Insurance Premium Funding Code

Associate Member Application Form

Applicant Details:
Trading Name:
ACN:
ABN:
Registered Office Address:
Registration Date:
Office Telephone:
Company Website:
Business Overview
Please indicate predominate membership type – consumer finance, commercial finance, property and land finance, equipment finance, motor finance, leasing and rental – and a brief description of the business, including product/service range, target customers, distribution channels, etc:
Confirm Membership Fee
Membership fees are determined annually by the AFIA Board and are tiered based on the size and tenure of the applicant/member. Please confirm the tier that reflects the size of your business:
Corporate Representative: We nominate the following person (Director, Senior Executive Level or an authorised alternate) to be our representative and to be entitled to exercise the same powersas our company as a Member of AFIA:
Corporate Representative Position:
Corporate Representative Email:
Corporate Representative Mobile:
Key Contact: This person will receive notices and information regarding AFIA membership:
Key Contact Email:
Key Contact Mobile:
Attestation + Acknowledgement
We certify that we meet the eligibility criteria for membership as detailed in the Membership Conditions. We acknowledge that, unless we advise AFIA otherwise, that details of our company and the name and position of our nominated corporate representative may be published by AFIA (including on the AFIA website) and shared with other members. We also confirm that to the extent that the information is personal information that we will notify the individual and, if required, obtain relevant consents from the individual. By ticking the box below, in the event of our admission as a Member, we agree (a) to be bound by the AFIA Constitution, Membership Conditions, and Protocols approved by the AFIA Board from time to time; and (b) confirm that we will abide by them as in force from time to time. Copies of the Constitution and Membership Conditions are accessible via the links below. A membership invoice will be forwarded if your application is accepted as per membership conditions:
Name:
Position Title:
Email: