My Financial Plan

Please fill this form carefully, as these details are vital for making a good financial plan for you. Feel free to contact the person who referred you or our manager for assistance/help.
Email address
Name
Please write your full name.
Your answer
Phone
Please write your mobile number.
Your answer
Gender
Please Select from the list
Date of Birth
Please write your date of birth in DD/MM/YYYY format, Example: 25/11/2012
Your answer
PAN
Please write your Permanent Account Number (PAN)
Your answer
Address
Please write your complete address.
Your answer
Occupation
Please select from the list.
Annual Income (Post Tax)
Please write values in Lakhs.
Your answer
Email Address
Please write your email ID.
Your answer
Association Mode
Please mention your association mode with MY CARE. Please select from list.
Date of association
Please mention your date of association with My Care in DD/MM/YYYY Format, Exapmle: 25/08/2015
Your answer
Day of association
Please mention your day of association with My Care. Please select from the list.
Name of First Child
Please write name of your first child. Please write Boy/Girl if you are planning your first baby in near future.
Your answer
Date of Birth OR Age in years of First Child
Please write age as -1, -2 -3 years etc if you are planning your First baby in near future.
Your answer
Age in years of Higher Education of First Child
Please write age of child in years when he/she will require higher education
Your answer
Present Cost of Higher Education of First Child
Assume as if the amount is needed Today
Your answer
Age in Years of Marriage of First Child
Please write age of child in years when he/she will marry
Your answer
Present Cost of Marriage of First Child
Assume as if the amount is needed Today
Your answer
Name of Second Child
Please write Boy/Girl if you are planning your Second baby in near future.
Your answer
Date of Birth OR Age in years of Second Child
Please write age as -1, -2 -3 years etc if you are planning your Second baby in near future
Your answer
Age in years of Higher Education of Second Child
Please write age of child in years when he/she will require higher education
Your answer
Present Cost of Higher Education of Second Child
Assume as if the amount is needed Today
Your answer
Age in Years of Marriage of Second Child
Please write age of child in years when he/she will be marry
Your answer
Present Cost of Marriage of Second Child
Assume as if the amount is needed Today
Your answer
Age of Retirement
Age at which you are planning your retirement (Example: 60 Years)
Your answer
Monthly Income needed on Retirement (Present Value)
Assume as if the amount is needed Today
Your answer
Other Goals 1. House/Property - Time Period
Please mention Years to Maturity,
Your answer
Other Goals 1. House/Property - Amount Needed
Amount needed (Please write the Present Value)
Your answer
Other Goals 2 Car - Time Period
Please mention Years to Maturity.
Your answer
Other Goals 2. Car - Amount Needed
Amount needed (Please write the Present Value)
Your answer
Other Goals 3 Holidays/Travel - Time Period
Please mention Years to Maturity
Your answer
Other Goals 3. Holiday/ Travel - Amount Needed
Amount needed (Please write the Present Value)
Your answer
Other Goals 4 Wealth Creation - Time Period
Please mention Years to Maturity
Your answer
Other Goals 4. Wealth Creation - Amount Needed
Amount needed (Please write the Present Value)
Your answer
Other Goals 5. Please Specify
What is your Goal?
Your answer
Other Goals 5 Please Specify - Time Period
Years to maturity
Your answer
Other Goals 5. Specific Goal - Amount Needed
Amount needed (Please write the Present Value)
Your answer
Life Insurance Requirement - Cover Period
For How Many Years do you wish to provide financial support to your family members in your absence (from today)
Life Insurance Requirement - Amount Required
How much support i.e. Rupees Per month would be needed
Your answer
Any Outstanding Loan/Liability - Total
If yes, Please write the Amount as on today
Your answer
Existing Life Coverage
If yes, Please write the Total Sum Assured (Life Cover)
Your answer
Existing Health Coverage - Mediclaim Policy
If yes, Please write the Total Sum Assured
Your answer
Existing Investments 1. Instrument
Please Select from the list
Existing Investments 1. Current Amount
Please Write Value in Rupee as on Today
Your answer
Existing Investments 1. Expected Returns
Annual Returns in Percentage you are Expecting, Please Select from the list
Existing Investments 1. Goal for which this money was saved
Please select from the list.
Existing Investments 2. Instrument
Please Select from the list
Existing Investments 2. Current Amount
Please Write Value in Rupee as on Today
Your answer
Existing Investments 2. Expected Returns
Annual Returns in Percentage you are Expecting, Please Select from the list
Existing Investments 2. Goal for which this money was saved
Please select from the list.
Existing Investments 3. Instrument
Please Select from the list
Existing Investments 3. Current Amount
Please Write Value in Rupee as on Today
Your answer
Existing Investments 3. Expected Returns
Annual Returns in Percentage you are Expecting, Please Select from the list
Existing Investments 3. Goal for which this money was saved
Please select from the list.
Existing Investments 4. Instrument
Please Select from the list
Existing Investments 4. Current Amount
Please Write Value in Rupee as on Today
Your answer
Existing Investments 4. Expected Returns
Annual Returns in Percentage you are Expecting, Please Select from the list
Existing Investments 4. Goal for which this money was saved
Please select from the list.
Existing Investments 5. Instrument
Please Select from the list
Existing Investments 5. Current Amount
Please Write Value in Rupee as on Today
Your answer
Existing Investments 5. Expected Returns
Annual Returns in Percentage you are Expecting, Please Select from the list
Existing Investments 5. Goal for which this money was saved
Please select from the list.
Total Monthly Income - Post Tax
Please mention your total monthly income excluding tax
Your answer
Total Monthly Expenses
Please mention your monthly expense amount (Total)
Your answer
Your Saving Potential Growing in coming years [0 - 15 Years]
Please indicate an Yearly % change saving potential
0-5%
5-8%
8-12%
12-15%
More than 15%
0-5 Years
5-10 Years
10-15 Years
Any Other Relevant Infotmation
Please provide any other relevant information regarding your financial matters, if you wish to share with us
Your answer
RISK SCANNER - QUESTION 1
Your age is? Please Select from the list
RISK SCANNER - QUESTION 2
Of the Total Income, your expenses account for? Please Select from the list
RISK SCANNER - QUESTION 3
You provide financial support to. Please Select from the list
RISK SCANNER - QUESTION 4
You are................. Please Select from the list
RISK SCANNER - QUESTION 5
Your job or business is......... Please Select from the list
RISK SCANNER - QUESTION 6
What is your current investment pattern? Please Select from the list
RISK SCANNER - QUESTION 7
You invest Rs.1,00,000 in the stock market via Mutual Funds and markets drop by 20% in value in about less than a months time. You would...........: Please Select from the list
RISK SCANNER - QUESTION 8
You are in a game show, with the following options to choose from. The option that appeals the most to you is: ............Please Select from the list
RISK SCANNER - QUESTION 9
You generally invest for a horizon of ............Please Select from the list
RISK SCANNER - QUESTION 10
In order to increase your returns you would ............Please Select from the list
RISK SCANNER - QUESTION 11
You are ............ years away from retirement. Please Select from the list
Agreement for fine adjustments in input while making the Financial Plan
The applicant agrees to do some fine adjustments in his input so as to make a good & feasible financial for him/her.
Your My Care Registration Code
Please mention your My Care Registration Code
Your answer
Application Form Filled By
Please mention the name and phone number of person who has filled this form
Your answer
A copy of your responses will be emailed to the address you provided.
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