Authorised Representative Application

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Step 1 of 17 - Personal Details

AUTHORISED REPRESENTATIVE APPLICATION FORM

Thank you for your interest in becoming an Authorised Representative of AMAFA. To assist us with your enquiry it would be appreciated if you could complete this application form.

While completing this form you can save and return to it at any time - if you have any questions or need assistance the contact details are at the bottom of the page.

Rest assured that each application is treated in the strictest of confidence.

We look forward to processing your application.

Thanks again.

Title*

Given Names*

Surname*

Preferred Name*

Previous Names

Date of Birth*

DD slash MM slash YYYY

Place of Birth*

Are you an Australian Citizen?*

If no, how long have you continually lived in Australia?*

Do you have a current VISA enabling you to work in Australia?*

If you are authorised or have been previously authorised - what is your AR number?

Do you speak a language other than English?*

If yes please specify.*

Home Address*

Suburb*

State*

Postcode*

Business Address*

Suburb*

State*

Postcode*

Please tick if postal address is the same as

Business Address

Home Address

Postal Address*

Suburb*

State*

Postcode*

Home Phone

Business phone

Fax

Mobile*

Email*

Website

Company/Entity Name*

Business Trading Name*

Are you currently registered for GST?*

Bank*

Branch*

Name of Account*

BSB*

Account Number*

ABN*

Set out details of your employment and business activities during the previous five (5) years, stating name, nature of business/employer, position held and period of employment (give details). A resume is also acceptable.

Employment History*

Period of Employment

Name of Employer/Business

Nature of Business

Position Held

Business History: Please provide a brief history of your business.

Previous Licensee

Legal Structure: Please outline below your business’ legal structure (e.g. two partner business, two family trust etc):*

Target Clients: Please outline below your target clients (e.g. retirees, high net worth, doctors etc):*

Referrals, Partners and Joint Ventures: Please outline below any referral or joint venture arrangements you may have:*

Business Partners and Senior Staff Details

Name

Position

Phone

What authorisation are you applying for?*

Are you currently a…

Mortgage Broker*

If yes, who are you licenced through?*

General Insurance Broker*

If yes, who are you licenced through?*

Real Estate Agent*

If yes, do you hold your own licence?*

Accountant*

If yes, through which industry body?*

Solicitor*

If yes, which state base law society?*

Other*

If yes, please provide details.*

SPECIALIST ACCREDITATION

Do you currently offer the following services, or have clients with:

Margin Lending*

If Yes, please complete the questions below:

Total Number of Clients that have Margin Lending:*

Total Value of All Margin Loans Outstanding ($):*

Maximum LVR when you set up a Margin Facility (%):*

Do you provide your clients with a copy of the current PDS for each funding provider when recommending marging lending products?*

Do you provide your clients with adequate details regarding the investment, interest rate, and margin call risks associated with Margin Lending?*

Do you recommend that your clients seek independent tax advice regarding the tax implications of margin lending?*

If No, do you refer them to a qualified accountant?

Please ensure that your approved products list notes all margin lending facilities utilised by you.

Hidden

Section Break

SMSF*

Risk Insurance*

Direct Equities*

Managed Discretionary Accounts*

Are you involved in client portfolio management on a discretionary basis (MDA)?

If Yes, please provide details below:

Total Number of Clients that have MDA's:*

Total Funds under Management in Respect of MDA's:*

Please attach a copy of the standard MDA client agreement.*

Accepted file types: docx, pdf, Max. file size: 128 MB.

