Lifestream Guaranteed Incme via Clnial First State FirstChice Instructin sheet Cmpleting the identificatin frm fr Australian regulated trusts and trustees (including self-managed super funds) 21119/1115 005-738 120517 Identificatin and Verificatin All clients applying fr a new plicy must cmplete the identificatin prcedures fr the purpses f Anti-Mney Laundering and Cunter-Terrrism Financing laws. In additin, in rder t cmply with the bligatins f the Freign Accunt Tax Cmpliance Act (FATCA) and Cmmn Reprting Standard (CRS) we are required t cllect further infrmatin. T d this, yu need t cmplete the attached frm. What d I need t cmplete? The sectins yu cmplete f the attached frm depend n what type f trust yu are. The belw table prvides yu with a guide t which sectins yu need t cmplete as identified by a slid dt ( ) and als prvides a brief explanatin f each f the sectins. Yu need t identify what type f trust yu are. Are yu a: Regulated trust eg a Self Managed Superannuatin Fund ( SMSF ) r a trust that is regulated by the Australian Securities and Investments Cmmissin ( ASIC ), the Australian Taxatin Office ( ATO ) r the Australian Prudential Regulatin Authrity ( APRA ) registered managed investment scheme (ie managed investment scheme that is registered by ASIC) Australian Gvernment superannuatin fund (ie a gvernment superannuatin fund established under Cmmnwealth r State/Territry legislatin), r ther regulated trust types. Will dcuments in a language ther than English be accepted? Dcuments that are written in a language that is nt English must be accmpanied by an English translatin prepared by an accredited translatr. An accredited translatr is any persn wh is currently accredited by the Natinal Accreditatin Authrity fr Translatrs and Interpreters Ltd (NAATI) at the level f Prfessinal Translatr r abve. Hw d I get a dcument certified? T be crrectly certified, we need the dcument(s) t be certified as True cpy f the riginal dcument and signed by ne f the fllwing: A persn wh is enrlled n the rll f the Supreme Curt f a State r Territry r the High Curt f Australia, as a legal practitiner A judge f a curt A magistrate A chief executive fficer f a Cmmnwealth curt A registrar r deputy registrar f a curt A justice f the Peace A ntary public (fr the purpses f the Statutry Declaratin Regulatins 1993) A ntary public in a freign cuntry A plice fficer (Pstal Agent) An agent f the Australian Pstal Crpratin wh is in charge f an ffice supplying pstal services t the public (Pst Office) A permanent emplyee f the Australian Pstal Crpratin with tw (2) r mre years f cntinuus service wh is emplyed in an ffice supplying pstal services t the public An Australian cnsular fficer r an Australian diplmatic fficer (within the meaning f the Cnsular Fees Act 1955) An fficer with, tw (2) r mre cntinuus years f service with ne r mre respective financial institutins (eg: bank, building sciety, credit unin r finance cmpany) An fficer with, r authrised representative f, a hlder f an Australian financial services licence, having tw (2) r mre cntinuus years f service with ne r mre licensees A member f the Institute f Chartered Accuntants in Australia CPA Australian r the Natinal Institute f Accuntants with tw (2) r mre years f cntinuus membership The party certifying the ID dcument(s) will als need t state what psitin they hld and sign and date the dcument(s). If the certificatin des nt appear n the dcument(s), yu may be asked t send in new certified dcuments. Clnial First State Phne: 13 13 36 Fax: (02) 9303 3200 Mail: GPO Bx 3956 SYDNEY NSW 2001 Email: cntactus@clnialfirststate.cm.au Issued by The Clnial Mutual Life Assurance Sciety Limited ABN 12 004 021 809, AFSL 235035 (CMLA). CmmInsure is a registered business name f CMLA. Clnial First State Investments Limited ABN 98 002 346 352 AFSL 232468 (Clnial First State) prvides platfrm administratin services t CmmInsure in respect f this annuity prduct. Fr further infrmatin see the relevant prduct disclsure statement. Page 1 f 5
