Client1 PDF Test: All Information Collected in This Financial Review Will Be Held in Strict Confidence

All information collected in this financial review will be held in strict confidence.
Name of Client (as in NRIC, passport) : Client1 PDF Test
Name of Client2 (as in NRIC, passport) : Client2 Pdf Test
Name of Adviser (as in NRIC, passport) : Yxw Fxxng Fxng
MAS Representative Number : FYF300037434
Case Number : 88800295200625170603
I declare I am authorized to:
Advise / arrange contract of Insurance in respect of Life & Health Policies

Advise / market Collective Investment Schemes
Aviva: Internal
Aviva Ltd 4 Shenton Way #01-01 SGX Centre 2 Singapore 068807 • Tel: (65) 6827 7988 • Fax: (65) 6827 7900 • Website: www.aviva.com.sg 1 of 26
Company Reg. No.: 196900499K GST Reg. No.: MR-8500166-8 Affinity EFNA V1.0
Before we get started, please take note of this
Important
Notice...
AVIVA LIMITED is a registered insurer under the Insurance Act (Cap 142) and an exempt financial adviser under the Financial Advisers
Act (Cap 110). As a registered insurer, Aviva provides and sells insurance products such as life policies and long term accident and health
policies. As an exempt financial adviser, Aviva is authorised to provide financial advisory services as listed below.
"Financial advisory services" includes (a) Marketing collective investment schemes; (b) arranging contracts of insurance in respect of life,
policies other than contracts of reinsurance; (c) electronic, print or other forms concerning any investment product; and (d) advising others,
either directly or through publications or writings, and whether in electronic, print or other forms, concerning any investment product, other
than in the manner set out in (c) or advising on corporate finance within the meaning of Securities and Futures Act (Cap 289).
"Investment Product" includes (a) any collective investment scheme as defined in section 2(1) of Securities and Futures Act (Cap 289)
and (b) any life policy.
Customer Knowledge Assessment

Monetary Authority of Singapore (MAS) require all Financial Advisers to assess their customers whether they possess the relevant
knowledge or experience to understand the risks and features of an unlisted Specified Investment Product (SIP) such as Investment-Linked
Plans (ILPs) and Collective Investment Schemes (CIS) beore recommending it to them.
The assessment will be in the form of a simple questionnaire on page 13 to 15.
Personal Data
In this document, we may collect, use, disclose and/or process certain personal information or data about you and your family. Such
personal data will be collected, used, disclosed and/or processed by Aviva Relationship Consultant (or Aviva group companies) for the
purpose(s) of performing financial needs analysis and planning, including providing financial advice and product recommendations. We may
also use the personal information to perform reviews of your financial plans from time to time. For more information on our data protection
policy, please visit http://www.aviva.com.sg/pdpa.html
Your Aviva Relationship Consultant must have sufficient information before making a suitable recommendation. The information
that you provide on your investment objectives, financial situation and your particular needs will be the basis on which advice
and recommendation will be given. If there have been any changes in your circumstances since completing this personal
financial record, please notify your Aviva Relationship Consultant as it may affect the needs analysis process. The
recommendations made for you may not be appropriate in the event of a partial or inaccurate completion of this personal
financial record.
Aviva: Internal
SECTION 1 - PERSONAL INFORMATION 88800295200625170603
A. Personal Details (This section is compulsory, please complete the entire Section A)
Client Client2
Title Mr Mrs Mdm Ms Dr Mr Mrs Mdm Ms Dr
Given Name Client1 PDF Client2 Pdf
Family Name Test Test
Date of Birth
02-06-1988 01-02-1989
(DD/MM/YYYY)
Nationality Singaporean Singapore PR Singaporean Singapore PR
(Complete Enhanced Customer Due
Diligence Form for Nationals from
Others France Others Russia
High Risk Countries and Jurisdictions)
App change: NRIC field to be move to
NRIC / Passport No E4676424F R54353466K
section 14.
FIN No (if applicable) No change to PDF.
99 Postal code not working 00 99 Postal code not working 00
Residential Address Singapore 068809 Singapore 068809
Contact Details
Home +65 12345678 +65 87654321
Office +65 87654321 +65 12345678
Mobile +65 91277396 +65 91277396
Email [email protected] [email protected]
Married Divorced Married Divorced

Marital Status
Single Widowed Single Widowed
Gender Male Female Male Female
Primary Secondary Primary Secondary
Highest Qualification N/O Levels Post Sec/ A Levels/ N/O Levels Post Sec/ A Levels/
Diploma Diploma
Degree and Above Degree and Above
Language Proficiency
English Malay Others English Malay Others
Conversant in Spoken Language
Mandarin Tamil Mandarin Tamil
English Malay Others English Malay Others

Proficient in Written Language
Mandarin Tamil Mandarin Tamil
Smoker(Smoked cigarettes or cigars

Yes No Text
Yeschange: "Have youNo smoked cigarettes
in the last 12 months?)
or cigars in the last 12 months?" G11
Politically Exposed Person Yes No requirement
Yes to use active
No voice and personal
(If yes, complete Enhanced Customer Due Diligence Form) pronoun.
Politically Exposed Person means: (a) a natural person who is or has been entrusted with prominent public functions whether in Singapore
or a foreign country; (b) immediate family members of such a person; or (c) close associates of such a person. “Prominent public functions”
includes the roles held by a head of state, a head of government, government ministers, senior civil servants, senior judicial or military
officials, senior executives of state owned corporations, and senior political party officials.
B. Employment Details (This section is compulsory, please complete the entire Section B)
Full Time Retired Full Time Retired
Employment Status Part Time Others Part Time Others
Self Employed Self Employed
Employer Aviva Na
Occupation Analyst - Business Housewife
Aviva: Internal
SECTION 2 - CLIENT'S 88800295200625170603
ACCOMPANIMENT
It is recommended for you to be accompanied by a Trusted Individual if you belong to one of the following profiles. If you belong to two or
more of the following profiles, it is compulsory for you to be accompanied by a Trusted Individual
Text change:
(c) (s/o) "I am unable to communicate, read or write in
Clients who cannot communicate, read or write in English English"
Clients who are aged 62 and above "I am aged 62 and above"
Clients who do not have a minimum of "N" or "O" levels "I have not obtained minimum educational
Trusted Individual's Declaration
qualification of GCE 'O' or 'N' levels"
This form has been explained in Russki (language) by Client1
Trusted Individuals details App Change:

NRIC Number E4465456F Collect last 4 characters of NRIC instead.
Relationship with Client Spouse E.g. use "567A" if the NRIC number is
Contact Number 91277396
"S1234567A". This is in line with Personal
Signature of TrustedAct
Data Protection Individual
for NRIC and other
national identification numbers.
Trusted Individual has to be an individual whom the client trusts and is between age 18 - 61, has a minimum of “N” or “O” levels and is able
to communicate, read and write in English. Fellow Adviser / Manager cannot be appointed as a Trusted Individual.
Client Declaration To make this paragraph in bullet point.

