Which product would you like? Opening a PremiumSaver will also open a RaboSaver account. To earn maximum interest you need to increase your balance by $50 (excluding interest) before the second to last business day of each month. Opening a Term Deposit will also open a RaboSaver account. Term E.g. 6 months Choose your interest frequency Monthly 6 monthly Quarterly Annually At maturity Auto-reinvest upon maturity? Yes, principal only Yes, principal & interest No Amount (min. $1,000) Primary applicant s details Title Mr Mrs Ms Miss Dr Rev Full name (Your full legal name as shown on your birth certificate, passport or marriage certificate.) First name Middle names Last name Preferred first name Date of birth Gender Male Female Page 1 of 9
Primary applicant s details (continued) We are required to ask you these questions to meet our legislative requirements. Please select your answers from the list provided on the last page and enter them below. What industry do you work in What is your occupation What is the purpose of your RaboDirect account What is the main savings goal of your RaboDirect account Where will your savings come from Contact details Phone number e.g. 09 4291234 Other phone number Email address e.g. email@example.com Residential address details The address where the applicant usually resides, this must not be a PO Box or delivery address. Property name (if applicable) Street address Suburb City/Town Postcode Postal address for this account The postal address is the same as the street address Yes (please go to the next section) No (please fill out your postal address below) Property name (if applicable) Street address Suburb City/Town Postcode Page 2 of 9
Primary applicant s identity verification details Anti-Money Laundering legislation means we need to verify your identity before opening your RaboDirect account. We can attempt to verify your identity electronically, or you can provide certified identity documents. Select how you would like to be verified Electronically I give consent for RaboDirect to verify my identity electronically using the details entered by providing those details to NZTA, a credit reporting agency or other entity for that purpose. Please provide as many of the following details as possible: NZ passport number e.g. LN654123 NZ driver s licence number e.g. BT 123456 Passport expiry date Licence version e.g. 605 Licence plate (on a vehicle registered in your name) e.g. DSB123 Manually, I will provide certified identity documents I agree to provide certified identity documents to RaboDirect to verify my identity prior to opening this account. For more information on certified documentation read our Identity Verification Checklist which can be found on our website, or contact us on 0800 22 44 33. Primary applicant s tax details You don t have to give us your IRD number, but without it we are legally required to deduct tax from the interest you earn at the highest rate. Don t worry if you don t have this handy now, you can always update your details later. IRD number Withholding tax rate e.g. 123456789 (optional) 0% (Exempt) 10.5% 17.5% 30% 33% Tax exemption certificate expiry date (if 0%) (optional) If you are exempt from withholding tax you will be required to provide a current tax exemption certificate. Are you a US citizen or resident of the US for tax purposes? Yes No If yes enter your US Taxpayer Identification Number below US Taxpayer Identification Number (please see the last page for examples of US Taxpayer Identification Numbers) xxx-xx-xxxx Page 3 of 9
Secondary applicant s details Title Mr Mrs Ms Miss Dr Rev Full name (Full legal name as shown on their birth certificate, passport or marriage certificate.) First name Middle names Last name Preferred first name Date of birth Gender Male Female Industry (Select the industry you work in from the list provided on the last page and enter it below.) Occupation (Select the occupation they work in from the list provided on the last page and enter it below. If their occupation is not in the list please enter it below) Secondary applicant s contact details Phone number e.g. 09 4291234 Other phone number Email address e.g. email@example.com Residential address details Is the secondary applicant s residential address the same as the primary applicants? Yes (please go to the next section) No (enter the residential address for the secondary applicant below) Property name (if applicable) Street address Suburb City/Town Postcode Page 4 of 9
Secondary applicant s identity verification details Anti-Money Laundering legislation means we need to verify your identity before opening your RaboDirect account. We can attempt to verify your identity electronically, or you can provide certified identity documents. Select how you would like to be verified Electronically I give consent for RaboDirect to verify my identity electronically using the details entered by providing those details to NZTA, a credit reporting agency or other entity for that purpose. Please provide as many of the following details as possible: NZ passport number e.g. LN654123 NZ driver s licence number e.g. BT 123456 Passport expiry date Licence version e.g. 605 Licence plate (on a vehicle registered in your name) e.g. DSB123 Manually, I will provide certified identity documents. I agree to provide certified identity documents to RaboDirect to verify my identity prior