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Additional Representatives

If you are wishing to be a Corporate Representative of KOSEC GROUP and intend to employ representatives under your corporate banner, please fill out an additional form with the authorised representatives’ details

Licensee Name

AFSL

Advisor Name

Authorised Rep No#

Date Issued

ABN No#

Corporate Rep No#

Date Issued

ABN No#

If CAR, Name of Co#

Residential Address

Work Address

Postal Address

Work Phone

Home Phone

Mobile

Date of Birth

Suburb of Birth

ID Number

Website

ow long have you been in the Financial Planning/ Wealth Management/ Broking Industry?

Please 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 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’s

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?