Letter of Authority

I hereby authorise Total Wealth Advisory (TWA) to obtain any information on my behalf in relation to my pensions held with you.

Total Wealth Advisory
PO Box 2351
Ocean Keys
Clarkson
WA 6030

Personal Details - Your Personal Details

Full Name:

Dependants:

Marital status:

Current Address:

Last Address:

Date of Birth:

National Insurance No.:

Date of Australian Residency:

Spouse’s Personal Details

Full Name:

Date of Birth:

Overseas Pension Provider Details - Your Overseas Pension Details

Name of Overseas Pension Provider:

Address of Overseas Pension Scheme:

Membership or Policy No:

Type of Pension Scheme Held : (e.g. personal, occupational,AVC, stakeholder)

Declaration

Signature: Applicant one (you)

Date:

Print Name: