Appointment of Financial Advisors (Form B)

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I/We appoint Collins House Private Wealth (Collins House), a Corporate Authorised Representative of Collins House Private Wealth Pty Ltd (AFSL No. 449146), as my/our Financial Advisors, effective immediately.

I/We also  authorise Collins  House to  attain  any  information  that  they  may  require  until  further notice.

Furthermore, if there are any  commissions  payable  to  licensed  advisors  please  rebate  them  to my/our account or reduce the premiums or management fees accordingly. If this cannot be done please pay the commissions to Collins House, who will rebate the same to me/us directly.

In the interim until such time as the appointment of Financial Advisor is in effect, I/We also grant Third Party Authority to Collins House Private Wealth (Collins House), a Corporate Authorised Representative of Collins House Private Wealth Pty Ltd (AFSL No. 449146), and its Financial Advisors, Consultants, and staff, namely  Mr  Dominic Alafaci, Mr  Sam  Campisi, Mr Con Vatmanidis, Ms Kate Nicol, Mr Lloyd Masocha, Ms Moira Bentley, Ms Margitta Wilkinson, Ms  Claire Jin, Ms Yi  Li  or Ms Sarah Chang, authority to obtain any confidential information they may require regarding the above.

If you have any queries, please contact Collins House as below and the aforementioned Financial Advisors, Consultants, and staff, who are acting on my/our behalf with regard to this matter.

PHONE (03) 9629 6922
EMAIL mail@collinshouse.com

POST
PO Box 24175
Melbourne VIC 3001

OFFICE
Level 13, 90 Collins Street
MELBOURNE VIC 3000

Confirmation of supplied details