Fillable BOM Verificationof Identity Video Conference (Australian National University)

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BOM Verificationof Identity Video Conference (Australian National University)

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© Bank of Melbourne - A Division of Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBC000104BOM_0320 Page 1 of 2
Verification of Identity Certificate
- Video Conference.
Instructions for completing this form
1. This form is used for Verification of Identity conducted in Australia during a video conference interview (only where a face-to-face
interview is not possible).
2. A separate form is to be completed for each individual acting in the capacity of Borrower, Guarantor, Attorney under a Power of
Attorney, or Identity Declarant.
3. The verifier can only be a Bank of Melbourne sta member or a Bank of Melbourne accredited Broker (for Broker-originated applications).
4. Current and original documents must be used for verification unless otherwise stated.
5. The verifier is to submit images of the originals with this document.
6. Where verification is undertaken by a Bank of Melbourne accredited Broker, the Broker must certify images of the original identification
documents by signing, dating, and endorsing the image as a true copy of the original document.
7. For Section 2 the verifier must be reasonably satisfied that the photographic documents bear a reasonable likeness to the person
being identified.
8. Place a tick (✓) in the box beside the documents for which images have been taken for Verification of Identity.
Section 1: Details of person being identified.
This identification relates to
Borrower Guarantor Attorney under a Power of Attorney Identity Declarant (tick one box)
Section 2: Primary identification with photographic identity documents.
Person being identified to supply two of the following documents containing their photo and signature. Where two documents containing
their photo are provided, no further documents are required.
Australian passport (can either be current or expired within the last two years but must not be defaced, mutilated or cancelled)
Foreign passport
Australian driver’s licence/permit (can either be a driver’s licence, learner’s permit)
Proof of age card issued by a State or Territory (or equivalent)
PRINT
CLEAR
Verification of Identity Certificate.
© Bank of Melbourne - A Division of Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBC000104BOM_0320 Page 2 of 2
Have you verified the individual’s full name including all middle names and date of birth using the two supplied documents above?
Yes No
If Yes proceed to Section 3
If No obtain a dierent Photographic Identity Document item from the list above with the required details. If none exist then complete
Section 2.A.
Section 2.A: Secondary Identification Documents
Person being identified to supply a document from Section 2 above plus two of the following documents:
Full Australian birth certificate or extract
Full foreign birth certificate
Australian Citizenship certificate
Citizenship certificate issued by a foreign government
Descent certificate
Medicare card
Centrelink pension card (Australian)
Department of Veterans’ Aairs card
Can the individual’s full name including all middle names and date of birth be verified using the two supplied documents?
Note: For Medicare cards, verify middle name initial only.
Yes No
If Yes proceed to Section 3
If No Refer to the Verification of Identity escalation procedures
Section 3: Verification certification.
I (insert your full name here)
Occupation (insert job title and full name of organisation)
hereby certify that:
a) The original and current identification as marked above, or over, were produced to me in a video conference interview and images of
these documents are attached to this certification.
b) Where evidenced the person identified has a reasonable likeness to the person in the photographs included in the identity documents.
c) The Verification of Identity has been conducted in accordance with Westpac Group process.
d) Images of the documents attached to this certification are endorsed by me as true copies (Brokers only).
Verifier’s signature Contact telephone number Date
✗
/ /
PRIVACY STATEMENT The personal information we collect from you on this form will be used to identify you. 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 at bankofmelbourne.com.au
or by calling 13 22 66, contains further information about how we manage your personal information.
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BOM Verificationof Identity Video Conference (Australian National University)

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Completed 18 July 2020

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