• Financial counsellor Authorisation Form

  • Purpose of the Authority form

    By signing this authority, you authorise the financial counselling agency to act on your behalf with the named third party, such as a creditor, debt collector, external dispute resolution scheme or a telecommunications company.

    When acting on your behalf, the financial counselling agency may (amongst other things):

    - seek and exchange personal information about you and your account/s;

    - negotiate; and

    - enter into arrangements.

  •  / /
    Pick a Date
  •  / /
    Pick a Date
  • Your Business details (if applicable)

  • Clear
  •  / /
    Pick a Date
  • Clear
  •  / /
    Pick a Date
  • This form was developed by Financial Counselling Australia in consultation with industry, peak bodies and EDR schemes | April 2020

  •  
  • Should be Empty: