Application Form
Acclaim Invest

THIS FORM IS INTENDED FOR INVESTORS WITH A FINANCIAL ADVISER

Please ensure ALL information is completed as indicated in this form for the relevant customer type. If information is incomplete, your application will not be processed. Before signing this application form, please ensure that you have read the latest Acclaim Invest Product Disclosure Statement (PDS), available from www.acclaimwealth.com.au or on request by phoning 1300 264 264.

To open an account all investors must have an adviser, online access, and nominate an email address and mobile telephone number for the purposes of receiving notices and information about their account.

In December 2006 the Australian Government introduced the AML/CTF Act which requires reporting entities such as Acclaim Wealth to conduct client identification and verification checks. Acclaim is required to collect and verify ‘Know Your Customer’ information which may vary by investor type. Applicants must supply identification and/or supporting documentation to open an Acclaim Invest account. Addiitonally, under the Common Reporting Standard (CRS) and Foreign Account Tax Compliance Act (FATCA), we are required to collect certain information to identify if applicants are a tax resident of a country other than Australia. For further details, please refer to the Acclaim Invest Application Form Guide.

Applicant type

Only complete the sections relevant to you, as indicated below:

Select account type

Authorised representative or agent

Appointment of power of attorney or other authorised representative

I am an agent under power of attorney or the investor’s legal or nominated representative

Documentation

You must attach a valid authority such as a power of attorney, guardianship order, grant of probate, appointment of bankruptcy trustee etc:

The document is an original or certified copyThe document is signed by the applicant / investor or a court officialThe document is current and completeThe document permits the attorney / agent / representative (you) to transact on behalf of the applicant / investor

Valid Authority Documentation

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Full name of authorised representative/agent

Title of role held with applicant

Signature

Clear

Date

If you are completing this application form as an agent under a direct authority such as a power of attorney, you must also complete information relevant to the investor/applicant that you are acting on behalf of

Individual(s) or individual trustee(s)

Type of investor

Select an option and complete the specified parts of this section

IndividualJointly with another individual(s)Individual trustee for a trustIndividual trustee for an individual (if there is more than one individual trustee)

Investor 1 (individual account holder, first joint investor, director, individual trustee, partner 1)

Existing customer number(if applicable)

Title

Given name(s)

Surname

Date of birth

Email

Telephone

Residential address(not a PO Box)

Town/suburb

State

Postcode

Country

Occupation

Industry

Retired

Provide previous occupation & industry

Do you hold a prominent public position or function in a government body (local, state, territory, national or foreign) or in an international organisation or are you an immediate family member or a business associate of such a person?

NoYes

Please give details

TFN or exemption code

Reason for TFN exemption

Citizenship

Nationality

Town of birth

Country of birth

Foreign tax residence and related taxpayer identification number (TIN)

Are you a tax resident of any jurisdiction other than Australia?

NoYes

Foreign Tax Jurisdiction

If there is more than one country of foreign tax residency, please provide the additional details as an attachment

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Do you have a TIN?

NoYes

TIN

Select a reason code if no TIN (or equivalent)

Investor 2 (second joint investor, director, individual trustee, partner 2)

Existing customer number(if applicable)

Title

Given name(s)

Surname

Date of birth

Email

Telephone

Residential address(not a PO Box)

Town/suburb

State

Postcode

Country

Occupation

Industry

Retired

Provide previous occupation & industry

Do you hold a prominent public position or function in a government body (local, state, territory, national or foreign) or in an international organisation or are you an immediate family member or a business associate of such a person?

NoYes

Please give details

Tax file number (TFN) or exemption code

Reason for TFN exemption

Citizenship

Nationality

Town of birth

Country of birth

Foreign tax residence and related taxpayer identification number (TIN)

Are you a tax resident of any jurisdiction other than Australia?

NoYes

Foreign Tax Jurisdiction

If there is more than one country of foreign tax residency, please provide the additional details as an attachment

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Do you have a TIN?

NoYes

TIN

Select a reason code if no TIN (or equivalent)

Signing authority

Please tick to indicate signing requirements for future instructions (e.g. withdrawals, change of account details, etc)

One investor required to signTwo to signAll investors must sign

If there are more than 2 applicants, please provide the additional details as an attachment

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Partnerships

General information

Full name of partnership

Registered business names of partnership

Country where partnership established

Nature of business

Tax file number (TFN) or exemption code

Reason for TFN exemption

Contact person title

Given names

Surname

Telephone number

Email

Registered office street address(not a PO Box)

Town/suburb

State

Postcode

Country

Type of partnership

Is the partnership regulated by a professional association?

YesNo

Name of professional association

Provide membership details

Full partnership details

Provide the names of and details of all partners.

Partner 1

Title

Given name(s)

Surname

Date of birth

Residential address(not a PO Box)

Town/suburb

State

Postcode

Country

Occupation

Industry

Retired

Provide previous occupation & industry

Citizenship

Nationality

Town of birth

Country of birth

Foreign tax residence and related taxpayer identification number (TIN)

Are you a tax resident of any jurisdiction other than Australia?

YesNo

Foreign Tax Jurisdiction

If there is more than one country of foreign tax residency, please provide the additional details as an attachment

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Do you have a TIN?

YesNo

TIN

Select a reason code if no TIN (or equivalent)

Is there an additional partner?

YesNo

Partner 2

Title

Given name(s)

Surname

Date of birth

Residential address(not a PO Box)

Town/suburb

State

Postcode

Country

Occupation

Industry

Retired

Provide previous occupation & industry

Citizenship

Nationality

Town of birth

Country of birth

Foreign tax residence and related taxpayer identification number (TIN)

Are you a tax resident of any jurisdiction other than Australia?

YesNo

Foreign Tax Jurisdiction

If there is more than one country of foreign tax residency, please provide the additional details as an attachment

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Do you have a TIN?

YesNo

TIN

Select a reason code if no TIN (or equivalent)

Beneficial ownership

Are there any individuals who ultimately own 25% or more of the Partnership; or are entitled (either indirectly or directly) to exercise 25% or more of the voting rights of the Partnership, including power of veto?

YesNo

Beneficial owners

Beneficial owner 1

Title

Given name(s)

Surname

Date of birth

Residential address(not a PO Box)

Town/suburb

State

Postcode

Country

Occupation

Industry

Retired

Provide previous occupation & industry

Citizenship

Nationality

Town of birth

Country of birth

Foreign tax residence and related taxpayer identification number (TIN)

Are you a tax resident of any jurisdiction other than Australia?

YesNo

Foreign Tax Jurisdiction

If there is more than one country of foreign tax residency, please provide the additional details as an attachment

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Do you have a TIN?

YesNo

TIN

Select a reason code if no TIN (or equivalent)

Is there an additional beneficial owner?

YesNo

Beneficial owner 2

Title

Given name(s)

Surname

Date of birth

Residential address(not a PO Box)

Town/suburb

State

Postcode

Country

Occupation

Industry

Retired

Provide previous occupation & industry

Citizenship

Nationality

Town of birth

Country of birth

Foreign tax residence and related taxpayer identification number (TIN)

Are you a tax resident of any jurisdiction other than Australia?

YesNo

Foreign Tax Jurisdiction

If there is more than one country of foreign tax residency, please provide the additional details as an attachment

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Do you have a TIN?

YesNo

TIN

Select a reason code if no TIN (or equivalent)

Other beneficial owners

If there are more than 2 beneficial owners please provide the additional details as an attachment

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If there are no beneficial owners, provide the names of the individuals who directly or indirectly control* the Partnership.

*Includes exercising control through the capacity to determine decisions about financial or operating policies; or by means of trusts, agreements, arrangements, understanding & practices. If no such person can be identified then the most senior managing official/s of the Partnership (such as the Managing Partner or Senior Managing Official).

Title

Given name(s)

Surname

Title

Given name(s)

Surname

Does any beneficial owner hold a prominent public position or function in a government body (local, state, territory, national or foreign) or in an international organisation or is the beneficial owner an immediate family member or a business associate of such a person?

NoYes

Provide details

Trust / Superannuation fund

General information

Full name of trust or superannuation fund

Full name of business(If any)

Country where established

Nature of business

Australian business number(if obtained)

Tax file number (TFN) or exemption code

Reason for TFN exemption

Contact person title

Given name(s)

Surname

Telephone number

Email

Registered office street address(not PO Box)

Town/suburb

State

Postcode

Country

Trustee details

Number of trustees

Individual

Company

Combination

Type of trust

Registered managed investment schemeRegulated trust (including self-managed superannuation funds and registered charities that are trusts)Other trust (unregulated)

Australian Registered Scheme Number (ARSN)

Name of regulator

Australian Business Number (ABN) or registration licensing details

Please describe

Beneficiaries of an unregulated trust

Does the trust deed name beneficiaries?

