Privacy Authorisation
Sharing your financial information with a Financial Mentor
Permission to provide information (for client to complete)
"Organisations" = any business, creditor, organisation, department, service or person involved in my financial affairs. Banks are not included.Tick the following boxes
*
I authorise organisations to share my financial information with my Financial Mentor on request so they can provide me with appropriate financial capability and budgeting advice (required).
I authorise my Financial Mentor to access on my behalf my credit information held with credit reporting agencies and the credit reporting agency to disclose my credit information to my Financial Mentor (optional).
I understand that I will be notified if my financial mentor receives personal information from organisations involved in my financial affairs.
I intend that this authorisation satisfies the requirements of the Privacy Act 2020 (required).
Client
Joint Client (if applicable)
Client name
Client date of birth
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Month
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Day
Year
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Client signature
Date
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Month
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Day
Year
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This agreement expires on 12 months from the above date or earlier on
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Service stamp / contact details:
IRD number
Verification of client's identity (for Financial Mentor to complete)
I have verified my client's identity by looking at:
O A valid driver's licence
A valid driver's licence
O Another valid form of photo ID (details):
Other
Financial Mentor name
Financial Mentor signature
Service name
Date
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Month
-
Day
Year
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Privacy Authorisation
Sharing your financial information with a Financial Mentor
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