Annual Broker Business Verification Form
Trading Name
(Required)
Trading Address
(Required)
Street Address
Suburb
State
Postcode
Mailing Address
(Required)
Same as above
Is different to Trading Address
Mailing Address (if different to the trading address)
Street Address
Suburb
State
Postcode
List the names of brokers who have left your business in the last 12 months
Supporting Documents
Please upload a copy of:
A. Your current Certificate of Currency for your Professional Indemnity Cover
Max. file size: 50 MB.
B. Your current industry membership certificate (either CAFBA, MFAA or FBAA)
Max. file size: 50 MB.
If you are unable to provide any of the supporting information above please provide brief details
