Financial Counselling Agency Authorisation

Formally authorise a counselling agency to deal with a third party on behalf of one or two clients, capturing agency, counsellor and reference details plus the required signatures. Includes an optional section for business clients.

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About This Authorisation

Third Party Details

Third party

Reference number

Client Details

Full name (client 1)

Date of birth

Address

Full name (client 2)

Date of birth

Address

If the Client Is a Business

Business name

ABN

Address

Authorised Agency Details

Financial counselling agency (authorised representative)

Financial counsellor's name

Registration number

Address

Phone

Mobile

Email

Signatures

Signature (client 1)

Sign here

Date

Signature (client 2)

Sign here

Date

Duration and Revocation

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