OVERALL ACTIVITIES

Please detail the approximate percentage of your income in the following area:

Financial Planning / General Advice

Investment Advice / Selection

Client Portfolio Administration and Reporting

Life Insurance

Personal Insurance

General Insurance

Mortgage Broking

Finance Broking

Accounts Preparation / Bookkeeping

Tax Returns

Tax Advice

SMSF Establishment & Administration

SMSF Audit

Total

LAST 12 MONTHS REVENUE | FOR ESTABLISHED ADVISERS

Current Funds Under Management (to be transferred)*

Current Premium Under Management (to be transferred)*

Last financial year gross revenue investment (sales/fees)*

Last financial year gross revenue insurance (sales/fees)*

ESTIMATED FIRST YEAR REVENUE

Estimated first year investment inflows*

Estimated first year gross revenue investment (sales/fees)*

Estimated first year gross revenue insurance (sales/fees)*

INVESTMENTS

Please advise the allocation of client investments across all licenses combined according to the following:

Australian Equities on a Direct Basis

Client Investment

Percentage

Australian Equities via Managed Funds

Client Investment

Percentage

Overseas Equities on Direct Basis

Client Investment

Percentage

Overseas Equities via Managed Funds

Client Investment

Percentage

Fixed Interest Securities and/or Cash

Client Investment

Percentage

Property Trust on Direct Basis

Client Investment

Percentage

Property Trust via Managed Funds

Client Investment

Percentage

Public Offer Superannuation

Client Investment

Percentage

Hedge Funds

Client Investment

Percentage

Derivatives (Other Than Hedge Funds)

Client Investment

Percentage

Registered Managed Investment Schemes

Client Investment

Percentage

Unregistered Managed Investment Schemes

Client Investment

Percentage

Tax Effective Schemes (with or without ATO Product Ruling)

Client Investment

Percentage

Unlisted Securities (for which a liquid market does not exist or for which units can not be redeemed on demand)

Client Investment

Percentage

Investments in single underlying asset or debt instrument

Client Investment

Percentage

Any other product or service from an entity which you are associated (financially or otherwise)

Client Investment

Percentage

Any other product or service that you would consider potentially high risk or speculative

Client Investment

Percentage

Hybrid Securities

Client Investment

Percentage

Others

Client Investment

Percentage

Total

Client Investment

Percentage

Has the above allocation of client investments varied significantly in the past 3 years?*

If Yes, please provide full details.*

Do you have clients that are exposed to frozen funds?*

Product Information*

Frozen Funds

Name of Funds

FUM

Do you have clients that are exposed to agribusiness?*

Product Information*

Agribusiness

Name of Schemes

FUM

Do you have clients that are exposed to collapsed funds?*

Product Information*

Collapsed Funds

Name of Funds

Funds

BUSINESS SYSTEMS

Preferred Platforms*

Preferred Life Insurance Providers*

Financial Planning Software*

Risk Comparator Software*

Research Houses Subscribed to*

Customer Relationship Management*

Set out any additional information (including any formal qualifications or training and the name of the institution that conducted the relevant course) considered relevant to this application.

Education*

Type (Bachelor, Diploma, Certificate)

Qualification

Provider

Date Completed

Please choose the appropriate answer.

Diploma in Financial Services (Financial Planning)

DFS 1 (Generic Knowledge & Financial Planning)

DFS 2 (Risk Management / Life Insurance)

DFS 3 (Investment Planning 1 / Managed Investments)

DFS 4 (Superannuation & Retirement Planning)

Advanced Diploma in Financial Services (Financial Planning)

DFS 5 (Taxation Planning)

DFS 6 (Estate Planning)

DFS 7 (Investment Planning 2)

DFS 8 (Financial Plan & Construction)

EXTRA ACCREDITATION FORMAL QUALIFICATIONS

SMSF*

Provider*

Margin Lending*

Provider*

Direct Equities (Securities plus ASX ALPA)*

Provider*

Risk Insurance*

Provider*

CONTINUING PROFESSIONAL DEVELOPMENT (CPD)

Are you currently up to date with your ongoing CPD requirements?*

If no, state reason:*

PRACTITIONER MEMBERSHIP

Associate of the Financial Planning Association (FPA)*

Senior Associate of the Financial Planning Association (FPA Snr)*

Certified Financial Planner (CFP)*

Member of the Association of Financial Advisers (AFA)*

Fellow Chartered Financial Practitioner (FChFP)*

Were you registered with the Tax Practitioners Board prior to 31 December 2022 or have you completed the required education to provide Tax (Financial) Advice?*