YesNo

How many?

Provide the full name of each beneficiary who directly or indirectly is entitled to an interest of 25% or more in the trust:

1

2

3

4

If there are no beneficiaries of the trust, describe the class of beneficiary

Settlor details

Please provide the full name and last known address of the settlor of the trust where the initial asset contribution to the trust was greater than $10,000

This information is not required if the initial asset contribution was less than $10,000This information is not required if the settlor is deceased

Settlor’s full name and last known address

Title

Given name(s)

Surname

Residential address(not a PO Box)

Town/suburb

State

Postcode

Country

Beneficial owner of an unregulated trust

Please provide details below of any beneficial owner of the trust. A beneficial owner is any individual who directly or indirectly has a 25% or greater interest in the trust or is a person who exerts control over the trust.This includes the appointer of the trust who holds the power to appoint or remove the trustees of the trust.

Beneficial owner 1 or controlling person 1

Beneficial owner 1Controlling person

What is the role?

Title

Given name(s)

Surname

Date of birth

Residential address(not a PO Box)

Town/suburb

State

Postcode

Country

Occupation

Industry

Retired

Provide previous occupation & industry

Citizenship

Nationality

Town of birth

Country of birth

Foreign tax residence and related taxpayer identification number (TIN)

Are you a tax resident of any jurisdiction other than Australia?

YesNo

Foreign Tax Jurisdiction

If there is more than one country of foreign tax residency, please provide the additional details as an attachment

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Do you have a TIN?

YesNo

TIN

Select a reason code if no TIN (or equivalent)

Is there an additional beneficial owner or controlling person?

YesNo

Beneficial owner 2 or controlling person 2

Beneficial owner 2Controlling person

What is the role?

Title

Given name(s)

Surname

Date of birth

Residential address(not a PO Box)

Town/suburb

State

Postcode

Country

Occupation

Industry

Retired

Provide previous occupation & industry

Citizenship

Nationality

Town of birth

Country of birth

Foreign tax residence and related taxpayer identification number (TIN)

Are you a tax resident of any jurisdiction other than Australia?

YesNo

Foreign Tax Jurisdiction

If there is more than one country of foreign tax residency, please provide the additional details as an attachment

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Do you have a TIN?

YesNo

TIN

Select a reason code if no TIN (or equivalent)

Does any beneficial owner hold a prominent public position or function in a government body (local, state, territory, national or foreign) or in an international organisation or is the beneficial owner an immediate family member or a business associate of such a person?

NoYes

Provide details

If there are more than 2 beneficial owners or managing officials, please provide the additional details as an attachment

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Company / Corporate trustee

Company Type

Australian listed public companyAustralian proprietary company or non-listed public companyForeign company

Company details

Date of establishment

Nature of business

Full company name(as registered with ASIC or other foreign registered body)

Australian Company Number

Australian Business Number or equivalent foreign company identifier(if registered in Australia)

Tax file number (TFN) or exemption code

Reason for TFN exemption

Contact person title

Given names

Surname

Telephone number

Email

Registered office street address(not a PO Box)

Town/suburb

State

Postcode

Country

Principal place of business in Australia

(Note for non-Australian companies registered with ASIC: You must provide a local agent name and address if you do not have a principal place of business in Australia.)

Address is same as above

Registered office street address(not a PO Box)

Town/suburb

State

Postcode

Registration details

Tick if the company is registered with a foreign regulatory body

Name of regulatory body

Australian Registered Body Number (ARBN)

Country of formation or registration

Company identification number issued (if any)

Controlling Persons, Directors and Beneficial Owners

All beneficial owners who own, hold or control either directly or indirectly 25% or more of the issued capital of a proprietary or private company that is not regulated (i.e. does not have an AFSL or ACLN etc), will need to provide Group A AML/CTF Identity Verification Requirements. In the case of an unregulated public company not listed on a securities exchange, provide the details of the senior managing official(s) as controlling person(s) (e.g. managing director, senior executive(s) etc who is/are authorised to sign on the company’s behalf, and make policy, operational and financial decisions) in the following sections. All proprietary and private companies, whether regulated or unregulated, must provide the names of all of the directors.

