Appointment of Financial Advisors (Form B)

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1. I/We appoint Collins House Pty Ltd trading as Collins House Private Wealth (Collins House), a Corporate Authorised Representative of Collins House Private Wealth Pty Ltd (AFSL No. 449 146), as my/our Financial Advisors, effective immediately.

Dealer Group/Advisor Code ____________________________

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.

2. Secondly I/We grant Third Party Authority to Collins House and its Financial Advisors, Consultants, and staff, namely Mr Dominic Alafaci, Mr Sam Campisi, Mr Con Vatmanidis, Ms Kate Nicol, Ms Sarah Manassa, Ms Margitta Wilkinson, Ms Claire Jin, Ms Yi Li, Mr Nhia Yang, Ms Sarah Chang, Mr David Varlamos, Mr Marcus Poretti, Mr Stuart Matheson and Ms Shia Jain to obtain any confidential information they may require regarding the above, until further notice.

If you have any queries regarding these two instructions, please contact Collins House as below

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

POST
PO Box 24175
Melbourne VIC 3001

OFFICE
Level 13, 90 Collins Street
MELBOURNE VIC 3000

Confirmation of supplied details