If no, please provide a short explanation why.*

Previous employer | If not possible, then another business reference

Name*

Company*

Address*

Business Landline Number Only*

Email Address*

Nature of Relationship*

Industry representative eg Business Development Manager

Name*

Company*

Address*

Business Landline Number Only*

Email Address*

Nature of Relationship*

Have you held an AFSL or been an AR of an AFSL holder?*

If yes, please provide details including previous Licensee and your Authorised Representative number:*

AFSL Number / Authorised Representative Number*

Are you currently still authorised?*

Have you been licensed, registered, or otherwise authorised by law to carry on any trade, business or professional in any place? (e.g. registered Tax Agent, Mortgage Broker etc)*

If yes, please provide details:*

Have you been refused the right or restricted in the right to carry on any trade, business or profession for which a specific licence, registration or other authority is required by law in any place?*

If yes, please provide details:*

Have you been a member or partner in a member firm of any stock exchange?*

If yes, please provide details:*

Have you been suspended or refused membership of any stock exchange or otherwise been the subject of any disciplinary action by a stock exchange?*

If yes, please provide details:*

Have you carried on business under any name other than the name or names shown in this application in paragraph 1 (a)? (e.g. Maiden name or changed name by Deed Poll)*

If yes, please provide details:*

Have you previously been convicted by any court or other regulatory authority of any offence (other than a traffic offence) in any place, or are you a subject to any such current proceedings which may possibly lead to a conviction?*

If yes, please provide full details including whether judgement is unsatisfied:*

Have you had any court or regulatory authority grant judgement against you in any civil and/or or criminal proceedings in relation to fraud, misrepresentation or dishonesty, or are there any such current unresolved proceedings which you are subject to?*

If yes, please provide full details including whether judgement is unsatisfied:*

Have you previously been declared a bankrupt in any jurisdiction and/or been an officeholder of any company which has been placed in receivership or any other form of management or administration as a result of an insolvency act occurring?*

If yes, please provide full details including whether judgement is unsatisfied:*

Have you been refused a fidelity or surety bond, in any place?*

If yes, please provide full details:*

Do you have any agreements / franchise / authorised representative status with any other provider (e.g. general insurance licensee?)*

If yes, please provide full details:*

Disclosure requirements to be completed by all potential representatives of AMAFA.

Are you a licensed Authorised Representative?*

If yes, please indicate the name of the Licensee:*

Have any claims ever been made against you in relation to your professional conduct?*

If yes, please provide details:*

Are you aware of any circumstances in relation to your existing client portfolio which could give rise to any insurance claim, lawsuit or other form of litigation in relation to your conduct?*

If yes, please provide details:*

Are you handling any current matter which has the potential to become an insurance claim, lawsuit or other form of litigation?*

If yes, please provide details:*

Have you ever had any professional liability insurer decline or cancel any application for insurance, or impose any special or restrictive conditions in relation to any insurance policy applied for?*

If yes, please provide details:*

Have you been subjected to a compliance audit inspection by your previous Licensee within the last [3 months / 6 months / 12 months]*

If yes, what was your audit / compliance rating:*

If no, please provide contact details of your previous compliance manager / officer:

Name*

Position*

Licensee*

Business Phone*

Have you undertaken a review of your clients within the last twelve (12) months?*

If no, please indicate when you last undertook a complete audit inspection of your files and whether you are prepared to undertake such a review prior to obtaining your Authorised Representative status with AMAFA:*

In your capacity as an Authorised Representative of [your previous Licensee]

Are you covered by a blanket professional indemnity insurance cover provided by [your previous Licensee]?*

Are you required to obtain your own insurance cover?*

Does your professional indemnity insurance contain retrospective cover?*

If yes, for what period?*

If yes, please indicate the period of such cover:*

If no, are you covered by run-off cover?*

If no, you will be required to negotiate/arrange such cover, either with your PI insurer or through your previous Licensee.

