Application

Become an authorised representative

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