On-line Account Nomination

Please enter your details and the details of your accounts / policies below to enable iRefund to collect your cashback as soon as possible.

First Name: *
Last Name: *
Address:*
Suburb:*
State:*
Postcode:*
Mobile Phone:*
Home Phone:*
Business Phone:*
Date of Birth:* / /
Member Number (if you are already a member):
Email Address: *
 
 

Details of Existing Products

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Financial Institution Name * (e.g. 'Colonial First State')
Account Name * (e.g. Bill Smith)
Name of fund/policy * (22 characters maximum, e.g. 'Superannuation')
Client account/policy number * If unsure you can add the Client account/policy number later. (client code or investor code as advised by your financial institution; usually found on front page of statement)
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Your Signature

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I/We request that the fund manager named above amend their records to indicate that Investor Refund Pty Ltd is the appointed broker for the investments listed above. I/We understand that Investor Refund Pty Ltd will replace the existing broker & request that Investor Refund Pty Ltd receive the existing trailing commission / adviser service fee currently being generated by my/our investment amount.

I/We have read and agree to the Investor Refund Pty Ltd terms and conditions and Financial Services Guide and acknowledge that Investor Refund Pty Ltd has not provided me/us with advice regarding the above investment/insurance.

I have read and agree to the Terms & Conditions, Privacy Policy and Financial Services Guide *

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