Name and registration number of financial adviser: [Client Name] [FSP No.] ​

Name of Adviser: [Client Name]
Trading Name: [Company Name]
Address: [Address]
Telephone number: [Phone Number]
Email: [Email]

This disclosure statement was prepared on: 1st December 2019

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.

What sort of adviser am I? 
I am a registered financial adviser, but not an authorised financial advisor. I can give you advice about life insurance contracts such as: term life insurance, trauma insurance, disability insurance, business income insurance and health insurance.

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, so that I can try to fix the problem.

If we cannot agree on how to fix the issue, you can contact Financial Services Complaints Limited, of which I am a member. This service will cost you nothing and will help us resolve any disagreements. You can contact Financial Services Complaints Limited at;

Address: PO Box 5867, Lambton Quay, Wellington 6145
Telephone number: 0800 347 257
Email address:

How am I regulated by Government? 
You can check that I am a registered financial adviser at . The Financial Markets Authority 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, [Client 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.