AIL of New Zealand Recruitment Information Form

Please enter your full name (as per your ID documents)(Required)

Are you known by any other name(s)?(Required)

Yes

Please provide details of your other name(s)

Date of birth(Required)

MM slash DD slash YYYY

Home Address(Required)

Street Address Suburb City Postcode

Phone Number(Required)

Email(Required)

Are you a NZ Citizen, or permanent resident?(Required)

NZ Citizen

Permanent Resident

Other

Do you have any relatives that currently work for/or are contracted to AIL of New Zealand?(Required)

Yes

Name of relatives

Do you currently hold an active Financial Advisers FSP registration?(Required)

Yes

FSP number (if known)

Are there any limitations or restrictions on your FSP registration?(Required)

Yes

Please provide details of your limitation or restriction

Have you ever been dismissed as an employee, or have you / your business been dismissed as agent or representative of a financial institution?(Required)

Yes

Please provide further details

Have you / your business ever had a product provider decline or withdraw your accreditation with their organisation?(Required)

Yes

Please provide further details

Do you have a NZ Certificate in Financial Services v2 (Level 5) - specialising in Life, Health, Disability Insurance(Required)

Yes

Do you have any financial services or other relevant industry experience?

In the last 7 years, have you, or any associated person in your business/company, including directors, been or is currently a declared bankrupt or been admitted to a no asset procedure?(Required)

Yes

Please provide more details

Have you / are you, or any associated person in your business/company, currently is a director or a responsible officer of a company which has gone into, or is pending, voluntary liquidation to which a receiver, administrator, liquidator, statutory manager has been appointed?(Required)

Yes

Please provide further details

Have / are you, or any associated person in your business/company,including directors and employees ever been found guilty of, charged with, or is / are currently under investigation for any offence involving fraud, dishonesty, drug trafficking, money laundering, violence, or any other criminal offence, in New Zealand or any other jurisdiction?(Required)

Yes

Please provide further details

Have / are you, or any associated person in your business/company, including directors and employees ever had a licence, registration or permission suspended or cancelled or disqualified for any occupation, profession, or business, in New Zealand or any other jurisdiction?(Required)

Yes

Please provide further details

Please upload the following documents to submit with your application

Proof of Citizenship or Residency Status

Max. file size: 500 MB.

Proof of Identity - Drivers License

Max. file size: 500 MB.

Proof of Identity - Passport

Max. file size: 500 MB.

Proof of residential address (Utility statement or similar)

Max. file size: 500 MB.

Proof of Qualifications

Max. file size: 500 MB.

Ministry Of Justice Criminal History Check

Max. file size: 500 MB.

If you don't have a MOJ Criminal History Check, click here and complete one (it's free). Once you have recieved it please send this document to your recruiter.

Confirmation(Required)

I confirm that all details are correct to the best of my knowledge.

AIL of New Zealand Recruit Information Form

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09 320-3031

0800-894-121

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