To proceed with submission, please upload the following required documents.

Please provide a police clearance certificate.*

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Please provide a police clearance certificate.*

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Please provide a copy of your visa or confirmation of your permanent residency status.*

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Please provide a copy of your visa or confirmation of your permanent residency status.*

Accepted file types: jpg, png, pdf, docx, Max. file size: 128 MB.

Please provide a clear copy of your driver's license or passport.*

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Please provide a clear copy of your driver's license or passport.*

Accepted file types: jpg, png, pdf, Max. file size: 128 MB.

Please attach a copy of certificate of incorporation or business registration certificate.

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Please attach a copy of certificate of incorporation or business registration certificate.

Accepted file types: jpg, png, pdf, docx, Max. file size: 128 MB.

Please provide copies of your qualifications and training records (including RG146 qualifications).*

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Please provide a copy of your TPB Certificate

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Please provide a copy of your TPB Certificate*

Accepted file types: jpg, png, pdf, docx, Max. file size: 128 MB.

Please attach a copy of your training register for the last twelve (12) months.*

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Please attach a copy of your training register for the last twelve (12) months.*

Accepted file types: docx, pdf, Max. file size: 128 MB.

Please attach the complete report of your last compliance audit inspection, including any compliance performance rating where such system applies.*

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Please attach the complete report of your last compliance audit inspection, including any compliance performance rating where such system applies.*

Accepted file types: docx, pdf, Max. file size: 128 MB.

Please attach a Certificate of Currency for own Insurance Cover.

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Please attach a Certificate of Currency for own Insurance Cover.

Accepted file types: jpg, png, pdf, docx, Max. file size: 128 MB.

Please attach a copy of your resume.*

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Please attached a copy of your Financial Adviser Exam - Statement of Results (Must show Exam Date or Date Notified))*

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Please attach a copy of your resume.*

Accepted file types: docx, pdf, Max. file size: 128 MB.

If you have completed all the required fields and updated the required documents you can submit alternatively or you can save and return to this application later. Please note that the application link will expire after 20 days.

Registration of Relevant Providers

I understand that AMAFA will be my registering agent and declare that:

I am a fit and proper person to provide personal advice to retail clients on relevant financial products.

I have attained a compliance position with respect to professional standards requirements and tax (financial) advice services as indicated below.

Specific Declarations:

(References are to Corporations Act 2001)

I have met the degree standard in s921B(2):

I have completed an approved degree or an equivalent qualification approved by the Minister, or a foreign qualification approved by the Minister.

I can rely on the experienced provider pathway having met the criteria for an 'experienced provider'.

I am an existing provider that will meet the standard by 1 Jan 2026.

I have met the exam standard in s921B(3) by passing the financial adviser exam.

I have met the professional year standard in s921B(4):

I have completed a professional year over the course of at least one year consisting of minimum of 1,600 total hhours experience, of which at least 100 hours was structured training. I have received a final completion certificate from my supervisor and authorising licensees in accordance withh the Corporations (Work and Training Professional Year Standard) Determination 2018.

The standard does not apply. I passed the exam before the exam cut-off day (either 1 Jan 2022 or 1 Oct 2022 under extension).

The standard does not apply. I was on a career break at the exam cut-off day and have subsequently passed the exam.

I have met the definition of a qualified tax relevant provider in s910A:

I am a registered tax agent.

I have otherwise met the requirements in section 921BB which are currently set out in the Relevant Providers Determination.

I do not and will not provide, a tax (financial) advice service.

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NOTE:

Please enter ‘N/A’ for required questions which are not applicable to your situation.

If you wish to clarify anything with regards to this application, please contact Mario Finocchiaro at 0435 888 166.