Accreditation Application - Nexus Partners

Your First Name*

Your Last Name*

Your Email

Section A

Referring Entity Name (as per Nexus Partners Referral Agreement)*

Referring Entity ABN*

Is the ABN registered for GST?*

Yes
No

Registered Address*

Address Type*

Commercial
Residential

Website Address

Email Address*

Phone*

Fax

Provide a Description/Overview of your Business Activity Description*

How many years have you been operating?*

List any industry accreditations/business related memberships in place*

Referring Entity Type?*

Australian Proprietary Company
Joint Venture
Partnership
Sole Trader
Trust

If you selected Sole Trader, please go to Section B. Otherwise, list all directors of Referring Entity.

Director 1 Name

Director 1 DOB

Director 2 Name

Director 2 DOB

Director 3 Name

Director 3 DOB

Director 4 Name

Director 4 DOB

Do any of the directors hold an ACL or Credit Representative Status under an ACL?

Yes
No

Do any of the directors have ownership/directorship of an entity which holds an ACL or Credit Representative Status under an ACL?

Yes
No

If the answer to either of the above is Yes, please provide details of ASIC licence/representative number and EDR membership body and number.

Please select service you would like more information on.

Financial Planning Referral Service
General Insurance Referral Service
Property Advocate Referral Service
Vehicle Equipment Finance Service

Section B - Sole Traders Only

First Name

Last Name

Date of Birth

How will you be sourcing referrals?

From own Business Activity as sole trader
As employee of another business
As contractor of another business

What is the name of the Business from which you will be sourcing referrals?

What is the ABN of the Business from which you will be sourcing referrals?

What is the Registered Address of the Business from which you will be sourcing referrals?

List all Directors of the Entity from which you will be sourcing referrals

Director 1 Name

Director 1 DOB

Director 2 Name

Director 2 DOB

Director 3 Name

Director 3 DOB

Director 4 Name

Director 4 DOB

Does the business from which you will be sourcing referrals offer a mortgage broker service or have a connection to a mortgage broker service?

Do you have the consent of the directors of the Business from which you will be sourcing referrals to refer clients to Nexus Partners for Finance?

Section C

Name of Referral Entity

Accredited Individual Details

Name

Date of birth

Drivers licence number

Home address

Phone number

Email Address

Please list industry Accreditation Details (for example Real Estate Licence Number, CPA Membership Number, AFSL/AFSR Number, Migration Agent Registration Number)

Please list any current / past lender or aggregator accreditations held in your own name

Declarations

Have you or any of your associates ever declared bankruptcy?

Yes
No

If yes, provide details

Have you or any of your associates ever been found guilty of an offence involving fraud, dishonesty, drug trafficking or anti money laundering?

Yes
No

If yes, provide details

Has your accreditation ever been refused or revoked with any other lenders?

Yes
No

If yes, provide details

Consent*

I have completed this form and declare the information I have provided to be true and correct.