G18 requirement,
I decline to have a Trusted Individual, despite my Adviser's recommendations and will be responsible principle
for the decision 2.
to purchase the
product(s) based on my own judgement
Shift Client Declaration to before "Trust
Individual's declaration client declines to
have a trusted individual then the "Trusted
Individual's Declaration" need not be shown.
Client Signature
G18 requirement, principle 3 - to skip
sections irrelevant to the client. Changes in
SECTION 3 - DEPENDANT'S DETAILS
If you do not have any dependants, please indicate "Nil" or "None"
App required too.
A. Dependants' details (Eg. Children, Elderly Relatives, Others) Replace: if you do not have any
DOB Years to dependents……
Name Relationship Remarks
(DD/MM/YY) support with:
Daughter1 Testtest Daughter 14 This information helps to facilitate your
Hgchfchgvhgvhvhgvhgvhcghgvhgvh
planning for the financial needs of your
dependants.
Add after A. Dependent’s details (Eg.

Children…..) :
[] I do not have any dependents.
And map selection in app over to this check
B. boxforif needs
I do not wish to disclose my dependants information and for it to be taken into consideration selected.
analysis and recommendations.
Please provide reasons:
Client 1: No dependents in singapore
Aviva: Internal
SECTION 4 - FINANCIAL 88800295200625170603
OBJECTIVES
Tick the following objectives where applicable - HIGH, MEDIUM or LOW
For financial objective(s) which are very important and you would like to address in this financial review, please tick under HIGH (H).
For financial objective(s) which are important and you would like to address in this or future financial reviews, please tick MEDIUM (M)
and/or LOW (L).
Client Client2
A. Protection H M L H M L
Protecting family / assets in the event of death
Providing for critical illnesses
Providing for disability
Providing for long term care / disability income
Providing for hospital, surgical, medical costs
Providing for dependant's protection needs
Client Client2
B. Wealth Accumulation H M L H M L
Planning for retirement
Providing for children's education
Saving for other purposes
Client Client2
C. Wealth preservation / Distribution H M L H M L
Supplementary Retirement Scheme (SRS) Planning
Estate planning (e.g. Will, Trusts, CPF Nomination, Lasting power of Attorney)
Client
Remove Section DClient2
‘Others’ as "Savings
D. Others H for Lother purposesHhandles
M M L ‘other
1Maternity objectives’.
2 includes app changes
Notes Text change heading to : "Further details on
client's objectives.”
Client 1: Hvgf gfcfgc .
Health Declaration
Do you or any applicants have any pre-existing medical conditions?
Yes No
If yes, please specify the medical condition:
Client 1: Some unknown disease
Aviva: Internal
SECTION 5 - INFLOW AND OUTFLOW 88800295200625170603
This section is compulsory. If you are providing information on Section 5A and 5B, it is not required to tick the box under Section 5C.
A. Monthly Inflow
Client Client2 Client Client2
Net Employment Income $ $ Dividend Income $ $
Bonus $ $ Rental Income $ $
Other Income $ $
Total Monthly Inflow $ 12,000.00 $ 12,000.00
B. Monthly Expenses
Household Personal
Utilities $ $ Mobile / Internet / Cable $ $
Groceries $ $ Food / Dining $ $
Property Tax $ $ Grooming / Shopping $ $
Maid Services $ $ Entertainment $ $
Cash Mortgage $ $ Vacation Text

$ change Title: add$ "Financial Inflow and
Others: $ $ Income Tax Outflow
$ $
Others: $ $
Total Household Expenses $ $
Total Personal Expenses Text change,
$ replace “This$ section is
compulsory… " This information helps to

Dependants Transportation
ascertain the affordability of the
Allowances - Parents $ $ Public Transport $ $
recommendation(s) and plan(s) for your
Allowances - Children $ $ Car Insurance financial need(s)."
$ $
School Fees $ $ Road Tax + Car Servicing $ $
Medical $ $ Parking + Petrol

Text
$
change, add (after
$
CPF) to Net
Employment income
Others: $ $ Car Loan $ $
Others: $ $
Total Dependants Expenses $ $
Others: $ $
Total Transportation Expenses $ $
Insurance - Cash premiums Regular Investments - Cash (incl. SRS )
Personal $ $ Unit Trusts $ $
Children $ $ Shares / Stocks $ $
Parents $ $ Endowment $ $
Others: $ $ Others: $ $
Total Premiums (Cash) $ $ Total Cash / SRS $ $
Monthly CPF Info Miscellaneous
Inflow Charity / Tithes $ $
Ordinary Account $ $ Other Loans: $ $
Special Account $ 150,000 $ Others: $ $
Medisave Account $ $ Others: $ $
Total Inflow $ 150,000 $

Total Miscellaneous Expenses $ $
Outflow
OA Mortgage $ $
Total Monthly Outflow $ 6,000 $ 6,000
OA Regular Investments $ 3,000 $
SA Regular Investments $ 7,000 $
MA Outflow $ $
SURPLUS / (SHORTFALL) $ 6,000.00 $ 6,000.00
Total Outflow $ 10,000 $
ANNUAL SURPLUS /
CPF Surplus / (Shortfall) $ 140,000.00 $ $ 72,000.00
Text change Add: (e.g.$ 72,000.00
(SHORTFALL) receiving an
Are there any factors within the next 12 months which may significantly increase or decrease your current income and inheritance or borrowing money for
expenditure position?
Yes No (If yes, please provide details) investment or purchase of a holiday home,
etc.)?
After …. expenditure position?
include text change in app
C. Add
I do not wish to disclose my cash flow information and for it to be taken in to consideration for needs analysis and Text: "Would
recommendations. you
Please like your
provide cash flow to
reasons
be taken into consideration for the Needs

Analysis and Recommendation(s)? ."
Moves question C to top of the page as per

app.
Then follow by A. Monthly Inflow

Aviva: Internal
SECTION 6 - ASSETS AND LIABILITIES 88800295200625170603
This section is compulsory. If you are providing information on Section 6A and 6B, it is not required to tick the box under Section 6C.
A. Assets (Current Market Value)

Client Client2 Client Client2
Cash/Near Cash Invested Assets
Savings $ $ Unit Trusts $ $
Fixed Deposits $ $ Stock $ $
Others: $ $ ILP $ $
Text change, replace “This section is
Total Cash/Near Cash $ $ Bonds $
compulsory… ": "This$ information helps to
Personal Use Assets Business Interests facilitate the planning$ of your financial
$
Property - Residence $ $ Insurance Endowments needs."

