Document ID: chunk:federal_register_of_legislation:F2024L00996:schedule:2:p1
Version: federal_register_of_legislation:F2024L00996
Segment Type: schedule
Provision Reference: sch 2 (pt 1/3)
Character Range: 30556–33608

Schedule 2—Template Consent Form (Future Mortgage Intermediary)

Consent by relevant mortgage broker for future mortgage intermediary to collect, use, disclose and store information for reference checking purposes
[name of individual] (You)
        1. We, [Insert future mortgage intermediary name and licence number], our related entities and any agent(s) acting on our behalf (Us/We), request your consent to collect, use, disclose and store your personal information for the purposes of Us considering your suitability for Us to act as a mortgage intermediary (i.e. a mortgage aggregator) in relation to You.
       2. We are seeking your consent to obtain a reference about You for the purposes of Us complying with the ASIC Reference Checking and Information Sharing Protocol under the ASIC Corporations and Credit (Reference Checking and Information Sharing Protocol) Instrument 2024/547 (the Protocol).

       3. The personal information (Information) that may be collected, used, disclosed and stored by Us is likely to include, but is not limited to, information in relation to:

           (a) (where representative of a licensee) the scope and length of your employment or authorisation by a financial services licensee or credit licensee;

           (b)  (where mortgage broker in relation to mortgage aggregator) the period for which a mortgage intermediary acted as an intermediary in relation to You;

           (c) your conduct in relation to financial services or credit activities while you were employed or authorised by the licensee or while the mortgage intermediary acted as an intermediary in relation to You;

           (d) the circumstances surrounding your departure from the licensee or the cessation of the arrangement with the mortgage intermediary;

           (e) your compliance audit record, including the results or outcomes of compliance audits;

           (f) compensation that was given to a client either as a financial payment offered to a client or any other non-financial remedy given to a client, as a result of your activities;

           (g) ASIC reportable breaches or reportable situations caused or contributed to by You;

           (h) details of written warnings or reprimands relating to You, given by ASIC or the Financial Services and Credit Panel to a financial services licensee under subsection 921S(2) or 921T(2) of the Corporations Act 2001, or instruments given by the Financial Services and Credit Panel to a financial services licensee under subsection 921M(1) of the Corporations Act 2001;

           (i) details of any unresolved inquiry or investigation concerning your conduct in progress at the time that the reference is given; and

           (j) any clarification or updates relating to the matters reported in the reference for a period of up to 6 months commencing after the day on which the reference is given.

       4. We will collect this Information from referee licensees, being:

           (a) (where representative of a licensee) one or more of the current or