Appoint, Change or Cancel a Financial Adviser Form | March 2017 | Page 1 of 3
PIMCO Investor Services
Phone (within Australia)
1300 113 547
International
+61 2 8823 2583
Email
Website
www.pimco.com.au
Appoint, Change or Cancel a Financial Adviser Form
Use this form if you are an existing investor and wish to appoint, change or cancel your financial adviser. You can also use this
form to change their details (such as their address).
Please complete all sections in block capitals and using a black pen. If you make an error while completing this form, do not
use correction fluid. Cross out your mistakes and initial your changes.
1. Instructions if you are appointing, change or cancel a financial adviser.
If you wish to appoint, change or cancel a financial adviser, the following needs to be completed:
• write your account number and account name as it appears on your latest statement
• complete section 2 ‘Appoint, change or cancel a financial adviser’
• sign the form as per the ‘Signing instructions’ in section 5.
2. Send your documents to us.
You can return your form by post or fax according to the details below:
Send by Post: PIMCO Funds – Unit Registry
GPO Box 804
Melbourne VIC 3001
Australia
Fax forms to: 02 9151 4096
3. Your Privacy
For the purposes of providing products and services to you, PIMCO Australia Management Limited ABN 37 611 709 507 AFS Licence No. 487 505
(“PIMCO”, "us", "our") collects personal information about you (as outlined in the PDS) including from sources such as account applications and other
forms, from other written, electronic or verbal correspondence, from your transactions, from your brokerage or financial advisory firm, financial adviser
or consultant, and/or from information captured on our internet websites.
When you sign this Application Form, you agree that PIMCO can, consistently with the Privacy Act 1988 (Cth) ("Privacy Act"), collect, use and disclose
personal information about you for those purposes. In some circumstances, PIMCO may be required by law to collect your personal information, for
example under the AML/CTF Act.
Your personal information may be disclosed to entities located outside Australia, including entities located in Brazil, Canada, Germany, Hong Kong,
Italy, Japan, Singapore, Switzerland, United Kingdom and United States of America where your personal information may not receive the level of
protection afforded under Australian law.
We take reasonable steps to ensure that any third party we disclose your personal information to is bound by privacy obligations to protect information
about you.
Under the Privacy Act, you have rights to request access to, and correction of, personal information PIMCO holds about you. You can find more
information about how PIMCO handles and manages your personal information, and about your rights in connection with access, correction and
complaints, in PIMCO's Privacy Policy at pimco.com.au. If you would like a copy of PIMCO’s Privacy Policy, please contact our Compliance Officer on
+61 2 9279 1771 or [email protected]mco.com.
Appoint, Change or Cancel a Financial Adviser Form | March 2017 | Page 2 of 3
DD MM YYYY
1. Investor details
Account number
Account name
2. Appoint, change or cancel a financial adviser
I/We wish to:
Appoint/change a financial adviser
Cancel a financial adviser
Please provide details of your financial adviser.
Dealer group name
Adviser name
AFSL number
Authorised representative number
3. Appointment of a financial adviser
This section should be completed by your financial adviser. Your
financial adviser will have online access to your account. If you
would like your financial adviser to receive copies of your statements
by email please enter their email address below.
Email address
Notice to financial adviser by completing this section of the
application form, you are confirming that you hold a current
Australian Financial Services Licence (AFSL), or are otherwise
authorised to advise on this product.
If you would like to register for adviser online to view your client’s
investment information please complete the below.
Financial adviser contact details
Business address. A PO Box/RMB/Locked Bag is not acceptable.
Property name/building name (if applicable)
Unit Street number
Street name
Suburb State
Post code Country
Postal address (if different to residential address)
A PO Box/RMB/Locked Bag is acceptable.
Property name/building name (if applicable)
Unit/Level Street number
Street name (or PO Box or other mail details if applicable)
Suburb State
Post code Country
Contact details
Business number (include country and area code)
Mobile number (include country code)
Adviser Signature
Please print full name
Date (DD/MM/YYYY)
/ /
4. Signing instructions
By completing and signing this form, you
• authorise us to act according with the instructions on this form
• acknowledge that the instructions on this form supersede, and
have priority over, all previous instructions received by us, and
• agree to indemnify us from and against all losses, costs,
expenses, claims, actions or proceedings brought against us in
connection with following your instructions on this form.
Who needs to sign this form
Individual – where the investment is in one name, the account
holder must sign.
Joint Holding – where the investment is in more than one name, all
of the account holders must sign.
Companies – where the company has a sole director who is also the
sole company secretary, this form must be signed by that person.
If the company (pursuant to section 204A of the Corporations Act
2001) does not have a company secretary, a sole director can also
sign alone. Otherwise this form must be signed by a director jointly
with either another director or a company secretary. Please indicate
the capacity in which the form is signed.
Trust – the trustee(s) must sign this form. Trustee(s) signing on
behalf of the trust confirm that the trustee(s) is/are acting in
accordance with such designated powers and authority under the
trust deed.
Power of Attorney – if you have not already lodged the Power of
Attorney with us, please attach a certified copy of the Power of
Attorney document that includes Certificate of Witness and
Statement of Acceptance and Certified Identification Document of
the Power of Attorney. I/We attest that the Power of Attorney has
not been rescinded or revoked and that the Donor is still living.
Appoint, Change or Cancel a Financial Adviser Form | March 2017 | Page 3 of 3
DD MM YYYY
DD MM YYYY
Signature of investor 1, director or authorised signatory
Please print full name
Date (DD/MM/YYYY)
/ /
Company officer (please indicate company capacity)
Director
Sole director and company secretary
Authorised signatory
Signature of investor 2, director/company secretary or authorised
signatory
Please print full name
Date (DD/MM/YYYY)
/ /
Company officer (please indicate company capacity)
Director
Company secretary
Authorised signatory