Names of the directors of a proprietary or private company, whether regulated or unregulated

1

2

3

4

If there are more than 4 directors please provide as an attachment

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Beneficial owner or senior managing official

Beneficial owner 1 of an unregulated or private companySenior managing official of an unregulated, unlisted, public (e.g. Limited) company

Title

Given name(s)

Surname

Date of birth

Residential address(not a PO Box)

Town/suburb

State

Postcode

Country

Occupation

Industry

Retired

Provide previous occupation & industry

Citizenship

Nationality

Town of birth

Country of birth

Foreign tax residence and related taxpayer identification number (TIN)

Are you a tax resident of any jurisdiction other than Australia?

YesNo

Foreign Tax Jurisdiction

If there is more than one country of foreign tax residency, please provide the additional details as an attachment

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Do you have a TIN?

YesNo

TIN

Select a reason code if no TIN (or equivalent)

Is there an additional beneficial owner or senior managing official?

YesNo

Additional beneficial owner or senior managing official

Beneficial owner 2 of an unregulated or private companySenior managing official of an unregulated, unlisted, public (e.g. Limited) company

Title

Given name(s)

Surname

Date of birth

Residential address(not a PO Box)

Town/suburb

State

Postcode

Country

Occupation

Industry

Retired

Provide previous occupation & industry

Citizenship

Nationality

Town of birth

Country of birth

Foreign tax residence and related taxpayer identification number (TIN)

Are you a tax resident of any jurisdiction other than Australia?

YesNo

Foreign Tax Jurisdiction

If there is more than one country of foreign tax residency, please provide the additional details as an attachment

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Do you have a TIN?

YesNo

TIN

Select a reason code if no TIN (or equivalent)

Does any beneficial owner hold a prominent public position or function in a government body (local, state, territory, national or foreign) or in an international organisation or is the beneficial owner an immediate family member or a business associate of such a person?

NoYes

Provide details

If there are more than 2 beneficial owners or managing officials, please provide the additional details as an attachment

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Association

Association type

Association type

IncorporatedUnincorporated

ABN(if applicable)

Nature of business/ industry type

Association details

Full name of association

Tax file number (TFN) or exemption code

Reason for TFN exemption

Contact person title

Given names

Surname

Telephone number

Email

Registered office street address(not a PO Box)

Town/suburb

State

Postcode

Country

Country of establishment

Identification number (if any)

Principal place of business in Australia

(Note for non-Australian companies registered with ASIC: You must provide a local agent name and address if you do not have a principal place of business in Australia.)

Address is same as above

Registered office street address(not a PO Box)

Town/suburb

State

Postcode

Role

Name

Residential address of chairman, secretary or treasurer (if no public officer)

Residential address (not a PO Box)(not a PO Box)

Town/suburb

State

Postcode

Country

Occupation

Industry

Retired

Provide previous occupation & industry

Citizenship

Nationality

Town of birth

Country of birth

Beneficial owners

Beneficial owner 1

Title

Given name(s)

Surname

Date of birth

Residential address(not a PO Box)

Town/suburb

State

Postcode

Country

Occupation

Industry

Retired

Provide previous occupation & industry

Citizenship

Nationality

Town of birth

Country of birth

Foreign tax residence and related taxpayer identification number (TIN)

Are you a tax resident of any jurisdiction other than Australia?

YesNo

Foreign Tax Jurisdiction

If there is more than one country of foreign tax residency, please provide the additional details as an attachment

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Do you have a TIN?

YesNo

TIN

Select a reason code if no TIN (or equivalent)

Is there an additional beneficial owner?

YesNo

Beneficial owner 2

Title

Given name(s)

Surname

Date of birth

Residential address(not a PO Box)

Town/suburb

State

Postcode

Country

Occupation

Industry

Retired

Provide previous occupation & industry

Citizenship

Nationality

Town of birth

Country of birth

Foreign tax residence and related taxpayer identification number (TIN)

Are you a tax resident of any jurisdiction other than Australia?

YesNo

Foreign Tax Jurisdiction

If there is more than one country of foreign tax residency, please provide the additional details as an attachment

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Do you have a TIN?

YesNo

TIN

Select a reason code if no TIN (or equivalent)

Does any beneficial owner hold a prominent public position or function in a government body (local, state, territory, national or foreign) or in an international organisation or is the beneficial owner an immediate family member or a business associate of such a person?