$ $
Motor Vehicle(s) $ $ CPF Balance (OA) $ $
Others e.g. (Valuables /

$ $ CPF Balance (SA) $ $
Collections)
Total Personal Use Assets $ $ CPF Medisave (MA) $ $
SRS $ $
Property - Investment 1 $ $
Others: $ $
Others: $ $
Others: $ $
Total Invested Assets: $ $
Total Assets: $ 1,200,000 $ 1,200,000
B. Liabilities (Please Indicate Outstanding Amount Owing on Liability)
Short Term Long Term
Mortgage Loan on
Credit Card(s) $ $ $ $
Residential Property
Mortgage Loan on
Bank Overdraft $ $ $ $
Investment Property 1
Mortgage Loan on
Outstanding Tax $ $ $ $
Mortgage Loan on
Others: $ $ $ $
Others: $ $ Car Loan $ $
Total Short Term Liabilities $ $ Others: $ $
Others: $ $
Total Long Term Liabilities $ $
Total Liabilities $ 700,000 $ 700,000
NET WORTH $ 500,000.00 $ 500,000.00
Are there any factors within the next 12 months that may significantly increase or decrease your net worth?
Yes No (If yes, please provide details)
C. Add Text:
I do not wish to disclose my assets and liabilities information and for it to be taken into consideration for needs analysis "Would you Please
and recommendations. like your assets
provide and
reasons liabilities to be taken into consideration for
the Needs Analysis and
recommendation(s)?"

app.
Then follow by A. Assets(current market

value)
Aviva: Internal
SECTION 7 - EXISTING INVESTMENTS AND INSURANCE
88800295200625170603
This section is compulsory. If you do not have either Investment or Insurance, please indicate "Nil" or "None" in the respective Investment or Insurance sub-sections
A.Existing Investments (e.g. Stocks, Bonds, Unit Trusts, Managed Accounts etc)
Investment Amount (SP /
Owner Type of Investment Cash / CPF/ SRS Current Value Remarks
RSP)
Client1 PDF Bond Cash 100,000 150,000
Client1 PDF Unit trust SRS 400,000 485,599 text change replace “This section is
Client1 PDF Stocks Cash 600,000 725,000 compulsory… " "This information helps to
evaluate if your existing investment &
Client2 Pdf Gold Cash 300,000 500,000 insurance portfolio is adequate in meeting
Client2 Pdf Faberge egg Cash 600,000 600,000 your financial needs. "
B. Existing Life / Health Insurance Policies (i.e. CPF Dependants' Protection Scheme, Investment-Linked, Endowment, Income Protection, Hospitalisation, Total Permanent Disability, Whole Life etc)
This sub-section is compulsory
Sum
Assured - Sum
Commencement Life Company Sum
Life Total & Assured -
Owner Date and Type of Premium Assured - Maturity / Remarks
Assured Permanent Critical
(DD/MM/YY) Policy Death
Disability Illness
(TPD)
Client1 PDF 5,000,000 5,000,000 5,000,000
Client2 Pdf 2,000,000 2,000,000 2,000,000
Daughter1 1,000,000 1,000,000 1,000,000 2000 per annum
C.
I do not wish to disclose my existing investment and insurance information and for it to be taken into consideration for needs analysis and recommendations.
Add Text: "Would you like your existing
Please provide reasons:
investment and insurance portfolio to be
taken into consideration for the Needs
Analysis and recommendation(s)?"

app.
Then follow by A. Existing investment….
Aviva:
AvivaInternal
Ltd 4 Shenton Way #01-01 SGX Centre 2 Singapore 068807 • Tel: (65) 6827 7988 • Fax: (65) 6827 7900 • Website: www.aviva.com.sg 8 of 26
SECTION 8 - INVESTMENT RISK PROFILE 88800295200625170603
to add
The following questions are designed to determine your investment risk profile taking into account your the following:
financial needs, circumstances and
objectives. Please indicate your preferences "This is important in recommending suitable

