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Affiliate Membership *

Affiliate Membership (until 31 Dec 2024) - $ 50.00 (includes GST of $ 0.00)

Affiliate Membership (Not Currently Employed) - $ 0.00 (includes GST of $ 0.00)

Total Amount

Member Contact Information

First Name *

Last Name *

Preferred name *

Current Employer *

If you are not currently working, please enter "None" above.

Job Title

Street Address (Home)

City (Home)

Postal Code (Home)

State (Home)

Country (Home)

Phone (Home)

Phone (Work)

Mobile (Primary)

Email (Primary) *

Payment Options

Payment Method

Credit Card I would like to receive an email invoice.

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Territory

Post Code

Employment and Education Details - New Affiliate Member

Employment Status *

If you have previously been an FC, what was your earliest date of employment?

Completed diploma? *

Yes No

Evidence of completion

Acceptable forms of evidence are:
(a) Diploma Certificate issued by the RTO
(b) Letter of Confirmation issued by the RTO
(c) Statutory declaration attesting to the completion of the Diploma, signed by an authorised person

Diploma Institution (Graduate)

Graduation year (Graduate)

Do you identify as Aboriginal or Torres Strait Islander:

Would you like to receive information from the ATSI network?

Yes No

If you speak a language other than English, we'd like to know. Please select all languages you can speak.

Other languages spoken:

Afrikaans	Albanian (Shqip)	Amharic (አማርኛ)	Arabic (العربية)	Armenian (Հայերեն)	Assyrian
Auslan	Bangla (বাংলা)	Bosnian (Bosanski)	Bulgarian (Български)	Burmese	Cantonese (廣東話)
Cebuano	Chaldean	Croatian (Hrvatski)	Dari (درى)	Dinka (Thuɔŋjäŋ)	Dutch (Nederlands)
Filipino	Finnish (Suomeksi)	French (Français)	German (Deutsch)	Greek (Ελληνικά)	Gujarati (ગુજરાતી)
Hakha Chin	Hebrew (עברית )	Hindi (हिन्दी)	Hmong (Hmoob)	Indonesian (Bahasa Indonesia)	Italian (Italiano)
Japanese (日本語)	Karen	Khmer (ខ្មែរ)	Kirundi (Ikirundi)	Korean (한국어)	Kurdish (Kurdî)
Lao (ລາວ)	Macedonian (Македонски)	Malayalam (മലയാളം)	Maltese (Malti)	Mandarin (普通话)	Mongolian (Монгол)
Nepali (नेपाली)	Pashto (پښتو)	Persian (فارسی)	Polish (Polski)	Portuguese (Português)	Punjabi (ਪੰਜਾਬੀ)
Rohingya	Romanian (Română)	Russian (Русский)	Samoan (Gagana Samoa)	Serbian (Српски)	Sinhalese (සිංහල)
Slovak (Slovenčina)	Slovenian (Slovenščina)	Somali (Soomaali)	Spanish (Español)	Swahili (Kiswahili)	Tamil (தமிழ்)
Thai (ไทย)	Tibetan (བོད་སྐད།)	Tigrinya (ትግርኛ)	Turkish (Türkçe)	Ukrainian (Українська)	Urdu (اردو)
Vietnamese (Tiếng Việt)

Do you currently hold or have you ever held a position for a fee for service organisation in the financial services sector? (e.g. debt administrator, credit repair, financial advice, bank etc.) *

Yes No

If "yes", please provide the details of positions and dates:

Do you currently hold, or work for an organisation that currently holds, either an Australian Credit Licence or an Australia Financial Services Licence? *

Yes No

Have you ever been convicted of a criminal offence, or subject to regulatory action by a federal or state government body including ASIC or ACCC? *

Yes No

Why am I being asked this question?

Professional Standing is assessed as part of the initial membership application process.

The Board places a duty and onus on its members and applicants to disclose any matter bearing on their capacity to practice financial counselling, in accordance with our Professional Standing Policy.
.

If you answered "yes" to the above question, you will be asked to provide more information about the nature of your situation. Any information provided will be treated in the strictest confidence.

The FCVic Board will take that information into account when reviewing your application.

To update your employer information, please email: [email protected]

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