Credit Representative Application

Step 1 of 6 - Business and Member Details

CREDIT REPRESENTATIVE APPLICATION FORM
Thank you for your interest in becoming a Credit Representative of AMAFA. To assist us with your enquiry it would be appreciated if you could complete this application form.
While completing this form you can save and return to it at any time - if you have any questions or need assistance the contact details are at the bottom of the page.
Rest assured that each application is treated in the strictest of confidence.
We look forward to processing your application.
Thanks again.
BUSINESS DETAILS
Business Name*
Contact Person*
MEMBER DETAILS
Title*
First Name*
Last Name*
Date of Birth*
DD slash MM slash YYYY
Email*
Driver's License Number*
Mobile*
Business Telephone*
Address*

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DECLARATION
If you have answered YES to any of the questions below, please provide a full detailed explanation as to how and why it occurred.
Have you ever had professional indemnity insurance refused, cancelled, declined or had any special conditions imposed?*
If YES, please provide a brief explanation.*
Have you ever been declared bankrupt, subject to any form of insolvency administration?*
If YES, please provide a brief explanation.*
Have you ever entered into a Scheme of Arrangement with Creditors?*
If YES, please provide a brief explanation.*
Have you ever been convicted of a criminal offence?*
If YES, please provide a brief explanation.*
Have you had any default or judgement lodged against you?*
If YES, please provide a brief explanation.*
Are you subject to a pending investigation or enquiry by or on behalf of any ASIC / Stock Exchange / Government Department / Banking Ombudsman and or similar regulatory or investigatory body?*
If YES, please provide a brief explanation.*
Have you ever been prosecuted under the Competition & Consumer Act 2010, National Credit Code or NCCP?*
If YES, please provide a brief explanation.*
Have you ever had a lender accreditation refused, terminated or suspended for any reason?*
If YES, please provide a brief explanation.*
Have you ever had an aggregator accreditation refused, terminated or suspended for any reason?*
If YES, please provide a brief explanation.*
Have you ever had an industry association membership refused, terminated or suspended for any reason?*
If YES, please provide a brief explanation.*
Have you ever been subject to disciplinary action by an industry professional body?*
If YES, please provide a brief explanation.*
Have you ever carried on business under any name other than the name or names shown in this application?*
If YES, please provide a brief explanation.*
Have you ever been known by any name other than the name or names shown in this application?*
If YES, please provide a brief explanation.*
Are you aware of any complaints against you that could lead to a potential claim against your existing professional indemnity policy?*
If YES, please provide a brief explanation.*

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SUPPORTING DOCUMENTS
Please upload the following documents:
PI Insurance Certificate*
Drop files here or
Accepted file types: jpg, png, pdf, docx, Max. file size: 128 MB.
For more information on our group policy, please refer to: https://connective.insurancehouseplus.com.au/.
Your professional indemnity insurance policy should cover not only your business, but also any principal, employee, director, partner or related entity whilst acting within the scope of credit assistance duties.
Your policy must include:
- $ 2M per claim
- $ 6M in aggregate
- 84 months runoff cover
AFCA Certificate*
Drop files here or
Accepted file types: jpg, png, pdf, docx, Max. file size: 128 MB.
For information please refer to: afca.org.au.
Certificate IV or Diploma in Finance and Mortgage Broking*
Drop files here or
Accepted file types: jpg, png, pdf, docx, Max. file size: 128 MB.
MFAA Initial Compliance/AML or FBAA AML Certificate*
Drop files here or
Accepted file types: jpg, png, pdf, docx, Max. file size: 128 MB.
Resume - include details of your credit assistance lending experience*
Drop files here or
Accepted file types: docx, pdf, Max. file size: 128 MB.
Mentor Details (if applicable)
Drop files here or
Accepted file types: docx, pdf, Max. file size: 128 MB.
Police Report (no older than 6 months old)*
Drop files here or
Accepted file types: jpg, png, pdf, docx, Max. file size: 128 MB.
For more information, please refer to:
AFP - www.afp.gov.au/what-we-do/police-checks/national-police-checks.aspx
OR CV Check - https://cvcheck.com/national-police-check
- Original must be sighted for AMAFA Credit Representatives
- If known by any other names please ensure that they are listed on the Report
Primary ID (Passport)*
Drop files here or
Accepted file types: jpg, png, pdf, Max. file size: 128 MB.
Primary ID (Driver's License)*
Drop files here or
Accepted file types: jpg, png, pdf, Max. file size: 128 MB.
Individual Credit Check (No older than 1 month old)*
Drop files here or
Accepted file types: docx, pdf, Max. file size: 128 MB.
For more information, please refer to: Equifax - https://www.equifax.com.au/
or CV Check https://cvcheck.com/credit-check
Individual Bankruptcy Search*
Drop files here or
Accepted file types: docx, pdf, Max. file size: 128 MB.
No older than 1 month old; Not required if it is included in the credit check.
For more information, please refer to: https://services.afsa.gov.au/brs/search
or https://cvcheck.com/credit-check

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NOTE:

Please enter ‘N/A’ for required questions which are not applicable to your situation.

If you wish to clarify anything with regards to this application, please contact Keith Marshall at 0411 875 504.

Lender	Date Commenced (MM/YY)	Annual Volume Estimate

Credit Representative Application

Step 1 of 6 - Business and Member Details

CREDIT REPRESENTATIVE APPLICATION FORM