Application to become an Authorised Representative of SMSF Advisers Network (SAN)

* Required fields

SECTION 1: CONTACT DETAILS & IDENTIFICATION
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Business Address

Business Postal Address (if applicable)

Please attach two references that include your industry experience, qualifications or good fame and character from colleagues or clients who state they have known you for at least five years. This needs to be on their company letterhead and signed by them.

(Both files are required)

REFERENCE 1

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REFERENCE 2

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PLEASE PROVIDE DETAILS

PLEASE PROVIDE DETAILS

View an example of a reference by clicking HERE

SECTION 2: DETAILS OF LICENCES & AGENCY AGREEMENTS PREVIOUSLY HELD *



SECTION 3: EDUCATION, EXPERIENCE AND QUALIFICATIONS

Please list your educational qualifications and attach proof.

(Include schooling level, degrees, diplomas etc).

These will be listed on the ASIC website under your name once you become authorised.

View an example of a Statement of Attainment for RG146 HERE

NOTE: Attach proof of meeting RG146 requirements:

1) Provide advice in Superannuation

2) Provide advice in Self-Managed Superannuation Funds

3) Including CPD/CPE training register, where qualifications were completed more than 2 years ago.

Qualification * Institution * Year Completed * Attach Proof *
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Please list your Financial Services Industry experience.

(Only applicable if you’ve provided advice under a licence in the past).

Date from * Date to * Employer * Position * Description *

Please list the professional bodies with whom you have a membership.

These will be listed on the ASIC website under your name once you become authorised.

Please attach proof below.

Date from Date to Professional Body Membership Category Attach Proof
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SECTION 4: GOOD FAME AND CHARACTER DETAILS

State whether in the last 10 years (All required):

NOTE: If you have answered Yes to any of the above, please provide further details as an attached document:

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A conviction of an individual does not have to be disclosed if:
(i) the conviction was subsequently quashed or set aside by a court; or
(ii) the individual was subsequently granted a pardon in respect of the offence; or
(iii) the individual did not receive a prison sentence for the offence, and the conviction happened more than 10 years ago, or more than 5 years ago if the court dealt with the individual as a minor; or
(iv) the conviction was for a State offence, and under the law of the State concerned relating to spent convictions the individual is permitted not to disclose the conviction in these circumstances.
An offence proven without conviction, a pecuniary penalty order or a civil penalty order need not be disclosed if it occurred more than 10 years ago (5 years ago where the person dealt with was a minor).

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A person is taken to be ‘associated’ with an insurance intermediary whose registration was refused, suspended or cancelled or who ceased trading without meeting all insurance liabilities if the person is or was:
(i) a director or principal of that intermediary; or
(ii) an employee or agent of that intermediary who is or was in a position of influence or control over the operations of that intermediary.

SECTION 5: COMPLAINTS HISTORY *

SECTION 6: DECLARATIONS AND UNDERTAKINGS
  • I declare that the information provided by me in this application is true and correct to the best of my knowledge and belief.
  • I undertake to advise the Licensee, for so long as I am an authorised representative of the Licensee, of any changes to the information provided by me in this application.
  • I undertake to submit to all compliance and business reviews as required by the Licensee.
  • I undertake to submit to all ongoing training and education as required by the Licensee.
  • I undertake to surrender my authorised representative authority on request by the Licensee.
  • I undertake to submit to all reasonable requests from the Licensee as required from time to time.

Please be advised that we have a 90 day application period, after which time your application will be automatically declined, you may be provided with the option to reapply – our re-application fee is $500 (exc. GST).
* This cost is subject to change, as determined by the SMSF Advisers Network.

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