Please make any additional notes/comments which you feel are relevant:

I/We confirm that the information provided adequately reflects my/our personal circumstances, priorities and attitude to risk.

I/We understand that where I/we have decided to provide information, the provided

will be restricted to specific areas and will not take into account all of my/our personal circumstances.

I/We provide the information contained in this questionnaire on the understanding that it will be used in strict confidence and that it places me/us under no obligation to take up any suggested recommendation.

Signature of self Signature of spouse/partner

_____________________________________ ______________________________________

Name _______________________________ Name ________________________________

Date ________________________________ Date _________________________________