Business and Retirement
To ensure we provide you with the most accurate and rapid assessment, please complete this brief questionnaire as fully as possible. Your details will be kept entirely confidential.

* Indicates required values

Your Full Name *
Your Date of Birth (dd/mm/yy)*
Email Address *
Country of citizen*
Your Address:
Telephone/s:
Fax
Spouse Name:
Your spouse's date of birth:
Spouse's Country of citizenship:

General Questions:

Do you have an overall successful business career ?	YesNo
Do you have a genuine and realistic commitment to business and/or investment in Australia?	YesNo
Have you had any adverse business history, i.e. bankruptcy, fraud, corruption etc ?	YesNo
Are you and your family well ?	YesNo
If any member of the family has a medical condition, please describe:
If any member of the family has a criminal history, please detail:
Name of your local currency:

In any 2 of the last 4 years please state (in your local currency) the following for you and/or your spouse (state year-end amount):

Amount of personal and business assets:

Year 1 Year 2

Business Owner:

What are your assets in business?	Year 1 Year 2
Percentage of ownership interest in the main business?	Year 1 Year 2
Your annual turnover:	Year 1 Year 2
What type of business is your main business?

Senior Executive:

Have you had continuous employment of 4 years in a senior management role ?	YesNo
Are you responsible for strategic policy development of the business?	YesNo
Annual turnover of the major business where you have a position in the 3 highest levels of management	Year 1 Year 2

Investor:

Do you have an overall successful investment or business activity?	YesNo
Do you have 3 years of direct management in 1 or more qualifying businesses or eligible investments?	YesNo
Percentage of ownership interest?
Nett value of managed investments?
Please state your email address again

^ Top

27 Boronia Crescent, City Beach Western Australia 6015 - Australia
Tel: +(61) 8 9285 1175 Fax:+(61) 8 9385 8968
Mobile: +(61) 0401 00 25 25 Email: