Banking Information Privacy Authorisation
Sharing your banking information with a Financial Mentor
Purpose of the form
This form gives permission for your Financial Mentor to speak to your bank about your finances.
Permission to provide information (for client to complete)
1. I authorise my bank to share my financial information with my Financial Mentor on request so that they can provide me with appropriate budgeting advice. This information includes bank statements, credit card statements, automatic payments (APs), direct debits (DDs), and loan documents.
2. I understand that the bank may contact me to verify this request.
3. I do not authorise my Financial Mentor to operate any bank accounts or conduct any transactions on my behalf, unless an account operating authority has been completed.
4. I understand that my Financial Mentor will notify me if they receive personal information from my bank.
5. I understand that if in future I do not want the bank to provide more information, I can cancel the authorisation before its expiry date by contacting the bank. I should also notify my Financial Mentor of the cancellation.
6. I understand that the Financial Mentor will be responsible for the information received (including its safe storage and appropriate use) rather than my bank.
7. I intend that this authorisation satisfies the requirements of the Privacy Act 2020.
Rows
Client
Joint client (if applicable)
Joint client (if applicable)
Joint client (if applicable)
Client name
Bank name
Customer or access number
Client date of birth
Client signature
Date This agreement expires
Back
Next
Banking Information Privacy Authorisation
Sharing your banking information with a Financial Mentor
Verification of client's identity (for Financial Mentor to complete)
I have verified my client's identity by looking at:
A valid driver's licence or
Another form of photo ID (details)
About the Financial Mentor and the financial capability and budgeting service (for Financial Mentor to complete)
I confirm that I represent this financial capability and budgeting service, am under the authority of the budgeting service manager, and am adequately trained for the role of Financial Mentor.
I have passed appropriate probity checks to ensure that I am of fit and proper character.
Service name
Service address and phone number
Service manager name
Financial Mentor name
Financial Mentor phone number
Format: (000) 000-0000.
Financial Mentor email address
example@example.com
Financial Mentor signature
Date
-
Month
-
Day
Year
Date Picker Icon
The format of this privacy authorisation has been agreed by the New Zealand Banking Association and FinCap.
Preview PDF
Submit
Should be Empty: