Portfolio Healthcheck/Fund Broker Nomination Form for Wealth Focus .

Personal details

First name

Surname

Date of birth

Company/SMSF (if applicable)

Position

Address

Suburb

State

Postcode

Daytime contact number

Alternative number

Email Address

List of known contracts (managed funds, wraps, insurance etc)

If you already hold these investments within the Wealth Focus Investment Service please do not add them below as they will automatically be included.

Name of provider & product

Client number/ref.

Adviser code(internal use)

Signatures

I/We request that the providers above amend their records to indicate that Wealth Focus Pty Ltd is the appointed broker for the investments listed, list may not be exhaustive, please check for others. I/We understand that Wealth Focus will receive the trailing commission if there is any payable. I/We understand that you will apply a 100% rebate on any managed fund entry fees and ongoing fees in the form of additional units in the relevant fund.