Client Identification Form Equipment Finance Brokers/Agents/Bank Employees

Transcription

1 Attach copies of identification documents here Client Identification Form Equipment Finance Brokers/Agents/Bank Employees Please complete all applicable sections to facilitate efficient data processing. Complete one form for each party to be identified Privacy Statement: The personal information we collect from you on this form will be used to satisfy the Bank s identification requirements under the Anti-Money Laundering & Counter-Terrorism Financing Act and Rules. We may disclose your personal information to other members of the Westpac Group, anyone we engage to do something on our behalf, and other organisations that assist us with our business. Our privacy policy, available on our website or by contacting your relationship manager, contains information about how we handle your personal information. ^ Compulsory information/document. Where a verification document has been provided and it is not in a language that I understand, it must be accompanied by an English translation prepared by an accredited translator. Where certified copies of verification documents are provided they must be accompanied by a completed Certified Copy Certificate Form... Part A: General Customer Details Full Borrowing Entity Name as registered with ASIC (as applicable)^ Any other name(s) under which the customer carries on their business (if any)^ ABN (if any)^ Complete Part A for all entity types Tick if N/A^ Tick if N/A^ Industry Description^ ANZSIC Code (Bank use only) Full address of registered office in Australia (PO Box not acceptable) (if any)^ Suburb: State: Postcode: Note: not applicable for Individual customers Tick if address is same as above^ Principal Place of Business / Operations in Australia (PO Box not acceptable) (if any)^ Suburb: State: Postcode: Note: not applicable for Individual customers Place of Incorporation/ Establishment / Registration State/Territory if Australian or foreign Country (if any)^ Tick if N/A^ Date of Incorporation / Establishment/ Registration (if any)^ / / Tick if N/A^ Purpose of Business Relationship^ Short Term Borrowing Long Term Borrowing Source of Funds^ Salary/Wages Business Income/Earnings Other (see Part I) Source of Wealth^ Salary/Wages Business Profits Other (see Part I) Part B: Individual & Sole Traders Details Complete Part A and this section if the applicant is an Individual or Sole Trader. (Please tick)^ Individual or Individual in the capacity of: sole trader director of a domestic company trustee of a trust member of a partnership guarantor Full Name ^ Date of Birth ^ / / ^ Gender ^ Male Female Employment Type^ Occupation^ If Sole Trader : Industry Description^ ANZSIC Code (Bank use only) country (PO Box not acceptable) ^ Westpac Group Pg 1 of 6 CID001 (11/2015)

2 Sight and verify from original or certified copies of identification documentation (see Part H - Accepted Documents for Individuals and Sole Traders) and complete the following: Part C: Company Details Complete Part A, B (signatory/ies) and this section if applicant is a company Company Type (Please tick) Domestic Public ^ Complete this form Domestic Proprietary ^ Complete this form Other ^ Contact your BDM for separate AML Form ACN For all Proprietary or other Companies, Note: It is not necessary to identify these individuals if they are not signatories. If there is not enough space, provide details on a separate sheet. For all Public companies, if listed on a domestic stock exchange. Listed companies are companies incorporated in Australia whose securities are listed (quoted or priced) and freely traded on an official list of a financial exchanges in Australia. Note: Publically unlisted companies are exempted from this section. Name of Domestic Stock Exchange^ For all Proprietary or other Companies, if regulated. 'Regulated companies' are companies that deal in or advise in investments, superannuation, insurance, deposit-taking and credit. This is different from being registered by ASIC. Name of Regulator ^ Licence details ^ (eg. Licence number) (Please tick) Verification original or certified copies of documents obtained. Ensure copies are attached to this form. ASIC Search^ ASIC Website URL: Date of Search: Part D: Trust Details Complete Part A, B (individual trustee/s) or C (company trustee/s) and this section if the applicant is a trust. Trust Type (Please tick) Standard Trust Complete this form ^ Other Trust Contact your BDM for separate AML form ^ Full trust name^ Trust description (e.g. Family, Unit, Testamentary or Discretionary Trust)^ Settlor of Trust (excluding testamentary trusts) (Individual or Organisation)^ Details of the Beneficiaries: Full name of the Beneficiaries and details of the Class, if there is not enough space, provide details on a separate sheet. Class Details (e.g. unit holders, charitable purpose)^ Full Name (1)^ Full Name (3)^ Full Name (2)^ Full Name (4)^ (Please tick) Verification original or certified copies of documents obtained. Ensure copies are attached to this form. Obtain Trust Deed or extract where the names of the trust, trustees, beneficaries, settlor(s) and execution page are evident^ Original document? Yes No Document Issued By: Search of a primary source information broker ^ Name of Information Broker: Date of Search: Obtain Settlement Deed or other document that contains a declaration of trust where the names of the trust and/or settlor(s) are evident ^ Original document? Yes No Document Issued By: Westpac Group Pg 2 of 6 CID001 (11/2015)