products that reflect your risk preferences.
For insurance planning excluding ILPs, answer minimally Q1. People make investment decisions based on
For investment planning including ILPs, answer ALL questions.
time, performance of an investment and the
risk they are prepared to accept.
Portfolio 1 You should consider that short term capital
losses might be a consequence of aiming for
Name: Client1 PDF Test Purpose: Others higher, longer term returns. As a general
rule, the higher the potential return from an
Portfolio 2
investment, the higher the risk that capital
Name: Client2 Pdf Test may not be returned. "
Purpose: Insurance
Score
Portfolio 1 Portfolio 2
1. Please circle the number on the line below indicating your preferred risk / return objective.
1 1
Lowest RISK and Lowest potential Highest RISK and Highest potential 2 2
App change: 3 3
RETURN 1 2 3 4 5 RETURN
Drop down list selection 4of purpose 4of
5 5
insurance to determine if rest of section 8
2. Investment Time Horizon: What is the expected time frame for your investment?
and/or section 9 is required.
1) 3 years or less 1 1
2) >3 - 5 years 2 2
3) >5 - 7 years 3 3
4) >7 – 10 years 4 4
5) More than 10 years 5 5
3. What is the average annualised gross return you reasonably expect to achieve from your investment
portfolio(s), over a longer term period of at least 10 years?
1) 0 - 2% 1 1
2) >2 - 4% 2 2
3) >4 - 6% 3 3
4) >6 - 8% 4 4
5) More than 8% 5 5
4. In your opinion, what percentage drop in the major market indices (e.g. STI, Dow Jones, NASDAQ, S&P,
etc) would you consider as a severe crisis?
1) -10% 1 1
2) -20% 2 2
3) -30% 3 3
4) -45% 4 4
5) -60% 5 5
5. If stock markets have dropped by at least 20% in its value over a year, how will you potentially respond?
1) I would probably be very upset and sell off all my investments 1 1
2) I would be upset and will only sell off those with little or no losses 2 2
3) I would not be happy but will keep my investments in the hope of a recovery 3 3
4) I would think it is a good buying opportunity and buy cautiously 4 4
5) I would think it is a great buying opportunity and buy aggressively 5 5
Aviva: Internal
6. The following chart shows the possible range of values for five different investments of $100,000 after Score
one year. Which investment would you be most comfortable in owning? Portfolio 1 Portfolio 2
1 1
2 2
3 3
4 4
5 5
Insurance and
Insurance Only Score Client Investment
Investment Score Score
(Q1 only) Risk Profile
(Q1 to Q6) Portfolio 1 Portfolio 2
1 6 to 9 Conservative 3 3
2 10 to 14 Moderate Investment Risk
3 15 to 21 Balanced Profile
4 22 to 26 Growth Balanced Balanced
5 27 to 30 Aggressive
Client Investment Risk Profile Choice
(Complete this only if client DISAGREES with the Investment Risk Profile above)
Not withstanding the Investment Risk Profile questionnaire, I hereby declare that my risk profile is
Investment Profile -
Portfolio 1
Investment Profile -
Portfolio 2
Aviva: Internal
Your Investment Risk Profile
Conservative - Score 6 to 9
Your investment risk profile suggests that you are able to take on low risk investments. Your main priority is safeguarding your investment
capital. You are prepared to sacrifice higher returns for peace of mind. This indicates that you wish to take a conservative approach towards
investing and the recommended asset allocation strategy would range between 80% to 90% products with risk = 1 (Developed Govt Fixed
Income) and 10% to 20% products with risk = 5 (Regional or Single Country Equities).
PORTFOLIO RISK ALLOCATION:
Less than or equal to (<) 1.8
Moderate – Score 10 to 14
Your investment risk profile suggests that you have some understanding of investment markets and their behaviour. You do not wish to see
all your capital eroded away by taxes and inflation and you are prepared to take short- to medium-term risk in order to gain longer-term
capital growth. This indicates that you wish to have a moderate approach towards investing and the recommended asset allocation strategy
would range between 60% to 70% products with risk = 1 (Developed Govt Fixed Income) and 30% to 40% products with risk = 5 (Regional
or Single Country Equities).
More than (>) 1.8 and less than or equal to (<) 2.6
Balanced – Score 15 to 21
Your investment risk profile suggests that you are seeking a greater growth component in your investment portfolio to help protect your
capital from the eroding effect of taxes and inflation. While you remain cautious towards taking high levels of risk, your general
understanding of investment markets enable you to feel comfortable with some short- to medium-term risk. Your priority is consistent capital
growth with some income to smoothen out any volatility in your returns. This indicates that you wish to have a balanced approach towards
investing and the recommended asset allocation strategy would range between 40% to 50% products with risk = 1 (Developed Govt Fixed
Income) and 50% to 60% products with risk = 5 (Regional or Single Country Equities).
Growth – Score 22 to 26
Your investment risk profile suggests that you are an investor who understands the movement of the investment markets. You are most
interested in maximising the value of your investments(s) through long-term capital growth, although you do not wish to make imbalanced
investment decisions. You are comfortable with short- to medium-term volatility from your portfolio to maximise the potential for long-term
capital growth. This indicates that you wish to have an assertive approach towards investing and the recommended asset allocation strategy
would range between 20% to 30% products with risk = 1 (Developed Govt Fixed Income) and 70% to 80% products with risk = 5 (Regional
or Single Country Equities).
Aggressive - Score 27 to 30
Your investment risk profile suggests that you are prepared to sacrifice your investment capital in pursuit of highest long-term potential
capital growth. You have a good understanding of the behaviour of investment markets and you are interested in negating the effects of
taxation and inflation. This indicates that you wish to have an aggressive approach towards investing and the recommended asset allocation
strategy would range between 0% to 10% products with risk = 1 (Developed Govt Fixed Income) and 90% to 100% products with risk = 5
(Regional or Single Country Equities).
Aviva: Internal
SECTION 9 - CUSTOMER KNOWLEDGE ASSESSMENT 88800295200625170603
It is important to find out if you have the knowledge or investment experience to understand the risk and features of unlisted "Specified
Text change: Unlisted Specified Investment
Investment Products" (SIP) which include Investment-Linked Policies (ILP)s, unit trusts or similar products.(SIP)
Products This assessment, known as the
Customer Knowledge Assessment (CKA), helps to assess your knowledge or investment experience before a solution(s) is / are offered to
you. The accuracy or completeness of the information provided may affect the suitability of the recommendations made. A copy of the form
delete inverted commas.
will be submitted to the relevant investment platform when necessary. By proceeding to provide this information, you have given consent
to
Part 1 : Knowledge Acquired Client Client2
Educational Qualifications Yes No Yes No
1. Do you have a diploma or higher qualification in any of the following fields?
(C) (S/O)
(C) (S/O) (C) (S/O) Economics
Accountancy Actuarial Science Financial Planning
Capital Markets Commerce Business /
Finance Financial Business Admin /
Computational Engineering Business
Finance Insurance Management /
Business Studies
Please also specify the full name of the Education Institution(s) in which the above qualification(s) were obtained and any other relevant
information:
Client: Client2:
Oxford Hgchfhgc
2. Do you possess any professional finance-related qualifications? Yes No Yes No

(e.g. AFP / AWP / CFP, AFC / ChFC, ACCA, CLU, CFA / CAIA, CPA / CA, FRM / PRM, CISI)
If yes, please specify the full name of the qualification(s), Education Institution(s) in which the qualification(s) were obtained and any other
relevant information:
Client: Client2:
Cpaa Htfchchc
Investment Experience
3. Have you made at least 6 transactions in the following unlisted “Specified Yes No
Yes No
Investment Products” in the past 3 years?
(C) (S/O)
Collective Investment Schemes (CIS) (e.g. Unit Trusts)
Investment-Linked Policies (ILP). includes intra-fund switches
If yes, please specify the full name of the Financial Institution(s) where the transactions were carried out and any other relevant information:
Client: Client2:
Citibank Hgfhfchfhfc
Work Experience
4. Do you have a minimum of 3 continuous years of working experience* in the Yes No
Yes No
preceding 10 years involving the following fields?
(C) (S/O)
Development / Structuring / Management / Sale / Trading / Research / Analysis of Investment Products
Provision of training on investment products
Accountancy, Actuarial Science, Treasury, Financial Risk Management and Legal work in financial areas
* Provision of general support functions in the above mentioned areas such as operations, HR, corporate services and IT will not be
considered as relevant experience.
Please also specify the full name of the business organisation(s) where the above work experience was obtained and any other relevant
information:
Client: Client2:
Bank NB hgchfchgvhgvhvgh
Aviva: Internal
SECTION 9 - CUSTOMER KNOWLEDGE ASSESSMENT 88800295200625170603
PART 2 : Outcome of CKA
Based on the guidelines prescribed by the Monetary Authority of Singapore (MAS), if any of theText change
above to is
response " "You
"Yes",are
youassessed totohave
are deemed
met the Customer Knowledge Assessment
have the relevant investment knowledge and / or experience for the purpose of this assessment.
criteria and am deemed to possess the
knowledge or experience
Client for transactions
Client2 in
a Collective Investment Scheme or an
You are assessed to have acquired the relevant knowledge and / or experience to understand and purchase
Investment Linked Policy"
"Specified Investment Products".
You are assessed not to have acquired the relevant knowledge and / or experience to understand and
purchase "Specified Investment Products ".
Note 1: In the event of a joint investment, both clients will be deemed to have not fulfilled the criteria in the CKA if one of them is assessed
not to have possessed the knowledge or experience in an unlisted Specified Investment Product.
Text change to :
"You are assessed to have not met the
I declare the above information provided to be correct and understand that any inaccurate Customer Knowledgeinformation
or incomplete Assessment criteria
provided by me may affect the outcome of the CKA.
and am deemed to not possess the
knowledge or experience for transactions in
a Collective
The personal information gathered here by the adviser, including the statement(s) and other documents Investment
provided by you, isScheme or an
for the purpose
Investment Linked Policy.
of providing you, the client, with suitable financial recommendations and will be kept confidential.
a Collective Investment Scheme or an
Client Acknowledgement of CKA Outcome
Investment Linked Policy. "
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
I understand and agree with the outcome of the Customer Knowledge Assessment.
Aviva: Internal
SECTION 10A - NEEDS ANALYSIS 88800295200625170603
(PROTECTION)
1.In the Event of Death
Client Client2
Income
Monthly needs for dependants $ 10,000 monthly $ monthly
Annual amount (pmt) $ 120,000.00 annually $ annually
Number of years required (n) 40 years years
Inflation-adjusted rate of return from investments (%) (i) 3
(A) Funds required to provide income (pv) $ 2,856,985.82 $
Liabilities App changes:

