Application Form — IIP Dealer Group

Please complete the form below to apply for authorisation under Insight Investment Partners. We will review your details and contact you to discuss next steps.

1. Personal Details

Full Name Email Mobile Preferred Contact Time

2. Practice & Business Details

Practice / Trading Name ABN / ACN Business Structure Primary Office Location (Suburb & State) Website

3. Licensing & Experience

Current Licensee (if any) Corporate Authorised Representative Number (if applicable) ASIC Adviser ID (if applicable) Years as a Financial Adviser

Have you passed the adviser exam? Yes No Not applicable

Are you seeking to rely on the experience pathway? Yes No Unsure

4. Advice Services

What types of advice do you provide?

Superannuation & Retirement Investments & Wealth Creation Personal Insurance SMSF Aged Care Other

Main platforms / products used Approximate annual advice revenue (excl. GST)

5. Compliance & Background

In the last 10 years, have you or any related entity: (a) been bankrupt or subject to insolvency administration; (b) been the subject of regulatory investigation or banning order; (c) had a PI claim, AFCA complaint, or other significant dispute upheld?

No Yes

If yes, please provide details Any other information relevant to your application

6. Declaration & Consent

I declare that the information provided is true and correct to the best of my knowledge and I consent to Insight Investment Partners contacting me about this application.

Let’s work together

Interested in joining IIP? Please fill out some info and we will be in touch shortly! We can't wait to hear from you!

IIP Dealer Group

Ph: 0421 830 731

The Commons, 39 Martin Place

SYDNEY NSW, 2000

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