Budgeting Agreement
This page sets out the responsibilities of the client, financial mentor and service.
Client agreement (for client to complete)
① I agree to accept budgeting advice and will be respectful with my financial mentor.
2 I will keep my financial mentor up to date with my contact details and tell them everything about my financial situation as part of our honest and open relationship.
If I cannot attend an appointment I will let the service know.
Either the service or I can withdraw from this agreement at any time.
6 I will do my best to keep to the agreed budget, keep to agreed arrangements, and will not obtain further credit without first discussing it with my financial mentor.
I understand that the service and/or the financial mentor is not liable to me under any circumstances for their actions or any advice they give, however that liability arises (including through negligence).
⑦ I understand that my file may be confidentially inspected by a representative of the financial capability or budgeting service's funder(s) or for the purpose of a quality review of this service.
8 I have discussed this document with my financial mentor, and I understand it.
Name of client
Client's signature
Date
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This agreement expires on:
Day
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Open-ended agreement
Service agreement (for financial mentor to complete)
1 We will keep all client details confidential, except as authorised by this Budgeting Agreement.
2 We will keep the client informed of matters relating to the client's finances.
6 When we or the client withdraw from this Agreement, we will immediately inform creditors and any other person dealt with in accordance with this Budgeting Agreement.
Name of financial mentor
Mentor's signature
Date
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Month
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Service
Affiliation number (optional)
Format: (000) 000-0000.
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PO Box 25332 Featherston Street, Wellington 6142, 04 471 1420
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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
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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 name
Client date of birth
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Month
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Year
Date
Client signature
Date
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This agreement expires on 12 months from the above date or earlier on / /
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:
A valid driver's licence
Another valid form of photo ID (details):
Financial Mentor name
Financial Mentor signature
Service name
Date
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Month
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Day
Year
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