authority to release financial information
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Authority to Release Financial Information
Use this form to authorise the release of financial information from your accountant, financial institution, or any other financial service provider that you currently (or may in future) use.
Please print in CAPITAL LETTERS.
1. Financial authority – insured person 1
! Only to be completed if you wish your accountant to release information to Resolution Life.
Full name of insured person 1
I,
hereby authorise my accountant1 (full name and address):
1 or any financial institution, or any other financial service provider that I currently (or may in future) use,
to release details of my financial history.
Signature of insured person 1
✗
Date
D D M M Y Y Y Y
2. Financial authority – insured person 2
! Only to be completed if you wish your accountant to release information to Resolution Life.
Full name of insured person 2
I,
hereby authorise my accountant1 (full name and address):
1 or any financial institution, or any other financial service provider that I currently (or may in future) use,
to release details of my financial history.
Signature of insured person 2
✗
Date
D D M M Y Y Y Y
Where to send this form
Mail or email this completed form to:
Resolution Life Customer Service Centre GPO Box 5441
SYDNEY NSW 2001
NS5
536_
RL
09/2
1
The product issuer, AMP Life Limited ABN 84 079 300 379 (AMP Life), is part of the Resolution Life Group. AMP Life has proudly served customers in Australia since 1849. AMP Limited ABN 49 079 354 519 has sold AMP Life to the Resolution Life Group whilst retaining a minority economic interest. AMP Limited has no day-to-day involvement in the management of AMP Life whose products and services are not affiliated with or guaranteed by AMP Limited. AMP Limited is not liable for products issued by AMP Life or any statements or representations made in the PDS for those products. ‘AMP’, ‘AMP Life’ and any other AMP trademarks are used by AMP Life under licence from AMP Limited.
Issue date: 1 October 2021