Document ID: chunk:federal_register_of_legislation:F2024L00996:schedule:1:p1
Version: federal_register_of_legislation:F2024L00996
Segment Type: schedule
Provision Reference: sch 1 (pt 1/3)
Character Range: 24007–27143

Schedule 1—Template Consent Form (Recruiting Licensee)

    Consent by prospective representative for recruiting licensee to collect, use, disclose and store information for reference checking purposes
    [name of prospective representative] (Prospective Representative/You)

       1. We, [Insert recruiting licensee 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 employment or authorisation by Us.

       2. We are seeking your consent to obtain a reference about You for the purposes of Us:

           (a) complying with the ASIC Reference Checking and Information Sharing Protocol under the ASIC Corporations and Credit (Reference Checking and Information Sharing Protocol) Instrument 2024/647 (the Protocol); and
(b) should You be employed or authorised by Us—complying with the general conduct obligations of a licensee under section 912A of the Corporations Act 2001 or subsection 47(1) of the National Consumer Credit Protection Act 2009, which include taking steps to ensure that a licensee's representatives comply with financial services laws or credit legislation and ensuring that representatives are adequately trained, and are competent, to provide financial services or engage in credit activities.

       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 You are the licensee) the services or activities authorised by your financial services or credit licence and the length of time you have held the licence;

           (c) (where mortgage broker in relation to mortgage aggregator) the scope and length of any arrangement under which a mortgage intermediary (i.e. a mortgage aggregator) acted as an intermediary in relation to You;

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

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

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

           (g) 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;

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

           (i) 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