Appointment of Advisors (Form B)

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I/We appoint Collins House Private Wealth (Collins House), a Corporate Authorised Representative of Collins House Private Wealth Pty Ltd (AFSL No. 449 146), as my/our Financial Advisors, effective immediately.
I/We also  authorise Collins  House to  attain  any  information  that  they  may  require  until  further notice.
Furthermore, if there are any  commissions  payable  to  licensed  advisors  please  rebate  them  to my/our account or reduce the premiums or management fees accordingly. If this cannot be done please pay the commissions to Collins House, who will rebate the same to me/us directly.
If  you  have  any  queries,  please  contact  Mr  Dominic  Alafaci, Mr  Sam  Campisi, Ms  Kate  Nicol,  Ms Moira Bentley, Ms  Claire Jin, Ms Yi  Li  or  Mrs Neda  Kuzmic of  Collins  House as below , who are acting on my/our behalf with regards to this matter.

PHONE (03) 9629 6922

PO Box 24175
Melbourne VIC 3001

Level 13, 90 Collins Street

Confirmation of supplied details