Outstanding mortgage $ 600,000 $
To disable liabilities and existing resources to be input
Debt (Loans, Credit cards, Overdraft, etc.) $ 100,000 $ select do not wish to disclose.
here if client
Funds required for dependants’ education (tertiary, etc) $ 100,000 $
Current logic of app prepopulating existing resource
Final expenses (Medical, Taxes, Funeral, etc.) $ 100,000 $ from section 5 onwards still applies.
and liabilities
Others: Will, $ 300,000 $
This applies to event of death, disability, CI , dependent
(B) Funds required to settle liabilities $ 1,200,000.00 protection,$retirement, child education, savings for other
purpose
(A + B) = (C) Total funds required $ 4,056,985.82 $
Existing Resources Allocated (Current Values)

Life insurance coverage $ 5,000,000 $
Cash assets (Savings, Fixed Deposits, etc.) $ 80,000 $
CPF $ $
Investments (Bonds, Unit Trusts, Shares, etc.) $ 1,360,599 $
Others: Painting, $ 300,000 $
(D) Total $ 6,740,599.00 $
(D - C) = Surplus / (Shortfall) $ 2,683,613.18 $
Notes
Client 1: Chgchgvhgvghvgvhh
2. In the Event of a Critical Illness

Client Client2
Critical Illness Needs
Monthly needs required for living expenses and / or dependants $ 10,000 monthly $ monthly
Annual amount (pmt) $120,000.00 annually $ annually
Funds required (pv) $ 4,800,000.00 $
Lump sum required for treatment of illness $ 1,000,000 $
Others: Maids, $ 50,000 $
(A) Total critical illness needs $ 5,850,000.00 $

Life insurance coverage $ 5,000,000 $
Cash assets (Savings, Fixed Deposits, etc.) $ 600,000 $
Others: Antique, $ 120,000 $
(B) Total $ 5,720,000.00 $
(B - A) = Surplus / (Shortfall) $ (130,000.00) $
Notes
Client 1: Fchcgfcfgcgfc
Aviva: Internal
SECTION 10A - NEEDS ANALYSIS (PROTECTION) 88800295200625170603
3. In the Event of Disability
Client Client2
Income
Monthly needs for living expenses and / or dependants $ 10,000 monthly $ monthly
Annual amount (pmt) $ 120,000.00 annually $ annually
Inflation-adjusted rate of return from investments (%) (i) 3
(A) Funds required to provide income (pv) $ 2,856,985.81 $
Expenses
Provision for medical expenses $ 1,000,000 $
Others: Living, $ 1,000,000 $
(B) Total Expenses $ 2,000,000.00 $
(A + B) = (C) Total funds required $ 4,856,985.81 $

Existing total permanent disability (TPD) payout $ 5,000,000 $
Existing disability income benefit payout (total) $ 5,000 $
Others: Trust, $ 500,000 $
(D) Total funds available $ 6,505,000.00 $
(D - C) = Surplus / (Shortfall) $ 1,648,014.19 $
Notes
Client 1: Fcvchfchc
4. In the Event of Disability (Long Term Care / Disability Income)

Client Client2
(A) Monthly needs required $ 10,000.00 monthly $ monthly
Preferred benefit payout period (years) 30 years years
(B) Current monthly benefits $ 3,000.00 $
Notes
Client 1: Expect to grow
5. In the Event of Hospitalisation / Medical Expenses

Client Client2
Private Private
What is the preferred hospital type and ward? Government / Restructured Government / Restructured
A B1 B2/C A B1 B2/C
Provision for Deductible and / or Co-Insurance? Deductible Co-Insurance Deductible Co-Insurance
Existing type of hospital plan cover? Medi Shield
Insurer name and plan type? Man U life , Medi Shield
Do you require maternity coverage? Yes No Yes No

Notes
Client 1: Hcggchhgchgchgcchf
Aviva: Internal
SECTION 10A - NEEDS ANALYSIS (PROTECTION) 88800295200625170603
6. Planning for Dependants Protection
Dependant(s)
Daughter1
Name of Dependant:
A. In the Event of Hospitalisation
Preferred hospital type? Private or Government / Private

Restructured?
Provision for deductible? Yes No Yes No Yes No Yes No
Provision for co-insurance? Yes No Yes No Yes No Yes No
Existing type of hospital plan cover? (Insurer name Medishield

and plan type)
B. In the Event of Critical Illness
Total Funds Required $ 1,000,000.00 $ $ $
Less existing resources (if any) $ 1,000,000.00 $ $ $
Surplus / (Shortfall) $ $ $ $
C. In the Event of Disability
Annual expenses (pmt) $ 120,000 $ $ $
Years to provide for (n) 75
Net rate of return (inflation adjusted) (i) 3
(A) Capital Sum Required (pv) $ 3,671,145.70 $ $ $
(B) Medical Expenses $ $ $ $
(A + B) = Total Funds Required $ 3,671,145.70 $ $ $
Less existing resources (if any) $ 1,000,000 $ $ $
$ (2,671,145.70) $ $ $
Surplus / (Shortfall)
D. In the Event of Death
Final expenses $ 100,000 $ $ $
Loans (e.g. education loan etc) $ 80,000 $ $ $
Others: $ 50,000 $ $ $
Total Cash Needs: $ 230,000 $ $ $
Less existing resources (if any) $ 1,000,000 $ $ $
Surplus / (Shortfall) $ 770,000.00 $ $ $
Notes
Important Note to Adviser
Fact find should always be completed on the proposer. In the case of adult child(ren) paying for parents'
Text to include
Eldershield
change: andCareShield
Eldershield Life?
supplements, fact find should be completed on the parents i.e. the proposer
Aviva: Internal
SECTION 10B - NEEDS ANALYSIS (ACCUMULATION) 88800295200625170603
7. Planning for Retirement
Client Client2
Desired retirement age 55 60
Number of years to retirement (n) 23 years 29 years
Desired Monthly Retirement Income in Today's Value (pv) $ 15,000.00 monthly $ 8,000.00 monthly
Assumed inflation rate, (%) (i) 3 3
Desired monthly retirement income (fv) $ 29,603.80 monthly $ 18,852.52 monthly
Annual amount $ 355,245.60 annually $ 226,230.24 annually
Inflation adjustment investment rate after retirement, (%) (i) 6 3
Number of years to provide for retirement (n1) 25 years 25 years
(A) Funds Required at Retirement Age $4,813,704.89 $ 4,057,562.01
(B) Remaining Liabilities at Retirement (if any) $ 300,000.00 $ 100,000.00
(A) + (B) = (C) Total Retirement fund Needed $ 5,113,704.89 $ 4,157,562.01
Existing Resources Allocated for Retirement
ROI(%)
(Projected Values)
Life insurance cash value 2,0 $ 15,000,000 $ 6,000,000
Cash assets (Savings, Fixed Deposits, etc.) 0.8 , 3 $ 120,000 $ 30,000
Investments (Bonds, Unit Trusts, Shares, etc.) 8,7 $ 1,360,599 $ 1,100,000
Others: Bitcoin, Collection 15 , 5 $ 80,000 $ 60,000
(D) Funds Available at Retirement Age (fv) $ 33,777,649.47 $ 14,143,347.86