3 Part E: Partnerships Complete Part A, B (individual partner/s) or C (company partner/s) and this section if the applicant is a partnership Partnerhsip Type (Please tick) Regulated ^ Not Regulated ^ If Regulated: Provide name of professional association ^ Provide membership details ^(eg. membership number) (Please tick) Verification original or certified copies of documents obtained. Ensure copies are attached to this form. If Regulated: Verify Partnership Name^: ASIC Search ASIC Website URL: If Unregulated: Verify Partnership Name^: Partnership agreement Original document? Yes No Issue Date: Search of the relevant government regulator databse Website URL: Verify Membership to a Professional Association^: Search of the relevant professional association database^ Website URL: or Search of the government business registration body Website URL: Part F: Beneficial Ownership Complete this section if the applicant is a Company (Exempted if company is publically listed or regulated), Trust or Partnership. Please provide the details of all individuals who ultimately own or control (either directly or indirectly) the organisation and sight and verify from original or certified copies of identification documentation (see Part H - Accepted Documents for Individuals and Sole Traders) Who is a Beneficial Owner? For a Domestic Public Company or Domestic Proprietary Company (publically listed or regulated companies are exempted from this section) beneficial owners can be determined by considering: 1) Owners (with 25% or more shareholding of the issued capital of company), if unavailable then; 2) Controllers (those with a capacity to make financial and operating decision), if unavailable then; 3) Other individuals (25% or more voting rights including power of veto or a senior managing official). For a Standard Trust beneficial owners can be determined by considering: 1) All individual trustees, as well as; 2) Appointers (ability to appoint/remove trustees), as well as; 3) Other Individuals (those with a capacity to make financial and operating decision). For a Partnership beneficial owners can be determined by considering: 1) All Partners (who own 25% or more of the partnership), if unavailable then; 2) Other Individual (25% or more voting rights including power of veto or controlling/managing partner) Number of Beneficial Owners (there must be at least one beneficial owner): Complete details below for each Beneficial Owner (if there is not enough space, provide details on a separate sheet). For any Beneficial Owners that have previously been identified by Westpac (as a customer), or have already been identified in Part B, only the name of that Beneficial Owner needs to be completed in the following section. Westpac Group Pg 3 of 6 CID001 (11/2015)

4 Beneficial Owner 1 Full Name ^ Date of Birth ^ / / Beneficial Owner 2 Full Name ^ Date of Birth ^ / / Beneficial Owner 3 Full Name ^ Date of Birth ^ / / Beneficial Owner 4 Full Name ^ Date of Birth ^ / / Westpac Group Pg 4 of 6 CID001 (11/2015)

5 Part G: Broker/Agent/Westpac Employee Details ^ NOTE: It is an offence under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 to knowingly provide false or misleading information or knowingly produce a false or misleading document. Complete the following details if you are a Broker or Agent: Broker/Agent name^ Broker/Agent ID^ Broker/Agent firm name^ Date verified^ / / I have followed the process for identification and verification as required by Westpac Group s policy and procedure and have verified the required information provided by the customer using an approved verification source(s). Where the verification source has been provided by the customer the document is to the best of my knowledge the original or certified copy. Broker/Agent Signature^ Or, complete the following details if you are a Bank Employee: Employee name^ Salary number ^ BSB^ Phone number^ ( ) Date verified^ / / I have followed the process for identification and verification as required by Westpac Group s policy and procedure and have verified the required information provided by the customer using an approved verification source(s). Where the verification source has been provided by the customer the document is to the best of my knowledge the original or certified copy. Employee Signature^ Applicant s Customer number^ Applicant s Customer key^ This form and any attached documents are a record of the identification procedure for this customer and the information obtained in the course of carrying out the procedure. If the applicant entity type is not included on this form contact your Equipment Finance Manager or Business Development Manager for a separate entity specific Customer Identification Form Westpac Group Pg 5 of 6 CID001 (11/2015)

