Moneywise Manawatu - Privacy waiver form

Sharing your financial informaton with a Financial Mentor

This page grants permission for your Financial Mentor to speak to organisations about your finances.

Permission to provide information (for client to complete)

“Organisations” = any business, creditor, organisation, department, service or person involved in my
financial affairs. Banks are not included.

Please tick the following boxes:

I authorise organisations to share my financial information with my Financial Mentor on request so they can provide me with appropriate financial capability and budgeting advice (required). Invalid Input

I authorise my Financial Mentor to access on my behalf my credit information held with credit reporting agencies and the credit reporting agency to disclose my credit information to my Financial Mentor (optional). Invalid Input

I intend that this authorisation satisfies the requirements of the Privacy Act 2020 (required). Invalid Input

First Name(s)(*)

Please type your full name.

Last Name

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E-mail(*)

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Client Date of Birth:

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Joint Client (if applicable)

Joint Client First Name(s)

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Joint Client Last Name

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Todays Date

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This agreement expires 12 months from the above date or earlier on

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Please tick the box below(*)

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Location

First Floor, Hancock Community House
77 King Street
Palmerston North

Contact

Freephone: 0800 228 343
Phone: 06 358 2279
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Office Hours

Mon–Tue

9 am – 3pm
Wed

9 am – 4.30 pm and until 7pm by appointment
Thurs

9am – 3 pm
Fri

9am – 12 pm

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