Contact us Email: info@crxwealth.co.za Email Us Phone: +27 82 355 5960 Call Us Start a conversation about your financial future Share your details below and we’ll connect to explore a strategy tailored to your goals Full Name Email Address Mobile Number ID Number Employment Status Employed Self-Employed Business Owner Retired Unemployed Monthly Income Below R20,000 R20,000 – R50,000 R50,000 – R100,000 R100,000 – R250,000 R250,000+ Approximate Net Worth Below R500,000 R500,000 – R2 million R2 million – R5 million R5 million – R10 million R10 million+ Percentage of Income Available for Investment Less than 5% 5% – 10% 10% – 20% More than 20% What are your primary investment goals? (Select all that apply) Wealth Growth Capital Preservation Retirement Planning Passive Income Tax Efficiency Estate Planning Asset Protection Offshore Investments/Structures Investment Time Horizon Less than 1 year 1 – 3 years 3 – 5 years 5 – 10 years 10+ years How would you describe your investment knowledge? None Basic Moderate Advanced Which products have you invested in before? Unit Trusts Shares / Equities ETFs Retirement Annuities Property Crypto Assets Offshore Investments/Structures None If your investment drops 10% in value, what would you do? Sell immediately Reduce exposure Do nothing Invest more What level of fluctuation are you comfortable with? Minimal (0–5%) Moderate (5–10%) High (10–20%) Very High (20%+) What is your priority? Protect capital Balance growth & safety Maximise growth Aggressive growth How do you react to market volatility? Very uncomfortable Slightly concerned Comfortable Opportunistic How soon may you need access to your investment? Immediately Within 1 year 1 – 3 years 3+ years Can you commit to long-term investing? No Unsure Yes I confirm that the information provided is accurate and complete I confirm that the information provided is accurate and complete I understand that investments carry risk and returns are not guaranteed I understand that investments carry risk and returns are not guaranteed I consent to CRX Wealth Management processing my information in accordance with POPIA I consent to CRX Wealth Management processing my information in accordance with POPIA Send
