Enclosure 2
PARTICIPATION IN THE ADF FINANCIAL ADVICE REFERRAL PROGRAM
DECLARATION
1 Insert the name,
address and
occupation of
person making
the declaration
I,1
make the following declaration.
2 Set out matter
declared to in
numbered
paragraphs
2
I acknowledge that it may be unlawful under Corporations Act 2001 (Cth) s 1041H and/or Australian
Securities and Investments Commission Act 2001 (Cth) s 12DA to make any statement in respect of
the Australian Defence Force Financial Advice Referral Program (the Program) that is in any way
misleading, deceptive or likely to mislead or deceive. I acknowledge that in the event that I have been
suspected of engaging in such conduct in respect of the Program, whether or not in connection with
this declaration, the administrators of the Program may refer the matter for investigation to the
Australian Securities and Investments Commission.
I declare that I [ am the holder of an Australian Financial Services Licence | am an employee of an
entity which holds an Australian Financial Services Licence | am a director of an entity which holds an
Australian Financial Services Licence | am an authorised representative of the holder of an Australian
Financial Services Licence | am an employee of an entity which is an authorised representative of the
holder of an Australian Financial Services License | am a director of an entity which is the authorised
representative of the holder of a Australian Financial Services Licence ] with full details of that
arrangement (including all relevant entity names, Australian Financial Services Licence details and
authorised representative details) being as follows:
[TO BE COMPLETED BY THE APPLICANT]
I believe that the following prior experience in the provision of personal financial advice renders me
with an appropriate level of expertise and familiarity with financial issues affecting members of the
Australian Defence Force:
1. [TO BE COMPLETED BY THE APPLICANT]
2.
I declare that the following of my formal and demonstrable qualifications render me adequately able
to provide advice to persons referred to me under the Program:
1. [TO BE COMPLETED BY THE APPLICANT]
2.
I declare that, in respect of any financial advice (including financial product advice as defined in of the
Corporations Act 2001 (Cth) pt 7.1 div 4) I provide in connection with the Program, I will at no times
be under the direct or indirect influence of a financial product manufacturer. For the purposes of this
paragraph, I acknowledge that “direct or indirect influence” means any relationship that could in any
way compromise the impartiality or quality of advice being given.
I declare that, in respect of all business conducted under the [ Australian Financial Services Licence |
representative’s authority of an Australian Financial Services Licence holder ] described above, the
only means by which I will receive remuneration from the provision of financial advice to Australian
Defence Force members and their families is through the charging of genuine fees for service. For
the purposes of this paragraph, I acknowledge that remuneration that is not by way of genuine fees
1
for service includes:
1.
2.
3.
4.
5.
6.
Commissions;
Trailing commissions;
Asset-based fees for service;
Bonuses (of whatever description);
Conflicted remuneration as defined in Corporations Act 2001 (Cth) pt 7.7A div 4; and
Any other form of remuneration that could reasonably give rise to a conflict between my
interests and the interests of my clients.
I declare that I have never been:
1. Convicted of a crime or offence; and/or
2. Found by a court or a regulatory body to have acted unlawfully under the Corporations Act
2001 (Cth) or the Australian Securities and Investments Commission Act 2001 (Cth);
where that conduct could reasonably have any bearing on my being a fit and proper person for the
provision of financial advice (including financial product advice as defined in of the Corporations Act
2001 (Cth) pt 7.1 div 4) in connection with the Program.
I enclose a copy of my Financial Services Guide (FSG) which is unequivocally consistent with the
undertakings that I have made in this declaration. I declare that, in the event any changes are made
to my FSG, I will provide a copy of that new FSG to the administrators of the Program who will
determine my continued eligibility to remain a listed provider under the Program.
I acknowledge that in the event that the administrators of the Program form the reasonable view that I
have conducted myself in a manner that is in any way inconsistent with the undertakings made in this
declaration, the administrators may remove me from the list of Program providers pending resolution
of the matter by the Australian Securities and Investments Commission. For the purposes of this
declaration, I acknowledge that “administrators” includes persons acting for or on behalf of the
Australian Defence Force Financial Services Consumer Council.
3 Signature of
person making
the declaration
3
4 Place
5 Day
6 Month and year
Declared at 4
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on 5
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