SRF_520_0: Responsible Persons Information

Australian Business Number

Institution Name

RSE Licensee

Reporting Period

Scale Factor

Reporting Consolidation

Ad hoc, Annual

N/A

Solo Books

1. Responsible persons information - Directors, executive officers and senior managers

1.1. Existing director, executive officer and senior manager employment information

Title

Given name(s)

Family name

Date of birth

Former name(s)

Type of responsible person

Position title

Main responsibilities

Employer name

Associate

Responsible person status

Assessed under Fit and Proper Policy

End date

Responsible person - Business phone number

Responsible person - Business email address

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

Director

Yes

Changed

Yes

Director (Chair)

Unchanged

Executive officer: CEO

No longer acting as a responsible person

Interim

Executive officer: CFO

Other executive officer

Secretary

Senior manager

Other responsible person

1.2. New director, executive officer and senior manager employment information

Title

Given name(s)

Family name

Date of birth

Former name(s)

Type of responsible person

Position title

Main responsibilities

Employer name

Associate

Assessed under Fit and Proper Policy

Start date

Responsible person - Business phone number

Responsible person - Business email address

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

Director

Yes

Director (Chair)

Executive officer: CEO

Interim

Executive officer: CFO

Other executive officer

Secretary

Senior manager

Other responsible person

2. Responsible persons information - RSE auditor

2.1. Existing RSE auditor

Title

Given name(s)

Family name

Date of birth

Former name(s)

Organisation name

ABN

Number of RSEs audited

Responsible person status

Assessed under Fit and Proper Policy

End date

Responsible person - Business phone number

Responsible person - Business email address

(1)

(2)

(3)

(4)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

Changed

Yes

Unchanged

No longer acting as a responsible person

Interim

2.2. New RSE auditor

Title

Given name(s)

Family name

Date of birth

Former name(s)

Organisation name

ABN

Number of RSEs audited

Assessed under Fit and Proper Policy

Start date

Responsible person - Business phone number

Responsible person - Business email address

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

Yes

Interim

3. Responsible persons information - RSE actuary

3.1. Existing RSE actuary

Title

Given name(s)

Family name

Date of birth

Former name(s)

Actuarial firm

ABN

Number of RSEs covered by actuary

Number of sub-funds covered by actuary

Responsible person status

Assessed under Fit and Proper Policy

End date

Responsible person - Business phone number

Responsible person - Business email address

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

Changed

Yes

Unchanged

No longer acting as a responsible person

Interim

3.2. New RSE actuary

Title

Given name(s)

Family name

Date of birth

Former name(s)

Actuarial firm

ABN

Number of RSEs covered by actuary

Number of sub-funds covered by actuary

Assessed under Fit and Proper Policy

Start date

Responsible person - Business phone number

Responsible person - Business email address

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

Yes

Interim

4. Notification that a responsible person is no longer fit and proper

Title

Given names

Family name

Date of birth

Position title

Fit and Proper assessment date

(1)

(2)

(3)

(4)

(5)

(6)

5. Address details

5.1. Registered address of the entity

Address Line 1

Address Line 2

Suburb

State

Postcode

Country (applicable if not Australia)

CI10340

5.2. Postal address of the entity

Address Line 1

Address Line 2

Suburb

State

Postcode

Country (applicable if not Australia)

CI10336

6. Billing contact information

Title

Given names

Family name

Position title

Business phone number

Business email address

Preference to receive invoice

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Mail

6.1. Address for billing

Address Line 1

Address Line 2

Suburb

State

Postcode

Country (applicable if not Australia)

CI10116

7. Crisis management contact details

7.1. Primary crisis management contact

Title

Given names

Family name

Position title

Mobile phone number

Direct phone number

(1)

(2)

(3)

(4)

(5)

(6)

(7)

7.2. Secondary crisis management contact

Title

Given names

Family name

Position title

Mobile phone number

Direct phone number

(1)

(2)

(3)

(4)

(5)

(6)

(7)

7.3. Recovery site phone number

CI10518