NoYes

Provide details

If there are more than 2 beneficial owners or managing officials, please provide the additional details as an attachment

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Adviser details

Adviser name

AFSL Number

Dealer group

Name of advisory firm

Postal address

Town/suburb

State

Postcode

Country

Email address of advisory firm

Email address of adviser

Business telephone

Facsimile

Consent to deduct advice fees

The Scheme must obtain your written consent before fees can be deducted from your account. If you do not agree with the amount described below, you do not have to sign this consent.

You may vary or withdraw your consent at any time by notifying your adviser or the Scheme in writing. If you sign this form, you will pay the following ongoing advice fee from your account from the start date indicated below.

Select applicable advice fee(s)

One-off advice feeInclusive of GST

As part of the advice, the dealer group will provide you with a Statement of Advice (SOA), which outlines what this fee includes. Refer to your SOA for detailed information about what services are associated with this fee.

Your consent expires once the amount is deducted from your super account. This means the dealer group will have to ask for your consent again if the Scheme wants to deduct fees from your super account for further advice from the dealer group in future.

You can withdraw your consent to the deduction of fees from your account by contacting the Scheme. However, your withdrawal must be received before the Scheme deducts the one-off fee from your account.

Ongoing advice fee

$ Based fee Inclusive of GST p.a.

Start date*

Anniversary date*

% Based feeUp to 2.2%, inclusive of GST p.a.

Fee estimate^

Start date*

Anniversary date*

Cease date - Your consent expires 150 days after the anniversary date of the ongoing advice fee. After this date, the dealer group will have to ask for your consent again if it wants to continue deducting ongoing advice fees from your account in return for ongoing services.

You can vary or withdraw your consent at any time by contacting your adviser or the Scheme directly.

^ This amount is a fee estimate only based on your current balance and an agreed percentage fee stated above which is to be applied at the time the deduction is processed.

* You must provide a start date and anniversary date for the fee to be applied.The anniversary date must be a maximum of 12 months from the start date.

Account instructions

Note that account instructions can also be established through Acclaim Online.

Initial investment amount

Amount to be depositedThe minimum initial investment in the Scheme is $5,000 including transferred investments

Investment instructions – Listed securities and term deposits

If you elect to invest in listed securities or term deposits or to sweep any excess cash or future investment in listed securities or term deposits, a cash management account (CMA) will be established and linked to your Acclaim Invest account. The CMA is used to facilitate the settlement of listed securities or term deposit buys and sells. For further information regarding CMAs, please see the Acclaim Invest PDS.

Options

Yes – I would like to open a share trading account which will result in a CMA being openedNo

Automatic buy instructions

When the cash amount exceeds the target cash balance and trade minimums have been met, invest the excess cash as follows:

Invest as per buy profileLeave excess funds in cash accountMove excess funds to CMA

Once your account is established, you will be able to login to Acclaim Online to establish your Buy Profile and Rebalance Profile for managed funds investment (if applicable).

Regular savings plan (if applicable)

Would you like to set up a regular savings plan?

YesNo

Regular investment amountThe total annual minimum contribution is $1,200

Specify day of the month (between 1 and 28)Last day of the month

Specify Day

Initial payment date

Indexation

NoneCPIPercentage

Percentage

Account name(must match applicant name)

Financial institution

Branch

BSB

Account number

Regular withdrawal plan (if applicable)

Would you like to set up a regular withdrawal plan?

YesNo

Regular withdrawal type

Amount onlyAmount & income distributionsIncome distributions only

Regular income amount

Specify day of the month (between 1 and 28)Last day of the month

Specify Day

Initial payment date

Indexation

NoneCPIPercentage

Percentage

Account name(must match applicant name)

Financial institution

Branch

BSB

Account number

Purpose of investment and source of funds

Please outline the purpose of investment (e.g. superannuation, portfolio investment, etc)

Please provide source of funds

Other source of funds

Please outline anticipated source of ongoing funding and expected level of funding activity or transactions

Transaction authority

I authorise my adviser as nominated in the section above to give or carry out instructions regarding the operation of my account (including investments)
I understand that in giving or carrying out instructions, my adviser may access my account details and transact on my account.
I acknowledge that the Responsible Entity or its service providers can accept and act on such instructions given by my adviser without requiring my signature, additional proof, instructions or further confirmation from me.
I understand that the instructions or transactions for which this authority applies are:
- Investment of the initial contribution in the Scheme
- Switching between investment strategies / underlying investment holdings including purchasing and selling investments
- Changing a regular payment amount
- Starting, changing, or stopping a regular withdrawal amount (where permissible under relevant law)
- Changing the weightings of securities held in respect of your account
- Requesting a cash withdrawal to my nominated bank account (full or partial)
I acknowledge that the Responsible Entity cannot accept my application to the Scheme without this authority in certain circumstances.