$ 28,663,944.58 $ 9,985,785.85
(D) - (C) = Surplus / (Shortfall) at Retirement
Notes
Client 1: Hgvghvghvh
Client 2: Incorrect to populate insurance value in section 7 here
8. Planning for Children's Tertiary Education
Daughter name
Name of child not populated
Number of years to university (n) years 15 years

Current annual cost of tertiary education (Tuition + Allowances) (pv) $ monthly $ 25,000 monthly
Education inflation rate (i) 3
Course duration (years) 4
(A) Funds Required (fv) $ $ 155,796.76
Existing Resources Allocated for Children's

ROI(%)
Education (Projected Values)
Life insurance cash value 2 $ $ 3,000,000
Cash assets (Savings, Fixed Deposits, etc.) 1.5 $ $ 30,000
Investments (Bonds, Unit Trusts, Shares, etc.) 6 $ $ 1,100,000
Others: Bearer bonds 3 $ $ 20,000
(B) Funds Available $ $ 6,742,485.34

$ $ 6,586,688.58
(B) - (A) = Surplus / (Shortfall)
Notes
Client 2: Insurance from section 7 not supposed to populate here No special char allowed here
Aviva: Internal
SECTION 10B - NEEDS ANALYSIS (ACCUMULATION) 88800295200625170603
9. Savings for Other Purposes
Client Client2
Purpose Maternity
(A) Target Amount $ 100,000.00 $

Years to target (n) 2 years years
Current savings and investments (pv) $ 40,000 $

Estimated rate of return (%) (i) 2
(B) Future Value of Current Savings and Investments (fv) $ 41,616.00 $
Notes
SECTION 11 - AFFORDABILITY
add text:
Please indicate the amount that is within your affordability to set aside for your objectives and whether the"If your answer
amount is “Yes”,
is a substantial youofmay
portion
your assets and income. encounter a potential risk in the future of not
being able
As a guide, the amount that you are willing to invest should not be more than 50% of your total assets or 20%to of
continue
your totalpaying
monthlyyour
inflow. t
premiumspurposes.
is also recommended that you should also set aside 3 to 6 months of your monthly outflow for emergency " I
Client Client2
Funds Annual Single Substantial Annual Single Substantial
Amount Amount Amount Amount Amount Amount
Cash $ 30,000 $ Yes No $ 30,000 $ Yes No
CPF Ordinary account $ $ Yes No $ $ Yes No
CPF Special account $ $ Yes No $ $ Yes No
CPF Medisave account $ $ Yes No $ $ Yes No
Supplementary Retirement Scheme $ $ Yes No $ $ Yes No
Aviva: Internal
SECTION 12 - ADVICE AND RECOMMENDATIONS 88800295200625170603
Basis of Recommendations (Complete this section for Life & Health Advice)
Aviva-MyProtector-Term Plan II Client's choice
Client1 PDF Test | 7 Needs(s) : Death,Critical Illness,Disability,Disability(Long Term),Hospitalisation,Retirement,Savings for

Other
Life Assured Frequency Settlement Mode
Client1 PDF Test Monthly Cash
Basic Cover:
Sum Assured Premium Premium Term Policy Term
$ 2,000,000 $ 1,000 25 Years 25 Years
Aviva: Internal
Basis of Recommendations (Complete this section for Life & Health Advice)
Aviva-MyEasySaver Client's choice
Client2 Pdf Test | 2 Needs(s) : Dependants protection,Children’s Tertiary
Life Assured Frequency Settlement Mode

Daughter1 Testtest Half-Yearly Cash
Basic Cover:
Sum Assured Premium Premium Term Policy Term
$ 200,000 $ 6,000 15 Years 15 Years
Aviva: Internal
Basis of Recommendations
Please elaborate on the following points (where applicable):
• How does the product features and benefits meet client’s financial objectives • What are the reasons for switching / replacement of
and needs? products?
• How does the product fit client's risk profile and time horizon? • How does the product meet client’s financial situation?
• Has affordability and liquidity of the client been

assessed?
Ghchfchgchgchgvh add "... objectives, needs and shortfall

amount?" to include in app and pdf.
Aviva: Internal
• What are the risks, disadvantages and limitations of the products and recommendations?
• What are the product fees & charges?
NB hgchghgchgvhgvhg
• What are the reasons for deviations? Eg Premium more than client's affordability (Refer to Section 11). Funds risk class is higher than
client's risk profile (Refer to Section 8).
• Additional Notes
Client Name: Client1 PDF Test

