Asteron Life - Apply Now for AdviserConnect

We welcome your application for access to AdviserConnect^TM, Proposal Tracking and Policy Information. By completing this form and submitting it to us, you will gain access to AdviserConnect^TM with materials and information to make doing business with us and working with clients easier.

In addition to the purposes stated in the Privacy Policy, we may contact you from time to time to ensure you are receiving the level of service you require from Asteron Life and that AdviserConnect^TM meets your requirements. If you do not want to be contacted, please advise us by calling AdviserConnect^TM Support 1800 151 488 or email adviserconnect_support@asteron.com.au.

The following application is in 4 sections:

Section 1 - Adviser Details
Within this section we ask for your details including agency/broker number and a security question.

Section 2 - Additional Adviser Details
This section is optional. It only applies where you wish to access Additional Advisers proposals and/or policy information under your user name and password. Please note, a confirmatory email will be sent to the Additional Adviser requesting confirmation for you to access their proposals and/or policy information.

Section 3 - Assistant Details
This section is optional. It only applies where you wish to grant an assistant access to your proposals and/or policy information.

Section 4 - Declaration
Within this section we ask you to agree to the Terms and Conditions of using AdviserConnect^TM.

* indicates mandatory fields

Section 1 - Adviser Details

Broker/Agent Number(s):*
First Name:*
Surname:*
Business Name:*
Security Question:*	(eg What is my mother's maiden name?)
Answer:*
The security question and answer are required for security and privacy reasons. You will be asked to answer this question when making enquires, to ensure the privacy of the client's details is upheld.
Mail Address:
State:
Postcode:
Business Phone:
Business Fax:
Mobile:
Email:*
Do you wish to have access to Proposal Tracking for your proposals?
	YesNo
If 'Yes', please indicate if you wish to receive proposal status updates (including password information) via:
	EmailFax
Do you wish to have access to Policy information?
	YesNo
Please advise the Email address or fax number for updates if they differ to details already provided:

Section 2 - Additional Advisers

Should you wish to view Additional Advisers proposals and/or policy information, please complete this section.

Additional Broker/Agent Number:*

Additional Advisers Email address for confirmation of this application:*

Please indicate if you wish to receive proposal status updates via (including password information) via:
	EmailFax
Please advise the Email address or fax number for updates if they differ to details already provided:

Additional Broker/Agent Number:*

Additional Advisers Email address for confirmation of this application:*

Please indicate if you wish to receive proposal status updates (including password information) via:
	EmailFax
Please advise the Email address or fax number for updates if they differ to details already provided:

Section 3 - Assistant Details

Should you wish to apply for access to AdviserConnect^TM, Proposal Tracking and Policy Information for an assistant(s), please complete this section.

First Name:*
Surname:*
Contact Number:*
Email:*
Security Question:*	(eg What is my mother's maiden name?)
Answer:*
The security question and answer are required for security and privacy reasons. You will be asked to answer this question when making enquires, to ensure the privacy of the client's details is upheld.

Section 4 - Declaration

I acknowledge that:

I have read and agree to be bound by the Terms of Use and Privacy Policy as they apply to AdviserConnect^TM including Proposal Tracking and Policy Information;
If I am applying for access to the website for an assistant or to view additional advisers proposals and policy information, I warrant that the assistant or additional adviser has been informed of and agree to be bound by the Terms of Use and Privacy Policy. I am responsible for ensuring that the assistant or person(s) comply with the same obligations I owe to Asteron Life in respect of the use of the website and the information available from the website, however I also understand that Asteron Life will contact any Additional Advisers nominated for verification.
I will promptly advise Asteron Life of any changes in details or circumstances that will affect the provision to me of AdviserConnect^TM, including Proposal Tracking and Policy Information (where I have opted for either or both features).
I understand that I may at any time notify Asteron Life that I no longer wish to receive marketing information from Asteron Life. However, I recognise that if I do so that this may affect the services that will be provided to me.
I understand that I, and any of the assistant(s) I have authorised to be given access, can only access Proposal Tracking and Policy Information in respect of:
(a) Agent Number(s) when a current agency agreement exists with Asteron; or
(b) Broker Numbers while the broker is registered as a life insurance broker, and subject to any contrary direction from the policyowner.
I understand that by submitting this form, I agree to all of the above.