to opening this account. For more information on certified documentation read our Identity Verification Checklist which can be found on our website, or contact us on 0800 22 44 33. Secondary applicant s tax details You don t have to give us their IRD number, but without it we are legally required to deduct tax from the interest earnt at the highest rate. Don t worry if you don t have this handy now, you can always update these details later. IRD number Withholding tax rate e.g. 123456789 (optional) 0% (Exempt) 10.5% 17.5% 30% 33% Tax exemption certificate expiry date (if 0%) (optional) If you are exempt from withholding tax you will be required to provide a current tax exemption certificate. Are you a US citizen or resident of the US for tax purposes? Yes No If yes enter your US Taxpayer Identification Number below US Taxpayer Identification Number (please see the last page for examples of US Taxpayer Identification Numbers) xxx-xx-xxxx Page 5 of 9
Regular savings plan Would you like to create a regular savings plan? No (go to the nominated account details section) Yes (please complete the section below) Payment amount Choose your frequency $ Enter an amount Weekly Fortnightly Monthly Four weekly Details to appear on your nominated account statement Particulars (optional) Start date (must start on a business day) Reference (optional) Please note if your account has not been opened by the start date you selected, the regular savings plan will start on the next available cycle date. Nominated account details The nominated account must be in the same name as this RaboDirect account. Nominated account holder s name As it appears on your bank statement, e.g. C D Black Main bank e.g. ANZ Nominated account number Bank Branch Account Suffix Enter your promo code here (if applicable) How often will you make deposits to your RaboDirect account Regular transfer/s from my account Regular transfer/s from third party Periodic transfer/s from my account Periodic transfer/s from third party Comments Enter any additional comments regarding this application here (optional) Page 6 of 9
Acceptance We have read and agreed to the Terms and Conditions of RaboDirect and authorise you to open an account. The Terms and Conditions can be found on our website rabodirect.co.nz Primary applicant s signature Signature Secondary applicant s signature Signature Date Date We d like to be kept up to date with what s happening at RaboDirect and receive special offers by email. Yes No Send Us Your Documents Postal address: FREEPOST RaboDirect PO Box 38567 Wellington 5045 Please check that you have enclosed the following documents and send with your signed application form: Evidence of the nominated account (showing the account name and number). This can be a recent statement, an internet banking print out or an encoded deposit slip (which must be the same name as this RaboDirect account) A completed and signed Direct Debit Instruction form A withholding tax exemption certificate (if applicable) Evidence of your current postal address, if that s not the same as your residential address If you have selected to not have your identity electronically verified: Please provide certified identification and proof of your residential address Access to online banking I would like to receive a digipass for the second applicant to access online banking to operate this account Should you have any questions, please phone our RaboDirect Customer Contact Centre on 0800 22 44 33, Monday-Friday 8am - 7pm Page 7 of 9
Direct Debit Instruction This form needs to be completed, signed and returned to Rabobank, to enable RaboDirect to transfer funds from your nominated account to your new RaboDirect savings account when instructed by you to do so. Nominated account details This account must have the same account name as your RaboDirect account. Account holder s name As appears on your bank statement e.g. M C Jones Account number Instruction to Accept Direct Debits (Not to operate as an assignment or agreement) Authorisation code 0 3 1 3 4 0 7 Bank Branch number Account number Suffix Name of Bank Branch Town / City I/We instruct you until further notice, to debit my/our account with all amounts which Rabobank New Zealand Limited (herein after referred to as the Initiator) the registered Initiator of the above authorisation code, may initiate by Direct Debit. I/We acknowledge and accept that the bank accepts this instruction only upon the conditions listed below. Information to appear on my/our bank statement Your Signature(s) Payer Particulars Payer Reference Date Date For Bank use only Approved 1340 09 14 Date received: Recorded by: Checked by: Bank Stamp: Conditions of this instruction to accept Direct Debits 1) The Initiator: a) Has agreed to give advance notice of the net amount of each Direct Debit and the due date of the debiting at least 10 calendar days (but not more than 2 calendar months) before the date when the Direct Debit will be initiated. This notice will be provided in writing (including by electronic means and SMS where the Customer has provided prior written consent (including by electronic means including SMS) to communicate electronically). The advance notice will include the following message: Unless advice to the contrary is received from you by (date*), the amount of $... will be directly debited to your Bank account on (initiating date). *This date will be at least two (2) days prior to the initiating date to allow for amendment of Direct Debits. b) May, upon the relationship which gave rise to this Authority being terminated, give notice to the Bank that no further Direct Debits are to be initiated under the authority. Upon receipt of such notice the Bank may terminate this Authority as to future payments by notice in writing to me/us. c) May, upon receiving written notice (dated after the date of this Authority) from a bank to which I/ we have transferred my/our account, initiate Direct Debits in reliance of that written notice and this Authority from the account identified in the written notice. 