Affordability Substantial Amount
Check if they are comparing Annual Figures or Monthly figures
Why reason of deviation here for substantial amount
Client Name: Client2 Pdf Test
Affordability Substantial Amount
Check if system is comparing annual figures or Monthly figures why prompt sustantial amount here. Annual surplus is 72000
Aviva: Internal
SECTION 13 - SWITCHING / REPLACEMENT OF POLICY 88800295200625170603
1. Are you switching / replacing in full or in part any existing or recently terminated collective investment scheme or insurance
policy, whether purchased from Aviva or other Financial Institution?
Yes No
If "Yes", please proceed to the next question. Your Adviser should provide the reasons in detail, in changes:
Basis of Recommendation
Text Delete highlighted(for
text, in both app
replacement of CIS, life and health policy(ies)). and pdf.
If "No", please proceed to Section 14.
2. Did your Adviser recommend that you switch / replace in full or in part any collective investment scheme or insurance policy,
whether purchased from Aviva or other financial advisers?
Yes No
3. Did the Adviser provide the basis of the recommendation and inform you of the transaction costs and / or possible
disadvantages listed below?
• Incurring transaction costs without gaining any real benefit from the switch / replacement
• The new investment product / insurance plan may offer a lower level of benefit at a higher cost or at the same cost, or offer the
same level of benefit at a higher cost
• Incurring penalties for terminating the existing investment products / insurance plans
• The new investment product / insurance plan may be less suitable and the terms and conditions may differ
• I may not be insurable at standard terms
• Loss I may incur as a result
• I may be entitled to free fund switching, if any.
Yes No
4. I hereby confirm that I wish to proceed with the switch / replacement notwithstanding that the fees, charges or disadvantages
that may arise could outweigh any potential benefits.
Text change:
Yes No
"I acknowledge that I have read and
understood the contents of the following
SECTION 14 - CLIENT ACKNOWLEDGEMENT AND DECLARATION
documents. I am also aware that I will
1. I acknowledge receipt and I have read and understood the following documents (where applicable)
receive electronic copies of the documents."
• Important Notice To Client
• Financial Needs Analysis Form
• Copy of the cover page, product summary, policy illustration, bundled product disclosure document and product highlights sheet (if
applicable) in respect of the life policy. Can we have individual checkbox for these
• Prospectus / Profile Statement including a supplementary prospectus or supplementary profile statement and Product Highlight Sheet
documents? To demonstrate compliance with
(if applicable) in respect of the collective investment scheme
g18 principle 2 where "a single checkbox
• High Conviction List - Cash SRS/CPFOA SRS (if applicable)
I have been directed to the following guides available online (if applicable) should not be used for a client's
• Your Guide to Life Insurance (https://www.lia.org.sg/media/1389/ygtli_english_jul2018.pdf) acknowledgement of receipt of multiple
sales documents".
• Your Guide to Investment-Linked Insurance Plans (https://www.lia.org.sg/media/1387/ilpguide17aug06.pdf)
• Your Guide to Participating Policies (https://www.lia.org.sg/media/1392/ygtpp_english_july2018.pdf)
Requires App changes to include check box
• Your Guide to Health Insurance (https://www.lia.org.sg/media/1385/may2016_lia_ygthieng_highresolution.pdf)
2. Investment Risk and Disclosure (where applicable)
I understand and acknowledge that I have been given a clear explanation on the possible investment risk involved. The value of a
To include check box for each of the
Collective Investment Scheme (“CIS”) may rise or fall and the potential returns are non-guaranteed. I may lose some or all of my
declaration
investment depending on the performance of the underlying securities of which performance factors include, without limitation, market
risks, fluctuations in interest rates, foreign exchange rates and political instability.
I acknowledge that before I invest in the recommended CIS, I am aware of the nature and objective of the product, details of the product
provider, the product’s intended investment time horizon, the liquidity and the commitment level required for the product and the
expected level of risk tolerance of the client. I am aware that there may be a price difference between the order placement date and the
trade execution date.
I am advised to refer to the fund’s prospectus and product highlights sheet for more information and I should not invest in the product if I
do not understand or I am not comfortable with such risks. I understand and acknowledge that Aviva and its representatives shall not be
held responsible and liable for any market performance of the investments.
Aviva: Internal
SECTION 14 - CLIENT ACKNOWLEDGEMENT AND DECLARATION 88800295200625170603
3. Payer's Source of Funds
Salary Financial Investment Inheritance
Business Income Insurance Benefits Family Gifts
Compensation or Remuneration Retirement Assets
Others (specify): Savings
Third Party Payment
For third party payment, please complete the following fields and provide a copy of third payer's identification document (e.g.NRIC/Passport
etc.)
Name: French mom NRIC/Passport No: E7764334F Relationship to Payer: Mother
Reason: Mom gift Nationality & Residency: FR,FR
4. Payer's Source of Wealth

Salary Financial Investment Inheritance
Business Income Insurance Benefits Family Gifts
Compensation or Remuneration Retirement Assets
Others (specify): Savings (e.g. one time receipts, sale of properties etc.)
5. Tax Declaration
Have I committed or been convicted of any serious tax crimes?
If Yes, please complete an ECDD form and provide more information in the box below.
Tax evasion
6. Personal Data Notice and Consent Clause

I agree to be contacted by Aviva (and/or Aviva group of companies or their service providers) for special marketing offers, promotions and
information about Aviva’s products and services which may be of interest to me. I consent to the collection, use and disclosure of my
personal data by Aviva and Aviva group of companies for the above purposes.
Please tick to provide your consent:
Mail Email SMS Call
View your policy details anytime, anywhere. Register for MyAviva at www.aviva.com.sg/myaviva.
I consent to Aviva (and Aviva related group of companies) collecting, using and/or disclosing my personal data (whether contained in this
form or obtained from other sources; existing data in Aviva’s record or to be collected in future) for the following purposes:
•to issue and administer my existing and/or new policy(ies) and/or account(s) with Aviva, and such other purposes ancillary or related to
the administering of the policy(ies) and/or account(s), including the processing of my personal data for underwriting purposes, payment of
premiums (including, where applicable, the deduction of premiums due from the Medisave accounts of the proposed Lives Assured)
and/or claims purposes;

•for statistical, research, compliance, audit and regulatory purposes; and
•to provide general information on product enhancements and services relevant to my needs or policies (including increasing benefits,
adding riders/supplements and/or Lives Assured) as well as to provide financial advice or product recommendations to me, where
applicable.
•I also consent to Aviva (and Aviva related group of companies) transferring my personal data to Aviva related group of companies and/or
third party service providers, reinsurers, suppliers or intermediaries, whether located in Singapore or elsewhere, for the above purposes.
•For more information on Aviva’s data protection policy and full details of the purpose of collection, use and disclosure of your personal
data, please visit http://www.aviva.com.sg/pdpa.html.
7. Additional Premium Support Clause