Investor 1

Full name

Date

Signature

Clear

Investor 2

Full name

Date

Signature

Clear

Applicant declaration and signature(s)

General

I understand that I am bound by the provisions of the constitution for the Scheme.
I have been provided with a copy and have read and understood the relevant PDS issued by the Responsible Entity including any conditions or limitations relating to investment in the Scheme or its investment options.
I consent to the Responsible Entity accepting and acting on directions, instructions, requests and other communications (including faxes and emails) in relation to investment management and administration in connection with the Scheme, from my adviser as nominated in this application and any duly authorised signatory appointed by my nominated adviser or the dealer group, acting on my nominated adviser’s behalf. I authorise the Responsible Entity to continue to accept, rely upon and act on these communications until I notify the Responsible Entity in writing otherwise.
I understand that the adviser or dealer group nominated in the Adviser Details section above is not an employee, partner, joint venturer or agent of the Responsible Entity.
I agree to indemnify the Responsible Entity against all losses, actions, liabilities, claims and expenses incurred by or on behalf of the Responsible Entity, directly or indirectly, in relation to the Responsible Entity (or a person acting on behalf of the Responsible Entity including, but not limited to, the Responsible Entity’s directors, employees or service providers) acting upon the directions, instructions, requests and other communications given or transactions made by my adviser as nominated in this application or a duly authorised signatory appointed by my nominated adviser or the dealer group acting on my nominated adviser’s behalf.
The information I have provided in this form is true and correct.
I acknowledge the important warning in the PDS about the differences between direct and indirect investment via the Scheme.
I acknowledge that by investing through the Scheme, I do not have access to some of the rights and entitlements that would otherwise be available to me as a retail investor if I invested in the underlying financial products directly. I understand that this includes not having the same rights as direct retail investors or not having access to cooling-off rights, withdrawal rights and voting rights.

Personal information

I have read, understood and agree to the handling of my personal information as outlined in the Privacy Statement in the PDS.
I acknowledge that I have read and understood the information about quotation of tax file numbers contained in the PDS.

Investment

I understand that my account can rise and fall, and that neither the Responsible Entity, nor any of its directors, Acclaim Management Group Limited, nor any of its directors, nor any of the fund managers named in the PDS guarantee the performance of the Scheme or its investment options.
I acknowledge that the Responsible Entity will invest my account in accordance with the selections made by me in this form (as varied by me from time to time) but that the Responsible Entity reserves the right not to do so where necessary or appropriate without liability to any investor or prospective investor.
I hereby direct the Responsible Entity to invest my account balance in the investment options in the proportions indicated in this application, based on the declarations and acknowledgments made in this request.
Where I have selected (or select) an illiquid investment, I acknowledge and accept that a period of longer than 30 days may be required to facilitate redemption or switching requests due to the illiquid nature of the investment.
I have received (either via the website or from the Responsible Entity, Administrator, or my adviser), read and understood the investment fund PDS (including any Supplementary PDS) for the single manager investment option/s I have selected or term deposit disclosure document for any term deposits I have selected.

Margin lending

I understand that further documentation will be required and that my account may be subject to further terms and conditions as may be required by my nominated lender.

Self certification

I undertake to provide a suitably updated self-certification within 30 days of any change in circumstances which causes the information contained herein to become incorrect.

Identity verification

I understand that if I supply Acclaim Wealth with a scanned copy of identification they will also need to electronically verify my identity.
I understand that if I do not want Acclaim Wealth to identify me electronically that I must supply original certified copies of my identification via post.
I understand that if I opt for electronic verification, the details of the documents I provide to Acclaim Wealth will be submitted to the Australian government’s Document Verification Service (DVS).The DVS is a national online system that allows organisations to compare an individual’s identifying information with a government record.
I understand that Acclaim Wealth is unable to electronically verify identity documents issued from overseas. I understand that the Acclaim Wealth will be unable to make any payment until my identity has been verified either by this method, or by receiving a certified original copy of your identification by post.

