Appointment of an Authorised Representative

Created - 30th August 2024

If you wish to appoint an Authorised Representative to deal with Computus Australis on your behalf, please complete the form below. Alternatively, you may provide Computus Australis with a letter or authorisation or other reasonable form of authorisation as may be reasonably required by Computus Australis.

Please note

When you appoint an Authorised Representative you are giving the person you appoint the authority to deal with us on your behalf as your agent. This means that the Authorised Representative has the power to act and access information as if they were you. This includes making complaints, changing account details or terminating a contract. You can of course specify limitations of your Authorised Representative’s rights.

Please note that only account holders can appoint an Authorised Representative. If you wish to appoint more than one Authorised Representative, please complete one Authorised Representative Form for each person you wish to appoint. You can appoint up to three Authorised Representatives.

For security reasons we require you to submit the completed Authorised Representative Form to us as a signed original and witnessed by one of the following persons below:

A Justice of the Peace;
An Accountant who is a member of the Australian Institute of Chartered Accountants, CPA Australia or the National Institute of Accountants with 2 or more years of continuous membership;
A Solicitor or Barrister;
A Police Officer;
An agent in charge of, or a permanent employee (with 2 or more years of continuous service) of an Australia Post outlet;
An officer with, or authorised representative of, a holder of an Australian Financial Services Licence, having 2 or more continuous years of service with one or more licensees;
A Dentist;
A Pharmacist;
A Medical Practitioner;
A Chiropractor or a Physiotherapist;

Please contact us on 0245711676 if this proves too difficult or inconvenient for you, and we will work with you to find an alternative way of appointing an Authorised Representative.

Appointment of Authorised Representative

Account Holder's Full Name(*)

Please type your full name.

Company

Please enter a company name

E-mail(*)

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Phone

Please insert a valid phone number (123-456-7890)

I wish to appoint the following person as my Authorised Representative

Authorised Representative's Full Name(*)

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Authorised Representative's Telephone Number(*)

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Authorised Representative’s Email Address (if applicable)

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Authorised Representative's Physical Address

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Limitations of the Authorised Representative’s rights (Specify anything that your Authorised Representative should NOT be allowed to do on your behalf. If left blank, the Authorised Representative has the power to act as if they were you.):

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I authorise Computus Australis to deal with the above person as my Authorised Representative.

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Signature

Place and date

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Account holder's signature

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Captcha(*)

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