[Due to circumstances beyond my control, it is not practicable for me to provide all of the information that I am required to include in this statement. However, I must still provide this statement to you and tell you how and why it is incomplete. I must also provide you with an updated and complete version of this statement as soon as practicable.]
Name and registration number of Authorised Financial Adviser: [Insert the registration number issued to you by the Registrar of Financial Service Providers.]
Trading name: [Insert trading name or, if you do not have a trading name, omit this heading.]
This disclosure statement was prepared on: [date]
It is important that you read this document
This information will help you to choose a financial adviser that best suits your needs. It will also provide some useful information about the financial adviser that you choose.
In addition to the information that I must disclose to you in this statement, I must also disclose other information to you in a separate disclosure statement (or statements), including information about the types of services that I provide, the fees that I charge, and any actual or potential conflicts of interest. If I have not provided that information to you at the same time as I give you this statement, I must provide it to you as soon as I can.
What sort of adviser am I?
I am an Authorised Financial Adviser. This means I have been authorised by the Financial Markets Authority (the government agency that monitors financial advisers) to provide the financial adviser services described below.
How can I help you?
I have been authorised to provide you with financial adviser services of the following categories: [List the financial adviser services that you are authorised to provide. The manner in which these services are disclosed must be in accordance with any terms and conditions imposed on you by the Financial Markets Authority.]
[Include the following 2 paragraphs only if you are permitted by section 17(1)(a) of the Act to provide a personalised discretionary investment management service (DIMS).]
I am permitted under the Financial Advisers Act 2008 to offer a personalised discretionary investment management service (DIMS). Under a personalised DIMS, I make decisions about how to invest your money in financial products on your behalf, based on an investment strategy that is designed to take account of your particular financial situation and goals. I [charge/do not charge] fees for this service. You will hold the financial products [in your own name/through a custodian].
Investing through a personalised DIMS has risks. Under this service you give up [control/some control] over investment decisions, and rely on my decisions. The value of your financial products invested in through a personalised DIMS could go down as well as up. It is possible you will not achieve the returns you expect and will not receive all your investment back. Different personalised investment strategies have different levels of risks relating to the financial products being invested in and their management.
When I do this, I will be able to [give you advice/provide a service] about—
[Tick the category that applies, which must correspond with the number of organisations providing the financial products that you distribute, offer, or otherwise provide. If an organisation (O) is a conduit for products that you provide to your clients, then the number of organisations should include the total number of organisations that provide products, through O and you, to your clients. For example, if you provide advice to your clients on the use of a platform or a portfolio management service, you must include both the provider of the platform or portfolio management service and all issuers of financial products that are provided through the platform or portfolio management service.]
financial products provided by only 1 organisation:
financial products provided by a small number of organisations (2 to 5 organisations):
financial products provided by a broad range of organisations (more than 5 organisations).
How do I get paid for the services that I provide to you?
[Tick the statement or statements that apply.]
My services are only paid for by the fees that you pay. I do not receive payments from other people or organisations that might influence my advice.
My services are paid for by the fees that you pay as well as in other ways.
[You do not need to tick this box if the only commission that you receive is passed on, in full, to your client.]
There are situations in which [I/my employer/my employer and I/my principal/my principal and I] will be paid by other organisations. How much that payment will be depends on the decisions that you make.
Extra payments from my [employer/principal]
I may receive extra payments from my [employer/principal] depending upon the decisions that you make.
Non-financial benefits from other organisations
Other organisations may give [me/my employer/my employer and me/my principal/my principal and me] non-financial benefits depending on the decisions that you make.
I am required to tell you the specific fees, commissions, extra payments, and other benefits that I have received or will, or may, receive in relation to the services that I provide to you. I must tell you these things before I [give you advice/provide a service] or, if that is not practicable, as soon as practicable after I [give you that advice/provide that service].
What are my obligations?
As an Authorised Financial Adviser, I must comply with the Code of Professional Conduct for Authorised Financial Advisers. I also have other obligations under the Financial Advisers Act 2008 (including regulations made under that Act) and under the general law.
What else should you know about me?
[Include the statements that apply to you. If none apply, omit all the statements and this heading.]
I have, within the previous 5 years, been adjudicated bankrupt: [Specify, in not more than 200 words, the date of every such adjudication, the court or other tribunal that made the adjudication, and the date on which you were discharged from the bankruptcy.]