IDENTIFICATION AND VERIFICATION PROCEDURE FOR THE TRUST AND TRUSTEE If the trust has ne trustee, yu need t cmplete either Sectin 2.1 (fr trustees that are individuals) r Sectin 2.2 (fr trustees that are an Australian cmpany r freign cmpany). If the trust has mre than ne trustee, yu need t prvide us with infrmatin fr ONLY ONE f the trustees. The Identity f the trust must be verified (nt the trustee). SECTION 1 Regulated trust identificatin prcedure 1.1 General infrmatin 1.2 Type f regulated trust 2 Trustee identificatin prcedure 2.1 Individual trustee T be cmpleted if the trustee is an individual (ie natural persn) 2.2 Cmpany trustee T be cmpleted if the trustee is an Australian cmpany. If the selected trustee is a freign cmpany, please cmplete the Freign Cmpany Identificatin Frm in additin t this frm. 2.2.1 Cmpany details As abve 2.2.2 Cmpany type As abve 2.2.3 Directrs T be cmpleted fr prprietary cmpanies nly 3 Tax infrmatin T be cmpleted, except fr regulated super funds (e.g. SMSFs and APRA regulated super funds) 3.1 Tax status 4 Regulated trust verificatin prcedure CmmInsure will perfrm the trust verificatin prcedure. Hwever if we cannt access the infrmatin t cmplete this prcedure we may ask yu t prvide us with further infrmatin. 5 Recrd f verificatin prcedure T be cmpleted by the adviser. Pst Fax (adviser use nly) epst (adviser use nly) Clnial First State Reply Paid 27 SYDNEY NSW 2001 (02) 9303 3200 Scan and uplad the frms via epst thrugh FirstNet adviser Clnial First State Phne: 13 13 36 Fax: (02) 9303 3200 Mail: GPO Bx 3956 SYDNEY NSW 2001 Email: cntactus@clnialfirststate.cm.au Issued by The Clnial Mutual Life Assurance Sciety Limited ABN 12 004 021 809, AFSL 235035 (CMLA). CmmInsure is a registered business name f CMLA. Clnial First State Investments Limited ABN 98 002 346 352 AFSL 232468 (Clnial First State) prvides platfrm administratin services t CmmInsure in respect f this annuity prduct. Fr further infrmatin see the relevant prduct disclsure statement. Page 2 f 5
(Including Self-Managed Super Funds) GUIDE TO COMPLETING THIS FORM This frm is fr nly. Australian Regulated Trusts include self-managed super funds, registered managed investment schemes, unregistered managed investment schemes, gvernment superannuatin funds r ther Trusts subject t the regulatry versight f an Australian regulatr. Fr Trusts that are nt subject t the versight an Australian regulatr, cmplete the UNREGULATED AUSTRALIAN TRUSTS & FOREIGN TRUSTS IDENTIFICATION FORM. Cllect infrmatin abut the Trust and ne Trustee. The identity f the Trust must be verified (nt the Trustee). Tax infrmatin must be cllected frm an authrised representative f the Trust Cmplete all applicable sectins f this frm in BLOCK LETTERS. SECTION 1: REGULATED TRUST IDENTIFICATION PROCEDURE Sectin 1.1: General Infrmatin Full name f Trust Cuntry where trust established (nly required if nt Australia) Full business name f trustee in respect f the trust (if any) Sectin 1.2: Type f Regulated Trust Tick Select ne f the fllwing type f Regulated Trust Self-Managed Superannuatin Fund Prvide the SMSF s ABN Registered managed investment scheme Prvide Australian Registered Scheme Number (ARSN) Unregistered managed investment scheme (Where the scheme is nt registered by ASIC, nly has whlesale clients and des nt make small scale fferings t which sectin 1012E f the Crpratins Act 2001 applies) Prvide the unregistered managed investment scheme s ABN Gvernment superannuatin fund Prvide name f the legislatin establishing the fund Other regulated Trust (A trust that is subject t the regulatry versight f a Cmmnwealth, State r Territry statutry regulatr such as an apprved depsit fund, a pled superannuatin trust r an APRA-regulated superannuatin fund) Prvide name f the regulatr (e.g. ASIC, APRA, ATO) Prvide the Trust s ABN r registratin/licensing details Other types f Trusts (e.g. family, unit, charitable, estate) r Trusts regulated by a freign regulatry bdy shuld cmplete the UNREGULATED AUSTRALIAN TRUSTS & FOREIGN TRUSTS IDENTIFICATION FORM, rather than this frm. SECTION 2: TRUSTEE IDENTIFICATION PROCEDURE (Please cmplete EITHER sectin 2.1 OR sectin 2.2) Fr Australian Regulated Trusts, identificatin infrmatin is required fr ne f the Trustees. This infrmatin is nly required fr ne Trustee, even if the Trust has a number f Trustees. Please prvide identificatin infrmatin fr either an individual Trustee (sectin 2.1) r a crprate Trustee (sectin 2.2). Sectin 2.1: Individual Trustee (T be cmpleted if the selected Trustee is an individual) Full given name(s) Surname Date f Birth (dd/mm/yyyy) Residential Address (PO Bx is nt acceptable) Suburb State Pstcde Cuntry OR 19 May 2017 versin Refer t FSC/FPA GUIDANCE - MANAGING AML/CTF AND FATCA/CRS CUSTOMER IDENTIFICATION OBLIGATIONS fr cnditins f use Cpyright May 2017 Financial Services Cuncil Limited and Financial Planning Assciatin f Australia Limited 1/3
