Authority to Obtain Confidential Information (Form A)

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I/We give authority to Collins House Private Wealth (Collins House), a Corporate Authorised Representative of Collins House Private Wealth Pty Ltd (AFSL No. 449146), and its Financial Advisors, Consultants, and staff, namely Mr Dominic Alafaci, Mr Sam Campisi, Mr Con Vatmanidis, Ms Kate Nicol, Mr Timothy Lim, Mr Lloyd Masocha, Ms Moira Bentley, Ms Margitta Wilkinson, Ms Claire Jin, Ms Yi Li, Ms Sarah Chang and Mr Marcus Poretti, authority to obtain any confidential information they may require regarding the above.

The authority is to remain valid until revoked.

If you have any queries, please contact Collins House as below:

PHONE (03) 9629 6922
EMAIL mail@collinshouse.com

POST
PO Box 24175
Melbourne VIC 3001

OFFICE
Level 13, 90 Collins Street
MELBOURNE VIC 3000

Confirmation of supplied details