Fillable Certied Copy Certicate Customer Identication Documents (to be (Australian National University)

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Certied Copy Certicate Customer Identication Documents (to be (Australian National University)

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© 2019 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBCP/C2026_0220 Page 1 of 4
Certified Copy Certificate – Customer Identification Documents
(to be used for individuals only).
Upon instructions from the Bank, this form may be used where the customer is not able to present their original
documents to the Bank in person.
Note: All information on this form must be completed in ENGLISH and clear BLOCK letters. Dierent identification
documents and methods can be used to verify the identity of Indigenous customers. Where needed, the Remote
Indigenous Communities Verification form (P/C 2055) can be used in conjunction with this form.
Part A – Customer Details.
Name Date of birth
/ /
Other names known by (if any)
Residential address (Please note: PO Box is not acceptable)
Signature
✗
Part B – Certifier Details.
Please complete Part B to enable the Bank to contact you if necessary to confirm any information provided on this form.
Full name of Certifier Occupation
Name of Certifier’s Employer Business phone number
Certifier’s Employment Address
Category of certifier – refer to Instructions and Checklist for Certifier
Details of original Customer’s Identification Documents sighted and photocopies attached
(e.g. Foreign passport, National Identity Card)
1
2
Where the name on the identification documents diers from the name used by the customer, provide an explanation
given by the customer or sight and record documentation which identifies the customer in their former name
e.g. marriage certificate or deed poll.
Certified Copy Certificate – Customer Identification Documents (to be used for individuals only).
© 2019 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBCP/C2026_0220 Page 2 of 4
Declaration of Certifier
• I have examined the originals of all the Customer’s Identification documents listed above.
• The copy of the customer’s identification documents attached are true and correct copies of the original documents
that I have examined and certified.
• The customer signed this form in my presence.
Privacy Statement: The personal information we collect from you on this form will be used to assist in the identification
of the customer named in Part A. 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 westpac.com.au or by calling 132 032, contains information about how we handle your
personalinformation.
Signature of Certifier Date
✗
/ /
Bank use only.
Bank ocer’s name Salary number
Branch/Department BSB Customer IDV Number
Signature Date
✗
/ /
Instructions and Checklist for Certifier – Please tick (✓)
  All parts of the Certified Copy Certificate have been completed.
  You are a person within a specified class of accepted certifiers defined below in “Category of Certifiers.”
  All identification documents are current, and the first page of the copies has been certified with “This is a true copy
of the original document” followed by the certifier’s signature, full name, position and date. All subsequent pages
have been initialled.
  Either ONE Primary Photographic identification document or ONE Primary Non-photographic identification
document AND ONE Secondary identification document are to be certified.
  The combination of identification documents certified contains the customer’s full name and date of birth.
  The customer has signed the Certified Copy Certificate in your presence.
  The certified copies of the identification documents are attached to the Certified Copy Certificate.
Note:
• It is an oence 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. Penalty: Imprisonment for
10years.
• If any document is written in a language other than English, it must be accompanied by an English translation
prepared by an accredited translator.
Certified Copy Certificate – Customer Identification Documents (to be used for individuals only).
© 2019 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBCP/C2026_0220 Page 3 of 4
Category of Certifiers (The following people can certify the customer’s identification documents).
Inside Australia
• A person who, under a law in force in a State or Territory,
is currently licensed or registered to practise in one of the
following occupations:
− Chiropractor
− Veterinary surgeon
− Dentist
− Trademarks attorney
− Legal practitioner
− Psychologist
− Medical practitioner
− Physiotherapist
− Nurse
− Optometrist
− Patent attorney
− Pharmacist
• A person who is enrolled on the roll of the Supreme Court of
a State or Territory, or the High Court of Australia, as a legal
practitioner (however described)
• Agent of the Australian Postal Corporation who is in charge of
an oce supplying postal services to the public
• Australian Consular Ocer or Australian Diplomatic Ocer
(within the meaning of the Consular Fees Act 1955)
• Baili
• Bank ocer with 2 or more continuous years of service
• Building society ocer with 2 or more years of
continuousservice
• Chief executive ocer of a Commonwealth court
• Clerk of a court
• Commissioner for Adavits
• Commissioner for Declarations
• Credit union ocer with 2 or more years of continuous service
• Employee of the Australian Trade and Investment Commission
who is:
− in a country or place outside of Australia; and
− authorised under paragraph 3(d) of the Consular Fees Act