6 Part H: Accepted Documents for Individuals and Sole Traders Verify the applicant s full name and date of birth from either: ONE Primary photographic identification document Or ONE Primary non-photographic identification document AND ONE Secondary identification document. If any document is written in a language other than English, it must be accompanied by an English translation prepared by an accredited translator. Table A: Primary photographic identification document Where photo identification is presented, ensure the likeness of the photo matches the applicant and the signature, if any, matches. Australian passport (can either be current or expired within the last 2 years but must not be cancelled, defaced or mutilated)* Foreign passport issued by a foreign government, the United Nations or an agency of the United Nations (must not be cancelled, defaced or mutilated)* Foreign travel document issued by a foreign government, the United Nations or an agency of the United Nations* Australian licence/permit (can either be a driver s licence, learner s permit)* Foreign driver s licence which contains a photograph** Proof of age card issued by a State or Territory (or equivalent)* National identity card issued by a foreign government, the United Nations or an agency of the United Nations* * must contain a photograph and signature ** must contain a photograph and/or signature Table B: Primary non-photographic identification document Full Australian birth certificate (or extract) issued by State/Territory Registry of Births, Deaths and Marriages Full Foreign birth certificate issued by a foreign government, the United Nations or an agency of the United Nations Australian citizenship certificate Citizenship certificate issued by a foreign government Centrelink pension card (Australian) Table C: Secondary identification document Where photo identification is presented, ensure the likeness of the photo matches the applicant and the signature, if any, matches. A financial benefits notice issued by the Commonwealth or a State/Territory within the last 12 months and includes the customer s name and residential address (e.g. a notice from Centrelink) Australian Taxation Office (ATO) notice issued within the last 12 months and includes the customer s name and residential address Utilities notice issued by a local government or utilities provider within the last 3 months and includes the customer s name and residential address Foreign driver s licence which does not contain a photograph Department of Veterans Affairs pension concession card (Australian) A current tenancy/lease agreement (must not be cancelled or expired) Medicare card Australian Marriage certificate issued by State/Territory Registry of Births, Deaths and Marriages Identification card issued to a student at an Australian higher education institution (TAFE or University)** If under 18 years of age, notice issued by the principal of a school (must be less than 3 months old, include the name of the customer, residential address, period of school attendance and issued on a school letterhead) A current card issued under a Commonwealth, State, or Territory law for the purpose of identification, for a government service, or as a licence ** must contain photograph and/or signature Part I: Source of Funds and Source of Wealth Source of Funds are the sources from where the customer s funds has come from that will service this new product or service. Source of wealth are the sources from where the majority of customer s overall net worth has come from. Source of Funds Source of Wealth Individual/Sole Trader Organisation Individual/Sole Trader Organisation Salary/Wages Corporate investments/earnings Employment income/earnings Corporate investments/earnings Commission Commission Business income/earnings Business income/earnings Bonus Bonus Business profits Business profits Business income/earnings Business income/earnings Rental income Rental income Business profits Business profits Superannuation/pension Rental income Rental income Redundancy Superannuation/pension Ext investment/capital Injection Insurance payment Insurance payment Loan Loan Compensation payment Compensation payment Insurance payment Insurance payment Government benefits Compensation payment Compensation payment Owns real estate/property Owns real estate/property Government benefits Government grant Sale of assets Sale of assets Sale of assets Sale of assets Liquidation of assets Liquidation of assets Liquidation of assets Liquidation of assets Gift/Donation Gift/Donation Gift/Donation Gift/Donation Inheritance Mergers & Acquisitions Redundancy Mergers & Acquisitions Windfall Controlled money account Inheritance Controlled money account None None x refund Tax refund Refused to answer Refused to answer Additional Sources: Please Additional Sources: Please Windfall Additional Sources: Please Additional Sources: Please Westpac Group Pg 6 of 6 CID001 (11/2015)