally, how did you hear about us?

If other, please provide details

Who referred you?

Recommendations from friends and colleagues are important to our business. Please let us know who referred you so we may pass on our thanks.

Who referred you?

In addition to allowing us to pass on our thanks, by reaching out to your professional adviser we can work together to ensure you get the best possible advice.

May we contact your professional adviser?

Yes, I give you permission to contact the professional adviser to request information about my situation.

Who referred you?

Recommendations from family are important to our business. Please let us know who referred you so we may pass on our thanks.

Relation to you