If you would like to proceed with electronic verification please tick ALL of the consent boxes below

I would like to proceed with electronic verification (please tick all consent boxes below)

You consent to us electronically verifying your identity; AND

You consent to us electronically verifying your identity; AND *

You are authorised to provide the identification documents to us; AND

You are authorised to provide the identification documents to us; AND *

You understand that the details of the identification documents will be checked against the Australian government’s document verification service and that privacy information is available from the DVS website www.idmatch.gov.au.

You understand that the details of the identification documents will be checked against the Australian government’s document verification service and that privacy information is available from the DVS website www.idmatch.gov.au. *

Applicant 1

Full name

Signature

Clear

Date

Applicant 2

Full name

Signature

Clear

Date

Adviser declaration

I make the following declarations, undertakings and acknowledgements personally and on behalf of the Dealer Group stated in the section titled ‘Adviser details:

I accept the terms stated in the section titled ‘Adviser transaction authority’ and agree to act in accordance with this authority and any written instructions I receive from the client. I agree to provide the client with any information or documents that they request in relation to any instructions or transactions generated under this authority.
I declare that all directions, instructions, requests and other communications I give to the Responsible Entity, or transactions I make on the client’s account will only be made after prior consent of the client and will include (where applicable) accurate and full information and disclose any facts or circumstances relevant to the communication or transaction.
I confirm I am authorised through a holder of a current AFSL.
I confirm that my authorisation enables me to provide financial services in relation to the Scheme, including the Scheme’s financial products and investment and options.
I have provided the client with a Statement of Advice in relation to any financial product advice I have provided to the client as required by government legislation.
I have provided the client with access to the current PDS or other disclosure documents for each of the selected investments available for investment through the Scheme.
I have fully disclosed to the client all fees and costs associated with investing in the Scheme in accordance with government legislation.
I confirm that any advice fees payable to me as agreed by the client are / will be for financial services relating only to the Scheme or its investments.
I confirm that any changes to the amount, frequency, method or manner of payment of advice fees will be signed off in writing by the client prior to making such changes and that I will immediately notify the Responsible Entity of such changes.
I confirm that all emails and other electronic communications containing personal or sensitive information will be sent through a secure site using encryption or other devices to protect the information and that I will ensure the security, confidentiality and privacy of information (including personal information) about the client that I access from the Scheme in accordance with all relevant government legislation.
Where I have submitted an electronic copy of this form, I confirm that I will retain the original copy of the form for a minimum period of seven years and supply the original to the Responsible Entity as requested by or on behalf of the Responsible Entity.
I agree to indemnify the Responsible Entity against all losses, actions, liabilities, claims and expenses incurred by or on behalf of the Responsible Entity, directly or indirectly, in relation to the Responsible Entity (or a person acting on behalf of the Responsible Entity including, but not limited to, the Responsible Entity’s directors, employees or service providers) acting upon the directions, instructions, requests and other communications given, or transactions made, by me or my duly authorised signatory.
I agree to promptly refund, on request by or on behalf of the Responsible Entity, any advice fees paid out of the Scheme’s assets that are not in accordance with the declarations and acknowledgements in this form.
I agree to provide the Responsible Entity with any information requested by or on behalf of the Responsible Entity in relation to the adviser details and advice fees shown in this form.
If contacted by or on behalf of the Responsible Entity from time to time to confirm my ongoing adherence to this Adviser Declaration, I will cooperate.
I agree to immediately notify the Responsible Entity if I breach or am likely to breach any relevant law, the terms of this Adviser Declaration or cease to be authorised to provide financial services relating to the Scheme.
I agree to immediately notify the Responsible Entity if any of the information provided by me in this form ceases to be true and correct or changes in any way.
I declare that I am duly authorised to provide the above declarations, undertakings and acknowledgements on behalf of the Dealer Group stated in the stated in the section titled ‘Adviser details’.
I declare that all information provided by me in this form is true and correct.

If any advice fee on this form is percentage based, please ensure you have populated the estimated dollar equivalent of this fee under the Advice fee section.

If you do not record this estimated dollar value we will not be able to establish the ongoing advice fee.

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