MORTGAGE MART ACCREDITATION FORM

Section 1 - Aggregation

Aggregation Structure*

Describe your current aggregation structure including Master and Sub aggregation if applicable.

Section 2 - Broker details (Name as per photo identification)

First Name*

Last Name*

Previously known names

Date of Birth*

Email Address*

Mobile Phone*

Office Number

Trading Name*

Trading ABN

Office Address (Address where you are predominantly based)*

Office Address Suburb*

Office Address State*

Office Address Post Code*

Section 3 - NCCP details

Broker - CRN or ACL Holder*

Credit Representative Number

Australian Credit Licence

Do you have a minimum of 2 years credit/lending experience?

Yes

AFCA/COSL Membership Number

MFAA/FBAA Membership Number

Professional Indemnity Number

Certificate IV or Diploma Number

Section 4 - Introduced By

Broker - Referred By*

Section 5 - Personal Identifier

The following information is required specifically for identity authentication purposes (i.e. To confirm caller identity prior to releasing confidential information) You must take reasonable measures to keep the nominated identifier confidential.

Identifying Question*

Identifying Answer*

Section 6 - Broker Declaration and Acknowledgement
Have you ever:

Declared Bankruptcy, been declared Bankrupt, or been subject to control under the Bankruptcy Act 1966?*

Yes

Been found guilty of, or been charged with any crime or offence (other than a minor crime such as a traffic offence) which has not been withdrawn or dismissed?*

Yes

Had an application for grant or renewal of any financial services licence or registration, authorisation to act as a credit representative or membership of an industry or professional association refused or revoked?*

Yes

Had an application for accreditation declined or been cancelled by any other credit provider?*

Yes

Been banned from holding a company directorship?*

Yes

Been known by or had any other name?*

Yes

If you have answered yes to any of section 6, please provide full details:

I acknowledge that:

This application for accreditation will be assessed by WLTH as the parent company of Mortgage Mart and that approval of this accreditation is at the discretion of WLTH. WLTH will notify me of the outcome of this application within 10 working days upon receipt of this fully completed application and all supporting documentation as required;
If approved, this application for accreditation will grant me dual accreditation and access to WLTH and Mortgage Mart product offerings;
Approval of my 'new' accreditation is subject to the completion of broker induction training as required;
If my accreditation is terminated, WLTH/Mortgage Mart may report full details of the reasons for termination (including for dishonesty or fraud) and provide copies of relevant documents, to any Approved Industry Association and/or any governing body which regulates or supervises the conduct of mortgage brokers and I will not hold WLTH or Mortgage Mart liable for such reporting.

By submitting this statement you agree to the following:

WLTH- terms and conditions, privacy, and disclosure statement.
Mortgage Mart- terms and conditions, and privacy.