ANZ MORTGAGE BROKER ACCREDITATION APPLICATION FORM
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ANZ MORTGAGE BROKER
ACCREDITATION APPLICATION FORM
ANZ MORTGAGE BROKER
ACCREDITATION APPLICATION FORM
Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522.
This form is to be used by Australia and New Zealand Banking Group Limited (ABN 11 005 357 522) to assess whether an applicant is suitable for training and
accreditation as an Accredited Broker in accordance with the Originator Agreement. This information will only be used and disclosed in accordance with the
Privacy Statement. An individual referred to on this form may access this information by contacting ANZ.
The individual seeking accreditation and the authorised company representative must complete all fields. The authorised company representative is required
to email the completed form to: origtraining@anz.com
SECTION ONE: BROKER INFORMATION (TO BE COMPLETED BY INDIVIDUAL APPLYING FOR ACCREDITATION)
Broker Details
Full Legal Name
First Name Middle Name Last Name
Mobile D.O.B (DD/MM/YYYY)
Registered Business Name (Please note: this should be the registered Individual Business Name with ASIC, NOT Aggregator Name)
ABN (Registered Business Name)
Trading Name (If different to the Registered Business Name)
Business Address
Suburb State Postcode
Telephone No. Fax No.
Email Address
Broker Background Information
Were you previously known by other names or aliases? Yes No
If the answer is ‘Yes’ to above question, please confrm your other names below:
Have you ever been accredited with ANZ? Yes No
If the answer is “Yes” to above question, please provide your previous TPMI code:
Have you ever been terminated/suspended from or by an originator/aggregator or other Lenders? Yes No
If the answer is “Yes” to above question, please provide further details
Do you have any criminal records? Yes No
If the answer is ‘Yes’ to above question, please provide further details:
Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. Page 2
ANZ MORTGAGE BROKER
ACCREDITATION APPLICATION FORM
Have you ever been declared bankrupt? Yes No
If the answer is ‘Yes’, Please provide a copy of Personal Credit History Report (Max 3 months old)
If the answer is ‘Yes’ to above question, please provide further details:
Have you ever been employed by the ANZ bank? Yes No
Previous employers
Please list your previous employers for the last fve years, including the name and contact number of your supervisor or manager
Reference Details
Business Reference 1 Business Reference 2
Individual Name(s) Only Individual Name(s) Only
First Name First Name
Last Name Last Name
Phone No. Phone No.
Security Questions/Answers
Security Question:
Answer:
SECTION TWO: AGGREGATOR INFORMATION (TO BE COMPLETED BY AUTHORISED COMPANY REPRESENTATIVEAGGREGATOR)
Aggregator Details
| Authorised Company Representative Name: |
| Aggregator Originator Company: |
| Have you satisfactorily confirmed the identity of the above applicant? | Yes No |
| Have you completed a Reference Check on the above applicant? | Yes No |
| Did the Reference Check result in any negative comments about the applicant? | Yes No |
| Have you completed a Police Check on the above applicant? | Yes No |
| Did the National Police Check produce any adverse findings? Please provide a copy of the Police Check Report along with this application form (Max 3 months old) Have you received a copy of the Personal Credit Report for above applicant? Did the Personal Credit History Report produce any adverse findings or has the applicant been previously bankrupt? If the answer is ‘Yes’, Please provide a copy of the Credit History Report (Max 3 months old) along with this application form. Please Note: If the credit history report includes a bankruptcy check, you don’t need to provide a separate bankruptcy check report |
Yes No |
| Yes No | |
| Yes No |
Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. Page 3
ANZ MORTGAGE BROKER
ACCREDITATION APPLICATION FORM
LICENCE INFORMATION
Please confirm which of the following is applicable to the above individual
The above individual has been issued with an Australian Credit Licence in own name
Please provide Licence Number:
The above individual is an Authorised Credit Representative of an entity that has been issued with an Australian Credit Licence
Please provide Authorised Credit Representative Number: Please provide the entity’s Licence Number:
The above individual is an Employee or director of an entity that has been issued with an Australian Credit Licence.
Please provide the entity’s Licence Number:
Is the applicant a member of an ASIC approved External Dispute Resolution Scheme?
[e.g. Australian Financial Complaints Authority (AFCA)] AFCA Other
Which Industry body is the Applicant a member of ? i.e: MFAA or FBAA (Specify if Other) MFAA FBAA Other
AGGREGATOR DECLARATION
I confirm:
• All the details provided as part of this application are true and correct;
• Above applicant has satisfactorily completed Police, Credit, Bankruptcy and Reference checks;
• Identity of the applicant has been satisfactorily confirmed.
Authorised Company Representative Signature Date (DD/MM/YYYY)
BROKER DECLARATION
I confirm that all the information provided as part of this application is true and correct.
I consent to ANZ Bank to collect, use and disclose my personal information in accordance with the Privacy Statement below.
Broker Signature Date (DD/MM/YYYY)
SUPPORTING DOCUMENTS
Please ensure all below supporting documents are provided along with this application form.
A copy of Police Check Report (Max 3 months old)
A copy of Credit History report (Max 3 months old), if the Personal Credit History Report produced any adverse findings or the applicant has been
previously bankrupt
A current membership certificate for one of the following industry bodies is required:
• Mortgage and Finance Association of Australia (MFAA), or
• Finance Brokers Association of Australia Ltd (FBAA)
A legible copy of ID (Driver’s Licence or Passport)
A copy of Membership Certificate of an External Dispute Resolution Scheme
PRIVACY STATEMENT
This statement explains when and how ANZ may collect, use and disclose personal information about you for the purpose of assessing your application for
accreditation as a broker and during the course of your relationship with ANZ as an accredited broker. It is important that the information we hold about you
is up to date. You must let us know when information you have provided to us has changed.
Collection, use and disclosure of information
You agree that ANZ may collect, use and disclose the information we collect about you for the following purposes:
• to assess and process your application for accreditation as an accredited broker;
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ANZ MORTGAGE BROKER
ACCREDITATION APPLICATION FORM
• to establish, provide and administer the accreditation process including any ongoing, training, assessment and/or accreditation renewals;
• to manage and administer any broker arrangements you have with us and to perform administrative tasks;
• to consider any concerns or complaints you raise against us and/or to manage any legal action involving us;
• to manage and respond to any complaints, claims or legal proceedings in relation to your role or conduct as an accredited broker;
• to identify, prevent or investigate any fraud, unlawful activity or misconduct (or suspected fraud, unlawful activity or misconduct);
• to identify you or establish your tax status under any Australian or foreign legislation, regulation or treaty or pursuant to an agreement with any tax authority;
• as required by relevant laws, regulations, codes of practice and external payment systems; and
• for any other purpose under the broker arrangements that you have with us.
Providing your information to others
You agree that ANZ may provide your information to:
• any of our related entities or other organisations with whom we have arrangements (which may use the information to assess your application for
accreditation as an accredited broker);
• any agent, contractor or service provider we engage to carry out or assist our functions and activities (for example, for verifying your identity);
• an organisation that assists us to identify, prevent or investigate fraud, unlawful activity or misconduct;
• regulatory bodies, government agencies, law enforcement bodies and courts;
• other parties we are authorised or required by law or court/tribunal order to disclose information to;
• other credit providers;
• any person who introduces you to us;
• your employer or the aggregator with which you engage in credit activities;
• our advisers, authorised agents and insurers;
• your advisers, authorised agents and insurers;
• service providers and our related entities which are located outside Australia and/or not established in or do not carry on business in Australia.
ANZ Privacy Policy
Collection of information from other parties
We may collect information in relation to you from other parties, including the aggregator with which you conduct credit activities, to enable us to assess
your application for accreditation. This includes, but is not limited to, credit history checks and a National Police Check.
Our Privacy Policy (www.anz.com/privacy) contains information about:
• the circumstances in which we may collect personal information from other sources (including from a third party)
• how to access personal information and seek correction of personal information; and
• how you can raise concerns that we have breached the Privacy Act or an applicable code and how we will deal with those matters.
Absence of relevant information
If you do not provide some or all of the information requested, we may be unable to:
• assess your application for accreditation as an accredited broker;
• manage or administer your broker arrangements with ANZ;
• manage complaints or issues you have raised with us or complaints or issues that have been raised in relation to you; and
• provide you with information.
Information required by law etc.
We may be required by relevant laws to collect certain information from you. Details of laws that require us to collect information about individuals (personal
information) and why these laws require us to collect personal information are contained in our Privacy Policy and at www.anz.com/privacy.
Collecting sensitive information
We will not collect sensitive information about you, such as information about your health, without your consent.
Australia and New Zealand Banking Group Limited (ANZ) ABN 11 005 357 522. Item No. 96920 12.2019 WX239400
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