I have, within the previous 5 years, been admitted to the no asset procedure under Part 5 of the Insolvency Act 2006: [Specify, in not more than 200 words, the date of every such admission to the no asset procedure, the name and contact details of the relevant Assignee, and the date on which you were discharged.]
I have, within the previous 5 years, been the subject of disciplinary proceedings before the disciplinary committee (which deals with complaints regarding Authorised Financial Advisers), which has made a recommendation or order in relation to me, or has censured me: [Specify, in not more than 200 words, the date and details of, and reasons for, every such recommendation, order, or censure.]
I have, within the previous 5 years, been the subject of disciplinary proceedings before another professional body that have resulted in my being expelled from, or prohibited from being a member of, that professional body: [Specify, in not more than 200 words, the date and details of, and reasons for, every such expulsion or prohibition, and the name of the professional body. The definition of professional body in the Code of Professional Conduct for Authorised Financial Advisers applies for the purposes of this disclosure statement.]
I have criminal convictions or have had adverse findings made against me by a court or disciplinary tribunal, which I am required, by the terms and conditions of my authorisation as an Authorised Financial Adviser, to disclose to you: [Specify the matters that you are required to disclose, and disclose those matters in accordance with your terms and conditions of authorisation.]
What should you do if something goes wrong?
If you have a problem, concern, or complaint about any part of my service, please tell [me/my employer/my internal complaints scheme] so that [I/my employer/my internal complaints scheme] can try to fix the problem.
You may contact the internal complaints scheme by [briefly explain how to contact the scheme and how to make a complaint under the scheme or, if not applicable, omit this statement].
If we cannot agree on how to fix the issue, or if you decide not to use the internal complaints scheme, you can contact [name of the approved dispute resolution scheme of which you, your employer, or your principal is a member]. This service will cost you nothing, and will help us resolve any disagreements. You can contact [name of scheme] at—
If you need to know more, where can you get more information?
If you have a question about anything in this disclosure statement or you would like to know anything more about me, please ask me.
If you have a question about financial advisers generally, you can contact the Financial Markets Authority.
How am I regulated by the Government?
You can check that I am a registered financial services provider and an Authorised Financial Adviser at http://www.fspr.govt.nz
The Financial Markets Authority authorises and regulates financial advisers. Contact the Financial Markets Authority for more information, including financial tips and warnings.
You can report information or complain about my conduct to the Financial Markets Authority, but in the event of a disagreement, you may choose to first use the dispute resolution procedures described above (under What should you do if something goes wrong?).
I, [full name], declare that, to the best of my knowledge and belief, the information contained in this disclosure statement is true and complete and complies with the disclosure requirements in the Financial Advisers Act 2008 and the Financial Advisers (Disclosure) Regulations 2010.
Notes for Authorised Financial Adviser on completing this form
To complete this form, you must—
omit all instructions and explanatory material (italicised text that is enclosed in square brackets) and, if required, replace that text with the information specified; and
omit all other text enclosed in square brackets that does not apply, including all inapplicable alternative text (which is enclosed in square brackets and separated by
“/”) and any other text that the instructions direct you to omit; and
omit all square brackets enclosing the text referred to above; and
omit these notes (including the heading to these notes); and
You need not set out the disclosure statement in the same format as this prescribed form, but the format you use must—
be typed (not handwritten) and printed in a font and font size that are easily readable by most people; and
include the same headings and words that appear in this form (other than the text that must be inserted or omitted, as detailed above); and
present the information in the same order as in this form; and
not be misleading in any way; and
not include any information (other than unobtrusive material such as a corporate logo) that is not required to be included in the disclosure statement; and
include all tick boxes and the text relating to those tick boxes.
Schedule 1 form: amended, on 1 December 2014, by regulation 9(1) of the Financial Advisers (Disclosure) Amendment Regulations 2014 (LI 2014/331).
Schedule 1 form: amended, on 1 December 2014, by regulation 9(2) of the Financial Advisers (Disclosure) Amendment Regulations 2014 (LI 2014/331).
Schedule 1 form: amended, on 1 December 2014, by regulation 9(3) of the Financial Advisers (Disclosure) Amendment Regulations 2014 (LI 2014/331).
Schedule 1 form: amended, on 1 May 2011, pursuant to section 73(1) of the Financial Markets Authority Act 2011 (2011 No 5).