Authorised Representative – Equity Lever
Macquarie Specialist Investments
To appoint an Authorised Representative to have access to your GearUp Facility, receive notices of Instalment Acceleration
Events and to issue instructions on your behalf, please complete this form.
Please note that if on an ongoing basis you are unlikely to be able to be contacted at the email address and phone number(s)
provided by you, you will be required to appoint a licensed financial adviser as your Authorised Representative and upon acceptance
by Macquarie of the appointment of that Authorised Representative, this form will constitute an agreement for the purposes of S985M
of the Corporations Act.
Please use black ink and BLOCK letters.
Facility name:
Facility number:
I/we hereby appoint the person whose details appear below (my/our Authorised Representative) as my agent and attorney:
1. to receive notices from Macquarie Bank Limited (Macquarie) of the occurrence of an Instalment Acceleration Event in respect of my/our
Facility;
2. to view and access my/our GearUp account in respect of my/our Facility;
3. to give the following instructions to Macquarie, including via GearUp, on my/our behalf in relation to my/our Instalment Receipts and the
Underlying Securities (whether in response to an Instalment Acceleration Event or otherwise):
a. Investment Instructions;
b. instructions in relation to Early Instalment Payments, Early Closure and Completion Payments;
c. instructions in relation to corporate actions and Ordinary Dividends;
d. instructions in relation to the interest rates applicable to my/our Facility; and
e. instructions to debit or credit my/our nominated account with any amounts owing by or to me/us;
4. to sign on my/our behalf any document which may be required in relation to any instruction referred to in 3 above;
5. to provide Macquarie with any missing or additional information about me/us or my/our Facility that may be required by law or in terms of
Macquarie’s internal policies;
6. to sign on my/our behalf a Third Party Data Form authorising Macquarie to disclose historical account and transactional (including
account balance) details (“Data”) to a specified third party so that the third party can then make the Data available to my/our adviser and
administrator. A copy of the form is available at www.macquarie.com.au/third-party-data-authority-form.pdf.
I/we would like to cancel the access of an existing Authorised Representative to my/our GearUp account.
Please specify
If you have an existing Authorised Representative they will continue to be able to access your GearUp account if this section is not
completed.
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New Authorised Representative details
Authorised Representative name
Mr
Mrs
Miss
Ms
Dr
Other
First name(s)
Last name
Other name known by
Residential address (this cannot be a PO Box)
Street number and name
Suburb/town
State
Postcode
Country (if not
Australia)
Contact details
Business hours
After hours
Fax
Mobile
Email
Does your nominated Authorised Representative have access to a Macquarie Access Code (MAC)?
No, please set them up with a new MAC
Yes, their existing MAC is
Additional details
Date of birth
/
/
Occupation
Is your Authorised Representative your financial adviser?
No
Yes, their existing AFSL number is
Has your nominated Authorised Representative previously supplied a FSC/FPA form or a certified copy of their driver’s license
or passport?
Yes
No (If “No”, then please ensure you provide this together with this form.)
Please note: The Authorised Representative signature is required on page 3 and the Investor
signature is required on page 4.
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Authorised Representative Acknowledgements
I acknowledge and agree that:
a. Macquarie may collect and use personal information about me:
i.
to process this Authorised Representative form;
ii. to give me notifications in accordance with this Authorised Representative form;
iii. to identify me as the person authorised under this Authorised Representative form when I give any instructions in terms of that
authorisation; and
iv. to comply with the Anti-Money Laundering and Counter-Terrorism Financing Act 2006, rules and other subordinate instruments
(AML/CTF Laws).
b. Macquarie may disclose information it holds about me in the following circumstances (even if the disclosure is to an organisation overseas
which is not subject to privacy obligations equivalent to those which apply to us):
i.
to companies and representatives (including related entities) that provide services in respect of the Investor’s Facility on Macquarie’s
behalf; and
ii. if the disclosure is required or authorised by law.
c. I do not have to disclose my personal information to Macquarie but if I do not Macquarie may not be able to accept my appointment as
an Authorised Representative under this form.
d. I can access, correct or update any of my personal information that Macquarie holds by contacting Macquarie on 1800 080 033. I can
also obtain a copy of Macquarie’s privacy statement at macquarie.com.au or by requesting it from Macquarie.
e. Macquarie is subject to AML/CTF laws. If requested, I will provide additional information and assistance and comply with all reasonable
requests to facilitate Macquarie’s compliance with AML/CTF Laws in Australia or an equivalent overseas jurisdiction.
f. I will not knowingly do anything to put Macquarie in breach of the AML/CTF Laws and I will promptly notify Macquarie if I am aware of
anything that would put Macquarie in breach of AML/CTF Laws.
g. I am not aware and have no reason to suspect that:
i.
the money used to fund any investment made by or on behalf of the investor appointing me as Authorised Representative (the
Investor) is derived from or related to money laundering, terrorism financing or similar activities (Illegal Activities); and
ii. proceeds of any investment made by or on behalf the Investor will fund illegal activities.
h. I acknowledge that in certain circumstances Macquarie may be obliged to freeze or block an account where it is used in connection with
Illegal Activities or suspected Illegal Activities. Freezing or blocking can arise as a result of the account monitoring that is required by AML/
CTF Laws. Pursuant to the AML/CTF Laws, Macquarie is not liable to me for any consequences or losses suffered as a result of the
freezing or blocking of the investor’s account in accordance with the AML/CTF Laws.
i.
Macquarie retains the right not to provide services or issue products to any investor that Macquarie decides, in its sole discretion, that it
does not wish to supply.
j.
I have read and understand the GearUp Investment Instructions Terms and Conditions and agree to act in accordance with those Terms
and Conditions when using GearUp in respect of an investor’s Facility.
k. I will keep secure and confidential any password or other security measure in relation to my use of GearUp.
l.
I will not access an investor’s Facility account, including placing instructions, in GearUp without proper authority.
m. The information contained in this form is correct.
Authorised Representative signature(s)
Date
/
/
Print Name
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Investor Acknowledgements
I/We acknowledge that Macquarie:
• will take reasonable steps to notify my/our Authorised Representative and me/us of the occurrence of an Instalment Acceleration Event;
• is authorised to act on any instruction given to it by the Authorised Representative that I/we have appointed in respect of the transaction
types listed above;
• is not obliged to verify instructions or obtain additional information before giving effect to an instruction which purports to be from my/our
Authorised Representative although it may do so;
• will continue to give notices of Instalment Acceleration Events to my/our Authorised Representative and to act on requests and instructions
from my/our Authorised Representative until I/we revoke my/our consent in writing;
• will not under any circumstances accept instructions from my/our Authorised Representative to credit funds to any bank account other
than my/our nominated bank account.
Executed as a deed.
If the investor is a company, this form is executed in accordance with section 127(1) of the Corporations Act 2001 by authority of its directors
in the presence of
Authorised signature(s)
Investor 1/Company Director/ Sole Director/Trustee 1
Investor 2/Company Director/ Secretary/Trustee 2
Print Name
Print Name
Witness(es)
Witness 1
Witness 2
Print Name
Print Name
Date
/
/
Date
/
/
Please complete and return to Macquarie Specialist Investments, GPO Box 4294,
Sydney NSW 1164, email [email protected] or facsimile 02 8232 6158.
If you require any assistance please contact the Client Service Team on 1800 080 033
or email [email protected].
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