AUTHORISATION TO COLLECT INFORMATION

Advice Manager
Organisation
Enva Advisory Pty Ltd

ABN: 12 634 043 093
Corporate Authorised Representative

of Enva Ausrtralia Pty Ltd Licence 424494

8/130 Main Road McLaren Vale SA 5171

PH: 1300 160 803
AUTHORISATION TO COLLECT INFORMATION
enquiry@enva.com.au/ www.enva.com.au

I authorise you to provide all representatives of Enva, including but not limited to:
Harpinder Chipra

Darren Farley

Ethel Caballero

Marek Lambert

Janine Towill
with any information and documentation they require regarding my insurance, superannuation, investments and/or any other information that you hold on record for me.

I am aware of the provisions of the Privacy Act and release you from those provisions in respect of information provided to the representatives of Enva.

This authority does not expire and is valid until revoked by me.
Name*
Date of Birth*

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Date
Address
Phone no.*
Policy/Account no.
How will this form be completed?*

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Signature*

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Enva Australia Pty Ltd A.C.N. 098 806 501 Australian Financial Services Licencee Licence number 424494

All information and advice is for the private use of the person to whom it is provided. The Authorised Representative provides you with advisory services in accordance with the disclosures in the Financial Services Guide.
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