Authority to Obtain Confidential Information (Form A)

Fields marked with an * are required

I/We give 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, 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.

This authority is to remain valid until revoked.

If you have any queries, please contact Collins House as below:

PHONE (03) 9629 6922

PO Box 24175
Melbourne VIC 3001

Level 13, 90 Collins Street

Confirmation of supplied details