Adelaide Bank a Division of Bendigo and Adelaide Bank Limited ABN 11 068 049 178 Australian Credit Licence 237879, GPO Box 1048, Adelaide SA 5001. ABL0411 (11/18)
Loan Writer Details
First name: Middle name: Surname: Preferred name*:
Completed accreditation forms to be returned to:
Adelaide Bank Broker Support
This application seeks accreditation for:
Residential Loans
Commercial Loans - Please specify years of experience in broking and/or the nancial industry
Note: Adelaide Bank Commercial workshop training is a mandatory requirement in order to receive the Commercial Accreditation.
* Your individual broker code will be
created under your preferred name.
Date of birth:
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Business/Trading/Company name: ABN/ACN:
Postal address (For delivery of loan documentation):
State: Postcode:
Ofce address:
State: Postcode:
**Mandatory Field
If this application is for a change to your current accreditation, please provide your existing broker code:
Ofce phone number:
Fax number:
Mobile number:
Proof of the following information is required to process your application.
All documentation must accompany this Accreditation Application Form or your accreditation will not proceed.
1. Aggregator Membership
Name of Aggregator:
Please attach a certicate or correspondence from your Aggregator conrming your active association with them.
2. Australian Credit Licence Number
Please attach a certicate or correspondence from ASIC conrming your personal Licence Number or evidence that you have been appointed as a
Credit Representative.
3. Industry Membership (MFAA, FBAA, FPA or equivalent)
Please attach a certicate or correspondence from your Industry body conrming your active association with them.
Loan Writer
Accreditation Application Form
Adelaide Bank a Division of Bendigo and Adelaide Bank Limited ABN 11 068 049 178 Australian Credit Licence 237879, GPO Box 1048, Adelaide SA 5001. ABL0411 (11/18)
I acknowledge that Adelaide Bank is relying on the truth and accuracy of the information contained in this declaration and that any error or omission may cause
Adelaide Bank to incur damage or loss and I declare the above information to be true and correct.
Full name: Signature:
Loan Writer Declaration
Privacy Statement/Disclosure
What this statement is about
Your right to privacy is important to us. This statement explains your privacy rights and our rights and obligations in relation to your personal information.
The Privacy Act 1988 regulates the way Organisations (“we”) use personal information provided about you. Please read the following carefully as it sets out
how we may use information about you.
You need not give us any of the personal information requested in the Application for Accreditation form or any other document or communication relating to
the application. However, without this information, we may not be able to enter into an Originator Manager Agreement with you.
You may seek access at any time to personal information held by us about you and ask us to correct it if you believe it is incorrect or out of date.
How we may use your personal information
We use your personal information to:
• assess whether to accept your Originator Application for Accreditation form,
• administer and manage our relationship with you,
• facilitate our internal business operations, including fullment of any legal requirements and condential systems maintenance and testing,
• and inform you in your business capacity of products and services provided by us which we consider may be of value or interest to your clients unless you
tell us not to.
Our right to disclose your personal information
We may disclose your personal information if it is necessary to do so in the following circumstances:
• to any regulatory body,
• to any credit reporting agency to obtain a commercial and/ or consumer credit report, trade reference or other commercial and/or consumer information
about you to accept your Originator Application for Accreditation form,
• to our external service providers that provide services for the purposes only of our business, on a condential basis, for example advisers and mailing
• to any persons acting on your behalf, including your solicitor or accountant, unless you tell us not to,
• to any party acquiring an interest in any business, and
• if you request us to do so or if you consent or where the law requires or permits us to do so.
Your authority to us
By signing this Originator Application for Accreditation form you authorise us to collect, maintain, use and disclose your personal information in the manner set
out in this privacy statement.
Accreditation Process
1. Complete accreditation form and return to Adelaide Bank by email to
2. Adelaide Bank will create an individual broker code per broker and will forward details via email. This broker code must be used when submitting any loan
3. If current accreditation is held for residential or commercial loans, any additional accreditation (if under the same Aggregator) will be added to the broker’s
existing broker code.
4. Upon receipt of broker code, or conrmation of updated accreditation, the broker may begin submitting loans to Adelaide Bank.
Note: Adelaide Bank reserves the right to grant, refuse or revoke accreditation at its discretion. Accreditation is subject to periodic review and update. This may
be as a result of (but not limited to), legislative changes, product reviews, compliance requirements or loan writers no longer representing the group to
whom accreditation was achieved.
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