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ECONOIMPACT AFRICA Wealth Discovery Questionnaire

Earning Income is no longer the ceiling, it’s the starting point.

Today’s professionals are building, earning and accessing opportunities at levels previous generations could only imagine. But without the right structure, even the highest income can remain underutilised, flowing in and out without creating lasting impact.

At EcoImpact Africa, we believe true wealth is built intentionally. It requires clarity, strategy and a system that ensures every shilling is working toward growth, sustainability and legacy.

This form is designed to help us understand where you are, where you want to go and how we can support you in building a financial and impact framework that outlives you.

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Full Name
Date of Birth
MM
/
DD
/
YYYY
Phone Number
Email Address
Occupation
Employer/Business
Marital Status
Clear selection
Dependants (if any)
What does financial success look like to you?
What are the top three things you would like your money to achieve for you?
If we met again 10 years from now and your finances had exceeded your expectations, what would have happened?
Monthly Net Income (after tax and deductions)
Additional Income Sources (e.g., side hustles, rentals)
Average Monthly Expenses
How much are you currently able to save each month?
Do you currently operate a budget?
Clear selection
Cash & Savings (Estimated Values)
Less than Ksh50,000
Ksh50,000 - Ksh200,000
Ksh200,001 - Ksh500,000
Over Ksh500,000
None
Bank Savings
Money Market Funds
Fixed Deposits
Emergency Fund Balance
Clear selection
Investment Holdings (Estimated Values)
Less than Ksh100,000
Ksh100,001 - Ksh500,000
Ksh500,001 - Ksh2,000,000
Over 2,000,000
None
Shares/Stocks
Unit Trusts/Mutual Funds
Bonds
SACCO Savings
Other Investments
Property and Other Asset Value
Less than Ks500,000
Ksh500,001 - 2,500,00
Ksh2,500,001 - Ksh5,000,000
Over Ksh5,000,000
None
Land
Residential Property
Rental Property
Other Assets
Clear selection
Business Interests - Estimated Value
Outstanding Loans (Total Balance)
Mortgage Balance
SACCO Loans
Credit Facilities (e.g., Credit Card Balance)
Other Debts (Specify in description if needed)
Monthly Debt Repayments (Total)
Do you currently have the following forms of Protection & Risk Management?
Yes
No
Medical Insurance?
Life Insurance?
Income Protection Cover?
Critical Illness Cover?
Will?
Trust Structure?
Clear selection
If you answered 'Yes' to any protection or trust structure question above, please provide details.
Do you contribute to a pension scheme?
Clear selection
Current Pension Value
Monthly Pension Contributions
Do you have additional retirement investments (e.g., personal retirement savings)?
Clear selection
Financial Confidence Assessment (Rate yourself from 1-10)
Low Confidence
High Confidence
Clear selection
Investment Knowledge (Rate yourself from 1-10)
Beginner
Expert
Clear selection
Confidence in Retirement Planning (Rate yourself from 1-10)
Uncertain
Very Confident
Clear selection
Confidence in Wealth Preservation (Rate yourself from 1-10)
Uncertain
Very Confident
Clear selection
Confidence in Legacy Planning (Rate yourself from 1-10)
Uncertain
Very Confident
Clear selection
Wealth Governance
Yes
No
A written financial plan?
Named beneficiaries on your investments?
An estate plan?
A succession plan for your assets?
A system for tracking your net worth?
Clear selection
Short-Term Goals (1–3 Years)
Medium-Term Goals (3–10 Years)
Long-Term Goals (10+ Years)
What are the three biggest challenges you currently face with your finances?
If there was one thing you would like to achieve from our Wealth Strategy Session, what would it be?
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