Sectin 2.2: Cmpany Trustee (T be cmpleted if the selected Trustee is an Australian Cmpany. If the selected Trustee is a freign cmpany then cmplete the FOREIGN COMPANY IDENTIFICATION FORM in additin t this frm) 2.2.1 Cmpany Details Full name as registered by ASIC ACN Registered Office Address (PO Bx is nt acceptable) Suburb State Pstcde Cuntry Principal Place f Business (if any) (PO Bx is nt acceptable) Suburb State Pstcde Cuntry 2.2.2 Cmpany Type (Select ne f the fllwing cmpany types) Public (cmpanies whse name des NOT include the wrd Pty r prprietary; generally listed cmpanies), prceed t sectin 3 Prprietary (cmpanies whse name ends with Prprietary Ltd r Pty Ltd; als knwn as private cmpanies), prceed t sectin 2.2.3 2.2.3 Directrs (T be cmpleted fr prprietary cmpanies, nt required fr public cmpanies as per 2.2.2) Prvide the names f all directrs. 1 2 3 4 Full given name(s) If there are mre directrs, prvide details n a separate sheet and tick this bx. Surname SECTION 3: TAX INFORMATION Cllectin f tax status in accrdance with the United States Freign Accunt Tax Cmpliance Act (FATCA) and Cmmn Reprting Standard (CRS). Regulated super funds (Self-Managed Superannuatin Funds, APRA regulated super funds, gvernment super funds r pled superannuatin trusts) are nt required t cmplete sectin 3 and can prceed t sectin 4. 3.1 Tax Status Prvide the Trust s Glbal Intermediary Identificatin Number (GIIN), if applicable If the Trust is a Financial Institutin but des nt have a GIIN, prvide its FATCA status (select ONE f the fllwing statuses) Deemed Cmpliant Financial Institutin Excepted Financial Institutin Exempt Beneficial Owner Nn Reprting IGA Financial Institutin (If the Trust is a Trustee-Dcumented Trust, prvide the Trustee s GIIN) Nnparticipating Financial Institutin Other (describe the Trust s FATCA status in the bx prvided) 19 May 2017 versin Refer t FSC/FPA GUIDANCE - MANAGING AML/CTF AND FATCA/CRS CUSTOMER IDENTIFICATION OBLIGATIONS fr cnditins f use Cpyright May 2017 Financial Services Cuncil Limited and Financial Planning Assciatin f Australia Limited 2/3
SECTION 4: REGULATED TRUST VERIFICATION PROCEDURE Regulated Trust Verificatin prcedure: Infrmatin t be verified: Full name f the Trust That the Trust is a Self-Managed super fund; registered managed investment scheme, unregistered managed investment scheme, gvernment superannuatin fund r ther regulated Trust, as applicable Tick Verificatin ptins (select ne f the fllwing ptins used t verify the Trust) Perfrm a search f the ASIC, ATO r relevant regulatr s website (e.g. Super Fund Lkup at www.abn.business.gv.au). A cpy f an ffer dcument f the managed investments scheme (e.g. a cpy f a Prduct Disclsure Statement) A cpy r relevant extract f the legislatin establishing the gvernment superannuatin fund surced frm a gvernment website IMPORTANT NOTE: Attach a legible certified cpy f the ID dcumentatin used t verify the Trust OR Alternatively, if agreed between yur licensee and the prduct issuer, cmplete the Recrd f Verificatin Prcedure sectin belw and DO NOT attach cpies f the ID Dcuments SECTION 5: RECORD OF VERIFICATION PROCEDURE ID DOCUMENT Dcument 1 Dcument 2 Verified Frm Perfrmed search Original Certified cpy Perfrmed search Original Certified cpy Dcument Issuer / Website Dcument Type / Search details Issue date / Search date By cmpleting and signing this Recrd f Verificatin Prcedure I declare that: an identity verificatin prcedure has been cmpleted in accrdance with the AML/CTF Rules, in the capacity f an AFSL hlder r their authrised representative and the tax infrmatin prvided is reasnable cnsidering the dcumentatin prvided. AFS Licensee Name AFSL N. Representative/ Emplyee Name Phne N. Signature Date Verificatin Cmpleted 19 May 2017 versin Refer t FSC/FPA GUIDANCE - MANAGING AML/CTF AND FATCA/CRS CUSTOMER IDENTIFICATION OBLIGATIONS fr cnditins f use Cpyright May 2017 Financial Services Cuncil Limited and Financial Planning Assciatin f Australia Limited 3/3