2) The Customer may: a) At any time, terminate this Authority as to future payments by giving written notice of termination to the Bank and to the Initiator. b) Stop payment of any Direct Debit to be initiated under this Authority by the Initiator by giving written notice to the Bank prior to the Direct Debit being paid by the Bank. 3) The Customer acknowledges that: a) This Authority will remain in full force and effect in respect of all Direct Debits passed to my/our account in good faith notwithstanding my/our death, bankruptcy or other revocation of this Authority until actual notice of such event is received by the Bank. b) In any event this Authority is subject to any arrangement now or hereafter existing between me/us and the Bank in relation to my/our account. c) Any dispute as to the correctness or validity of an amount debited to my/our account shall not be the concern of the Bank except in so far as the Direct Debit has not been paid in accordance with this Authority. Any other dispute lies between me/us and the Initiator. d) Where the Bank has used reasonable care and skill in acting in accordance with this Authority, the Bank accepts no responsibility or liability in respect of: - The accuracy of information about Direct Debits on Bank statements; and - Any variations between notices given by the Initiator and the amounts of Direct Debits. e) The Bank is not responsible for, or under any liability in respect of the Initiator s failure to give notice in accordance with 1(a) nor for the non-receipt or late receipt of notice by me/us for any reason whatsoever. In any such situation the dispute lies between me/us and the Initiator. 4) The Bank may; a) In its absolute discretion conclusively determine the order of priority of payment by it of any monies pursuant to this or any other authority, cheque or draft properly signed by me/us and given to or drawn on the Bank. b) At any time terminate this Authority as to future payments by notice in writing to me/us. c) Charge its current fees for this service in force from time-to-time. Page 8 of 9
References Industry Accommodation Agriculture Business & professional services Catering Casino & gambling activities Charity / fundraising Commercial property (investment or development) Communications Computer services Construction Culture & recreation Dealers in art or antiques Education Occupation Accounting / Financial professional Administration Arts, Design & Media Art or antique dealer Automotive, Engineering, Science & Transport Beneficiary Casino / gambling activities Charity / fundraising activities Cleaner, factory or laundry Construction, mining or farm Defence Force employee Education Professional Finance Fishing Forestry Government Health & community services Households Insurance Legal services Mining Oil, gas & energy Other manufacturing Personal services Precious stone & jewellery Executive / Senior Manager Household executive Hospitality / tourism Health or welfare ICT Professionals Jeweller / precious stones dealer Labourer Legal professional Machine or plant operator Other business professional Personal assistant or secretary Property developer Public works contracts Retail trade Residential property Scrap & metal dealers Telecom companies Textiles & clothing manufacturing Tourism Transport & storage Vehicle dealers Wholesale trade Wood & paper manufacturing Real estate agent Retired Road & rails driver Sales Storeperson Scrap metal dealer Sports or Personal Service Worker Student Telecommunications worker Trades person Vehicle dealer Purpose of account Long term investment/s Lump sum savings Regular savings Short term investment/s Main savings goal Build nest egg Car Education Emergencies Holiday Purchase business Purchase property Retirement Other (please describe) Savings will come from Asset sale Competition or other winnings Compensation payment Donations Government pension of Benefits Inheritance/gift Investment proceeds Private Superannuation Property sale Rental income Salary or wages Other income (please describe) US Citizens or Tax Residents The Tax Administration Act 1994 requires New Zealand financial institutions to identify and report on account holders who are US tax payers. The purpose of those requirements is to ensure certain US individuals and entities with financial accounts outside of the US pay tax on their income. US Taxpayer Identification Number A Taxpayer Identification Number may be one of the following: a Social Security number an Individual Taxpayer Identification Number an Employer Identification Number (also known as a Federal Employer Identification Number) an Adoption Taxpayer Identification Number a Preparer Tax Identification Number Page 9 of 9