Anyone who pays for, or is insured under MyShield/MyHealthPlus/MyCare/MyCare Plus is not eligible for Additional Premium Support
(APS) from the Government.*
If you are currently receiving APS to pay for your MediShield Life and/or CareShield Life Premiums, and you choose to be insured under
this MyShield/MyHealthPlus/MyCare/MyCare Plus, you will stop receiving APS. This applies even if you are not the person paying for this
MyShield/MyHealthPlus/MyCare/MyCare Plus.
In addition, if you choose to be insured under this MyShield/MyHealthPlus/MyCare/MyCare Plus, the person paying for
MyShield/MyHealthPlus/MyCare/MyCare Plus will stop receiving APS, if he or she is currently receiving APS
*APS is for families who need assistance with MediShield Life and/or CareShield Life premiums, even after receiving premium subsidies
and making use of MediSave to pay for these premiums.
I acknowledge that I have read and understood the above warning clause on the eligibility of APS.
Aviva: Internal
8. Customer Knowledge Assessment Declaration To delete this note
Note: In the event of a joint investment, both clients will be deemed to have not fulfiled the criteria in the CKA if one of them is assessed not
to have possessed the knowledge or experience in an unlisted Specified Investment Product.
IMPORTANT NOTICE TO CLIENTS
Please note that should you choose to proceed with the investment after being advised that theTo deleteisthis
product/s note
/ are not suitable for you, you
will not be able to rely on section 27 of Financial Advisers Act (FAA) to file a civil claim should you suffer a loss in future.
I acknowledge that I have been given a clear explanation of the objectives for CKA, as well as understand and agree with the
outcome of the CKA.
checkbox to be added in app and pdf for the
Client
acknowledgement.
PASS CKA
I understand that I have PASSED CKA and I DO NOT WISH to receive any advice offered by my Adviser. I understand that by
choosing not to receive any advice, I will not be able to rely on Section 27 of Financial Advisers Act (FAA) to file a civil claim in
the event of a loss.
I understand that I have PASSED CKA and I 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
DID NOT PASS CKA
I understand that I DID NOT PASS CKA and I WISH TO PROCEED with my investment. I understand that I will need to receive advice
from my Adviser, who will assess me on the suitability of the investment product for my investment. Based on the assessment of the
me, and I would like to PROCEED with the investment.
Client2
PASS CKA
I understand that I have PASSED CKA and I DO NOT WISH to receive any advice offered by my Adviser. I understand that by
choosing not to receive any advice, I will not be able to rely on Section 27 of Financial Advisers Act (FAA) to file a civil claim in
the event of a loss.
I understand that I have PASSED CKA and I WISH to receive advice offered to me by my Adviser. Based on the assessment of the
me, and I would like to PROCEED with the investment
DID NOT PASS CKA
I understand that I DID NOT PASS CKA and I WISH TO PROCEED with my investment. I understand that I will need to receive advice
from my Adviser, who will assess me on the suitability of the investment product for my investment. Based on the assessment of the
me, and I would like to PROCEED with the investment.
Financial Advisers Act Section 27 Extract
Recommendations by licensed financial advisers
To remove this extract
1. No licensed financial adviser shall make a recommendation with respect to any investment product to a person who may reasonably be
expected to reply on the recommendation if the licensee does not have a reasonable basis for making recommendation to the person.
2. For the purposes of subsection (1), a licensed financial adviser does not have a reasonable basis for making 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
(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 the 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.
[2/2005] [SF Bill, Clause 121]
Aviva: Internal
checkbox to be added in app and pdf for
I acknowledge that each of the acknowledgement.
a) The recommendation(s) prepared by my Adviser is / are based on the facts furnished by me in this form, and any incomplete or
inaccurate information provided by me may affect the suitability of the recommendation(s) made. As such, Aviva shall have no
responsibility for any errors and / or omissions
b) In the event I choose not to provide information requested, I am aware that it is my responsibility to ensure the suitability of the
product(s) selected.
c) In the event that this intended transaction is a substantial portion of my assets / income, I am aware and willing to proceed with the
transaction and bear the responsibility of this decision.
d) The Adviser has explained to me in detail the recommendation(s) made and
i) by affirming it with my signature below, I agree to proceed with the proposed recommendation(s) as indicated with tick(s) in Client’s
Choice in Section 12 (Advice and Recommendations);
or
ii) by NOT affirming it with my signature below, I disagree to proceed with the proposed recommendation(s).
e) Beneficial owner is a natural person who contributes to or exercises control over the account(s)/policy(ies). I am the beneficial owner
and have not appointed any natural person to act on my behalf. If you are not the beneficial owner or have appointed natural
person(s) to act on behalf of you, kindly complete the Enhanced Customer Due Diligence Form.
Client1 PDF Test Client2 Pdf Test

Signature of Client / Date Signature of Client2 / Date
SECTION 15 - ADVISER'S DECLARATION
I declare that 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 in this form. The information will be treated as confidential and will be used as part of fact find to recommend suitable
investment product(s) and shall not be used for any other purposes without client’s consent.
For Switching / Replacement of Policy (where applicable):
1. I have explained to the client the possible disadvantages of the Switching / Replacement and where applicable, informed him of other
options besides Switching / Replacement.
2. I have also explained the basis for Switching / Replacement and why the Switching / Replacement is suitable for the client as stated
in section 12 (Advice and Recommendations).
Yxw Fxxng Fxng 25-06-2020

Name of Adviser Adviser's Signature Date
Aviva: Internal

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All information collected in this financial review will be held in strict confidence.

Name of Client (as in NRIC, passport) : Client1 PDF Test

Name of Client2 (as in NRIC, passport) : Client2 Pdf Test

Name of Adviser (as in NRIC, passport) : Yxw Fxxng Fxng

MAS Representative Number : FYF300037434

Case Number : 88800295200625170603

I declare I am authorized to:

Advise / arrange contract of Insurance in respect of Life & Health Policies

Customer Knowledge Assessment

The assessment will be in the form of a simple questionnaire on page 13 to 15.

Married Divorced Married Divorced

Gender Male Female Male Female

Primary Secondary Primary Secondary

English Malay Others English Malay Others

Smoker(Smoked cigarettes or cigars

This form has been explained in Russki (language) by Client1

Trusted Individuals details App Change:

Client Declaration To make this paragraph in bullet point.

Add after A. Dependent’s details (Eg.

Client 1: Some unknown disease

Net Employment Income $ $ Dividend Income $ $

Bonus $ $ Rental Income $ $

Total Monthly Inflow $ 12,000.00 $ 12,000.00

Utilities $ $ Mobile / Internet / Cable $ $

Groceries $ $ Food / Dining $ $

Property Tax $ $ Grooming / Shopping $ $

Maid Services $ $ Entertainment $ $

Cash Mortgage $ $ Vacation Text

compulsory… " This information helps to

School Fees $ $ Road Tax + Car Servicing $ $

Medical $ $ Parking + Petrol

Total Transportation Expenses $ $

Insurance - Cash premiums Regular Investments - Cash (incl. SRS )

Personal $ $ Unit Trusts $ $

Children $ $ Shares / Stocks $ $

Total Premiums (Cash) $ $ Total Cash / SRS $ $

Monthly CPF Info Miscellaneous

Inflow Charity / Tithes $ $

Ordinary Account $ $ Other Loans: $ $

Special Account $ 150,000 $ Others: $ $

Medisave Account $ $ Others: $ $

Total Inflow $ 150,000 $

SA Regular Investments $ 7,000 $

be taken into consideration for the Needs

Moves question C to top of the page as per

Then follow by A. Monthly Inflow

A. Assets (Current Market Value)

Cash/Near Cash Invested Assets

Savings $ $ Unit Trusts $ $

Fixed Deposits $ $ Stock $ $

Property - Residence $ $ Insurance Endowments needs."

Motor Vehicle(s) $ $ CPF Balance (OA) $ $

Others e.g. (Valuables /

Total Personal Use Assets $ $ CPF Medisave (MA) $ $

Total Invested Assets: $ $

Total Assets: $ 1,200,000 $ 1,200,000

B. Liabilities (Please Indicate Outstanding Amount Owing on Liability)

Short Term Long Term

Others: $ $ Car Loan $ $