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INVESTOR 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

About You
Surname
First name(s) *
Date of birth (dd/mm/yy) *
Email address *
Nationality / Citizenships: *
Full postal address:
Telephone number (home):
Telephone number (mobile):
Fax Number:
How well do you speak English?
About your partner
Surname
First name(s)
Date of birth (dd/mm/yy)
Email address
Nationality / Citizenships:
How well does your partner speak English?
General
Please indicate your current annual level of income from pensions and / investments (in Australian Dollars):	$55,000.00 to $65,000.00 $65,000.00 to $85,000.00 $85,000.00 +
Are you willing to live in a regional area of Australia?	Yes No
Do you and your family enjoy good health?	Yes No
If any member of your family has a medical condition, please provide brief details:
Do you or your family members have any criminal convictions?	Yes No
If yes, please provide brief details:
Please indicate which State of Australia you would like to live in:
Have you ever visited Australia for holiday or work purposes?	Yes No
Do you have family or friends living in Australia?	Yes No
Approximately how much money (in your own currency) do you have available to bring to Australia with you?
If you are eligible to apply for migration to Australia, do you intend to start the process within the next 12 months?	Yes No
Kindly let us know how you heard about our website: Family / Friend / English Magazine / Irish Magazine / www.aussiehome.com / www.aussieadvice.com / Other
How do you want this to be assessed?	Free Assessment Priority Assessment (a fee of AUD $150.00 is payable.)

INVESTOR RETIREMENT

About You

About your partner

General