Fillable Declaration Form Financial Advice Provider Address Financial Adviser (City of Oakland)

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Declaration Form Financial Advice Provider Address Financial Adviser (City of Oakland)

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1
August 2021
Declaration Form
Financial Advice Provider
Address
Financial Adviser
Lender means a lender (including their associated parties)
Insurer means an insurance product provider (including their associated parties)
Please complete and review this Declaration Form carefully. By signing this Declaration Form you are acknowledging that
you understand and agree to each of the statements set out in Sections A - I below.
Section A: Authority to act
I/We give the Financial Advice Provider express authority to act on my/our behalf with all Lenders and Insurers in respect of:
obtaining or maintaining a loan
insurance products associated with my/our loan.
Section B: Fees & Commission Arrangements
I/We confirm that I/we have been provided with and have read and understood the Financial Adviser’s Disclosure Guide. I/We
understand that the Financial Adviser’s Disclosure Guide details, amongst other things, the commission, fees and expenses that may be
received by, or payable to, the Financial Adviser / Financial Advice Provider. I/We also understand and agree the circumstances in
which I/we may need to pay fees to the Financial Adviser / Financial Advice Provider (if applicable).
Section C: Relationship of Financial Advice Provider
I/We understand that:
● the Financial Adviser is a director, employee and/or contractor of the Financial Advice Provider and acts on behalf of the Financial
Advice Provider.
● the Financial Adviser and the Financial Advice Provider are members of NZ Financial Services Group Limited (NZFSG). NZFSG
provides services which can include a client management system, facilitating payment of commission, training, and access to th
e
Lenders and/or Insurers.
● the Financial Adviser and the Financial Advice Provider are not employees, agents, partners or joint venture partners of the
Lender(s)/Insurer(s) or NZFSG.
● the Financial Adviser and the Financial Advice Provider do not act on behalf of the Lender(s)/Insurer(s) or NZFSG.
Section D: Privacy
D.1 Privacy Authorisation
● I/We authorise my/our personal information (client information) to be collected, used and disclosed in accordance with
the Financial Advice Provider’s privacy policy (available on the Financial Advice Provider’s website or provided with this
Declaration Form).
● I/We authorise my/our client information to be shared with the Lender(s)/Insurer(s) and collected and used by them in
accordance with their privacy policies available on the Lender(s)/Insurer(s)’ website(s).
D.2 Privacy Summary
The key terms of the Financial Advice Provider’s privacy policy are summarised below:
Collection: The Financial Advice Provider may collect client information from a number of third parties. These
third parties include credit reporting agencies and, with your authorisation, employers and banks
(e.g. through the use of illion BankStatements).
Purpose: The Financial Advice Provider will collect and hold client information for the purpose of
recommending lending and/or insurance products to me/us.
Disclosure:
The Financial Advice Provider may disclose client information to third parties if the Financial Advice
Provider considers it necessary to do so for the purpose above. These third parties include the
following:
● the Lender(s)/Insurer(s)
● NZFSG
● credit reporting agencies
● service providers, e.g. organisations that provide the Financial Advice Provider with
administrative and management assistance and services
● the Financial Markets Authority and other regulators
● organisations involved in auditing the Financial Advice Provider.
PSL Enterprises Ltd trading as MORTGAGE PARTNERS
18 Whittaker Place, Havelock North, Hastings
Paul McCarthy
✔
✔
2
August 2021
Prior to disclosing client information, we will take all reasonable steps to ensure the third party has
the same level of commitment to protecting the client information.
Further Use &
Disclosure:
The third parties referred to above may also use and disclose client information in accordance with
their own privacy policy. For example, in the case of a Lender, this includes using and sharing the
information for the purpose of assessing the application and administering the loan – e.g.
information might be shared with a previous or current employer; the lender’s credit reporting
agency; authorities to assist in fighting fraud, money laundering or other criminal offences; and
guarantors. If the Financial Advice Provider has an ongoing commission arrangement in place with
the Lender over the term of the loan, the Lender will periodically disclose the loan balance to the
Financial Advice Provider and NZFSG.
Credit Reporting
Agencies:
The client information (including information about default and repayment history) may be
exchanged with credit reporting agencies. This information will be used by and held on the systems
of those agencies to provide their credit reporting services and may be disclosed to the Financial
Advice Provider, the Lender(s)/Insurer(s) and other customers of the credit reporting agencies.
Marketing: The Financial Advice Provider and/or Lender(s)/Insurer(s) might use client information for market
research purposes and for direct marketing purposes (whether through mail, email or telephone
(including SMS/MMS) or other electronic means) to notify me/us of products or services that may be
of interest to me/us. You have the right to opt-out of electronic direct marketing.
Consequences: I/We are not required by law to provide any personal information to the Financial Advice Provider,
but any failure to do so might prejudice my/our chances of obtaining a loan or insurance.
Rights:
I/We have the right to request access to and correction of my/our personal information held by the
Financial Advice Provider and Lender(s)/Insurer(s).
Obligations: If I/we provide any personal information about anyone else to the Financial Advice Provider or to a
Lender/Insurer (or authorise the Financial Advice Provider or Lender/Insurer to collect that
information), I/we confirm that such persons consent to and authorise the collection and use of their
personal information in accordance with the Financial Advice Provider’s and Lender/Insurer’s
respective privacy policies. I/We confirm that I/we have advised such persons of their rights to
access and request correction of their personal information.
Section E: Legal and Valuation Costs
I/We confirm that (Please tick if applicable)
I am/We are to meet legal and valuation costs in relation to obtaining a loan.
Section F: GST Matters
I/We confirm that: (Please tick the applicable box)
I am/We are not registered for GST and will not be with respect to the security property.
I am/We are or will be registered for GST, but the security property is not/will not be used for the purpose of a taxable activity.
I am/We are or will be registered for GST and the security property is/will be used for the purposes of a taxable activity.
Section G: Specialist Insurance Advice
I/We acknowledge that:
● as part of the intended lending transaction I/we understand I/we should review my/our personal risk insurance requirement(s).
● I/we have been offered the option to have a specialist insurance adviser review my/our personal risk insurance requirements
and
have decided to: (Please tick the applicable box)
have the review completed by the specialist insurance adviser
decline the option to review my/our personal risk insurance requirements and exempt the Financial Advice Provider, the
Financial Adviser and specialist insurance advisers from any liability or loss caused as a result of this decline.
Section H: Loan Repayment
I/We understand that:
● should my/our circumstances change before the loan is repaid, I am/we are responsible for continuing to make loan repayments
(subject to applicable laws).
● in the event of my/our death, it will be my/our estate’s responsibility to make the loan repayments and/or to pay off any loan balance.
✔
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3
August 2021
Section I: Loan Application Form
I/We confirm that:
● I/we have read, understood and agree to the content of this Declaration Form
● the information included in the Loan Application Form, including my/our Asset & Liability Statement, is true and correct.
Signed
Signed
Name
Name
Date
Date
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Declaration Form Financial Advice Provider Address Financial Adviser (City of Oakland)

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Completed 16 May 2022

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