Application Booklet

Licensee
Name*
First
AFSL*
Adviser Details
Name of Adviser
Representative Type
Authorised Rep No#
Date Issued
MM slash DD slash YYYY
ABN NO#
Corporate Rep No#
Date Issued
MM slash DD slash YYYY
ABN NO#
If CAR, Name of Co#
Address
Residential Address
Work Address
Postal Address
Contact Details
Work Phone
Home Phone
Mobile
Date of Birth
MM slash DD slash YYYY
Email
Suburb of Birth
Website
ID Number
Additional Representatives

If you are wishing to be a Corporate Representative of RM Capital and intend to employrepresentatives under your corporate banner, please fill out an additional form with the authorised representatives details
Declaration
I
Name*
hereby warrant that the information given above and contained in my CV is true and correct and is not misleading in any way
Signature:
Accepted file types: jpg, png, jpeg, pdf, Max. file size: 1 MB.
Date
MM slash DD slash YYYY

Questionnaire
Wholesale Investors
ow long have you been in the Financial Planning/ Wealth Management/ Broking Industry?
lease provide a brief description of the type of business you have been engaged in eg, Financial Planning/ Wealth Management/ Broking etc.
Do you currently hold an Authorised/Corporate Authorised Representative License? If no, skip to question
If yes, what is your Authorised Representative License Number (you can find this on the ASIC website
Please list your two most recent Australian Financial Services Licensee’
How long have you held a Proper Authority / Authorised Representative License?
Are you currently compliant with FASEA Professional Standards?
Do you know your study requirements?
Are you a member of any professional organisations such as the Australian Financial Planning Association, Finsia etc? If yes, please state

Have you had any ASIC and / or ASX investigations, disciplinary proceedings or charges during your period in the Broking/ Financial Planning /Finance industry? If yes, provide a description
Have any of your activities in the Broking / Financial Planning / Finance industry directly or indirectly lead to any insurance claims? If yes, provide a description
What level of gross revenue do you think you will write after your new business has been established (allowing say 9-12 months to rebuild your business to current levels)?
How many clients do you currently have on your existing client base?
What is your total FUM for these clients?
What has your previous two years of revenue been?
What systems are you currently using – settlement agent / database etc?
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Questionnaire