1955; and
− exercising his or her function at that place
• Fellow of the National Tax Accountants’ Association
• Finance company ocer with 2 or more years of
continuousservice
• Holder of a statutory oce not specified elsewhere in this table
• Judge of a court
• Justice of the Peace
• Magistrate
• Marriage celebrant registered under Subdivision C of Division 1
of Part IV of the Marriage Act 1961
• Master of a court
• Member of Chartered Secretaries Australia
• Member of Engineers Australia, other than at the grade
ofstudent
• Member of the Association of Taxation and Management
Accountants
• Member of the Australian Defence Force who is:
− an ocer; or
− a non-commissioned ocer within the meaning of the
Defence Force Act 1982 with 2 or more years of continuous
service; or
− a warrant ocer within the meaning of that Act
• Member of the Institute of Chartered Accountants in Australia,
the Australian Society of Certified Practising Accountants or the
Institute of Public Accountants
• Member of:
− the Parliament of the Commonwealth; or
− the Parliament of a State; or
− a Territory legislature; or
− a local government authority of a State or Territory
• Notary public
• Permanent employee of the Australian Postal Corporation with
2 or more years of continuous service who is employed in an
oce supplying postal services to the public
• Permanent employee of:
− the Commonwealth or a Commonwealth authority; or
− a State or Territory or a State or Territory authority; or
− a local government authority, with 2 or more years of
continuous service and is a person not already specified
elsewhere in this table
• Person before whom a statutory declaration may be made
under the law of the State or Territory in which the declaration
is made
• Police ocer
• Registrar, or Deputy Registrar, of a court
• Senior Executive Service employee of:
− the Commonwealth or a Commonwealth authority; or
− a State or Territory or a State or Territory authority
• Sheri/Sheri ocer
• Teacher employed on a full-time basis at a school or tertiary
education institution
• Member of the Australasian Institute of Mining and Metallurgy
• An ocer with, or authorised representative of, a holder of an
Australian financial services licence, having 2 or more years of
continuous service with one or more licensees
• An ocer with, or a credit representative of, a holder of an
Australian credit licence, having 2 or more years of continuous
service with one or more licensees
Outside Australia
• A legal practitioner who holds a current practicing certificate
under a law in force in a State or Territory in Australia
• An ocer of an Australian bank, building society or finance
company branch or oce located in a foreign jurisdiction with 2
or more years of continuous service
• Australian Consular Ocer or Australian Diplomatic Ocer
(within the meaning of the Consular Fees Act 1955)
• Employee of the Australian Trade and Investment Commission
who is:
− in a country or place outside of Australia; and
− authorised under paragraph 3(d) of the Consular Fees Act
1955; and
− exercising his or her function at that place
• Employee of the Commonwealth who is:
− in a country or place outside Australia; and
− authorised under paragraph 3(c) of the Consular Fees Act
1955; and
− exercising his or her function in that place
• Judge of a court or Magistrate
• Registrar, or Deputy Registrar, of a court
• A person authorised as a notary public in a foreign jurisdiction
• Member of the Institute of Chartered Accountants in Australia,
the Australian Society of Certified Practising Accountants or the
Institute of Public Accountants
• A person who is authorised by law in the relevant jurisdiction to
administer oaths or armations or to authenticate documents.
Certified Copy Certificate – Customer Identification Documents (to be used for individuals only).
© 2019 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBCP/C2026_0220 Page 4 of 4
Identification Documents.
Primary photographic identification documents
• Australian passport (can either be current or expired
within the last 2 years but must not be cancelled, defaced
ormutilated)^
• Australian licence/permit (can either be a driver’s licence,
learner’s permit)^
• Proof of age card issued by a State or Territory (or
equivalent)^
• 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^
• Foreign driver’s licence which contains a photograph^^
• National identity card issued by a foreign government, the
United Nations or an agency of the United Nations^
Primary non-photographic identification documents
• Full Australian birth certificate (or extract) issued by
State/Territory Registry of Births, Deaths and Marriages
• Australian citizenship certificate
• Centrelink pension card (Australian)
• Full Foreign birth certificate issued by a foreign government,
the United Nations or an agency of the United Nations
Secondary identification documents
• 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 Oce (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
• Department of Veterans’ Aairs 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)^^
• 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 signature
^^must contain photograph and/or signature
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Certied Copy Certicate Customer Identication Documents (to be (Australian National University)

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Completed 1 February 2022

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