Commission Refund - Transfer of Servicing
(Complete separate form for each fund manager or insurer)
Please complete, scan & email to jb@justinbrand.com.au or fax to 02 8014 5765.
Personal Details
Client 1
Client 2
/
/
Given Names
Surname
Date of Birth
/
/
Address
Phone
Email
Bank Details (for transfer of your monthly refund)
Account Name
BSB
Account Number
Superannuation, Investment or Insurance Details (Complete separate form for each financial company)
Product Name
Owner
Account/Policy Number
I/we request that all servicing rights for the above financial products be transferred to our new adviser (listed
below).
I/we understand that any existing adviser will no longer be remunerated for the above products and will no longer be able to
provide me/us with any ongoing service regarding the above products.
I/we understand that no personal advice was given by Justin Brand or Arc Financial Consulting or its representatives as to the
suitability of the above products to my/our needs and objectives. I/we take full responsibility for ensuring that the above
products remain appropriate to my/our needs and objectives. I/we understand that I/we can seek advice specific to my/our
personal situation at anytime and understand that there may be an additional cost for any personal advice.
I/we understand that any commission from the above products will be paid to Justin Brand at Arc Financial Consulting and
refunded to me/us in full every 3 months. I/we agree to subscribe to the newsletter at http://justinbrand.com.au/newsletter/
and understand that my refund is conditional upon me/us reading this newsletter. I/we understand that an administration
fee may apply, or I/we may not receive a refund, if I/we do not maintain this subscription.
I/we understand that these terms and conditions are subject to change, but that there is no exit fee and I/we will be advised in
advance of any changes.
I/we understand that commission refunds will only be paid once the above financial companies have transferred servicing
rights and Justin Brand and Arc Financial Consulting have received the commission payment.
I/we consent to the collection and use of my/our personal information as outlined in the Privacy Policy*.
I/we have read the Financial Services Guide* and General Advice Warning*.
Client 1
Client 2
Signature
Date
Authorised Representative Details:
Justin Brand of Arc Financial Consulting Pty Ltd, Authorised Representative #412968 of Dover Financial Advisers Pty Ltd
ABN 87 112 139 321, Australian Financial Services Licensee 307248, 71 Tulip St, Cheltenham Vic 3192.
Authorised Representative Signature ____________________________________________________________________________ Date ________________
* Available at justinbrand.com.au