FrontRunner Aggregation Services Membership Application Form

Application Form:

Please complete a separate form for each Company Director / Business Partner (if applicable).
Please print and sign the completed application. You can click the Print button at the bottom of the page.

Full Member Name:

ABN:

Associate Name:

Associate Business Address:

Associate Mailing Address:

Telephone - Fixed:

Telephone - Mobile:

Fax:

Email:

Associate Member Details / Applicant

Name:

Home Address:

Date Of Birth:

Drivers License Number:

MFAA Membership #:

Expiry Date:

COSL Membership #:

Expiry Date:

FBAA Membership #:

Expiry Date:

PI Insurance Policy #:

Expiry Date:

GST Registered:

Bank Details:

Bank Name:

BSB:

Account Name:

Account Number:

Please provide two Referees from within the Lending industry:

Referee 1:

Name:
Lender:
Phone:

Referee 2:

Name:
Lender:
Phone:

Past experience with Mortgage Origination Industry:

Residential:

Commercial:

Plant & Equipment:

Consumer Finance:

With whom do you hold accreditation?

Please provide your accreditation details above and click Add. You can add as many accreditations as you like in this manner.
You can select multiple association types for an individual institution by holding CTRL while selecting.

Institution:

Length Of Association:

Type Of Association:

Years:
Months:

Click the item you wish to remove above, then click Remove.

Declarations:

Have you ever had insurance refused, cancelled, declined or had any special conditions imposed?
Have you ever been declared bankrupt, subject to any form of insolvency administration?
Have you been convicted of a criminal offence?
Have you ever entered into a Scheme of Arrangement with Creditors?
Have you had any default or judgement lodged against you?
Are you subject to a pending investigation or enquiry by or on behalf of any Stock Exchange / Government Department / Securities Commission / Banking Ombudsman and or similar regulatory or investigatory body?
Have you ever been prosecuted under the Trades Practices Act or Consumer Credit Code?
Have you ever had a lender accreditation refused, terminated or suspended for any reason?
Have you ever had an aggregators accreditation refused, terminated or suspended for any reason?
Have you ever had an industry association membership refused, terminated or suspended for any reason?
Do you currently hold that status of Accredited Mortgage Consultant with the Mortgage Industry Association of Australia (MIAA) or like body?
Do you currently hold that status of Accredited Mortgage Consultant with the Mortgage Industry Association of Australia (MFAA) or like body?

Load Fraud Declarations:

In the last 10 years, have you:

Ever had a securities licence or proper authority refused, suspended, withdrawn or cancelled or been subject to a banning order?
Ever had a business related licence, registration or membership revoked, denied or suspended?
Have you ever been convicted of an offence involving criminal charges, or is there any charges pending?
Ever been refused membership of a statutory, professional or other body in respect of your professional capacity?
Ever been subject to disciplinary proceedings or expelled by a statutory body, professional or other body?
Ever been dismissed or had a proper authority withdrawn on ethical or legal grounds ?
Any past or pending claims made against your professional indemnity insurance?
Ever been refused professional indemnity insurance?

Privacy Acknowledgement and Consent:

Under this heading "we", "us" and "our" refer to FrontRunner Mortgage Group Pty Ltd A.C.N. 096 328 979 and Connective Services Pty Ltd ACN 107 366 496.

Collection of Personal Information:
We collect personal information (including your full name, address and contact details) so that we may assess your application and administer our relationship with you and provide you with products and services you request as well as information on the Frontrunner Mortgage Group’s and or Connective Group’s products and services.

Where necessary to do so, we also collect information on individuals such as company directors and officers (where the company is our customer), as well as customers’ agents and persons dealing with us on a “one-off” basis.

You must provide us with accurate and relevant information:
If you provide us with incomplete or inaccurate information, we may not be able to assess your application and administer our relationship.

Other Members of the Connective Group:
We are permitted by the Privacy Act to disclose personal information to other members of the Connective Group.

Other Disclosures:
We may communicate personal information to organisations to which we outsource certain functions. For greater detail on outsourcing, please refer to our Privacy Policy Statement, which is available at www.frontrunnerbrokers.com.au and www.connective.com.au

In all circumstances where contractors and agents may become aware of personal information, confidentiality agreements apply. Our agents and contractors may only use personal Information for our purposes.

We may be allowed or obliged to disclose information by law, eg. Under Court Orders or Statutory Notices pursuant to taxation or social security laws.

Access:
You may (subject to permitted exceptions) access your information by contacting FrontRunner Mortgage Group Pty Ltd 3-5 Gladstone Street Wentworth Falls NSW 2782 or Connective OSN Pty Ltd, Level 5, 530 Collins Street, Melbourne VIC 3000.

Applicants Authorisation:
I have read and understood the service expectations required of me if my application is successful.

I hereby declare that the information in this application is accurate and true and authorise Connective to confirm the details in this application with third parties as required.

In accordance with Connective’s compliance procedures to appoint an associate member, it is a requirement that each associate member is identified and a credit search conducted. I authorise Frontrunner and or Connective to obtain reports from Baycorp Advantage Business Information Services Ltd to enable them to assess my application to become an Associate member.

Your Acknowledgment and consent:
Your signature below indicates your consent to such use and disclosure of your personal information as indicated above and that you have disclosed all relevant information about yourself so that we can assess your application fully. Your Signature below shall also indicate that you understand and accept the Fraud Policy as set by Connective and that you will comply with any reasonable future policies that Frontrunner and or Connective instigate with respect to detection and prevention of Fraud or any other policy as set by a lender the applicant becomes accredited with.

Applicant Signature:

Date: ________/__________/20_______

Associate members either franchised, licensed or employed by the full member may be authorised to act, but will need to be accredited by the individual lender as well as being an approved associate member of Connective, prior to conducting any interview with clients.

FrontRunner Mortgage Group Consent For Applicant to become an Associate Member:

Signature:

Date: ________/__________/20_______

Director Frontrunner Mortgage Group
Connective Full Member

Frontrunner Mortgage Group Pty Ltd
PO Box 796 Katoomba NSW 2780
P: 02-95483395
F: 02 95483380
E: recruit@frontrunnermortgage.com.au

CONNECTIVE SERVICES PTY LTD (ACN 107 366 496)
Level 5, 530 Collins Street Melbourne VIC 3000
P: 03 96146080
F: 03 96293831
E: info@connective.com.au