Fillable Certified Copies Identification Form (Commonwealth Bank of Australia)

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Certified Copies Identification Form (Commonwealth Bank of Australia)

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Certified Copies Identification Form
Commonwealth Bank of Australia
ABN 48 123 123 124
Australian credit licence 234945
Purpose of this form
The Commonwealth Bank of Australia is collecting your personal information in order to comply with its regulatory obligations, including
the Anti-Money Laundering and Counter-Terrorism Financing Act 2006. This form will assist the Bank to verify your identity and may
be used where you are not able to present original identification documents to the Bank. This form is not intended to be used as an
application for any of the Bank’s products or services.
For more information about how we collect and handle personal information, including how you can access, or seek correction of, your
information or contact us with any feedback, please see our Privacy Policy available on www.commbank.com.au.
Instructions for completion
• You must arrange for a prescribed person to complete Section 3 of this form
• This prescribed person is a person described in Section 6 commencing on page 2.
• You must show the prescribed person original identification documents, as well as the copies to be certified
• Return this completed form along with the original certified copies of the identification document(s) to your Bank
Representative or your nearest branch
• If your identification cannot be verified using this form you are requested to visit a branch of the Commonwealth Bank of
Australia to be identified
• Please note that the Bank will not accept scanned or photocopies of the certified documents
It is an offence under the Anti-Money Laundering and Counter-Terrorism Financing Act 2006 for you or the
prescribed person to make a false or misleading statement.
Section 3 – Details of prescribed person
Prescribed person’s full name
Prescribed person’s
day time phone number
Prescribed person’s category (refer listing in Section 6 on page 3) Prescribed person’s business name
Notes of guidance for completing this form: To be an acceptable prescribed person you must be a person listed overleaf.
Please complete all information in black ink. You (being the prescribed person) need to examine the person’s original identification
documents and certify the copy of the document by writing: ‘I certify this to be a true and correct copy of the original
document’, then record your signature, print your full name and date.
Signature of prescribed person
✗
Authenticating stampDate document(s) certified
Prescribed person’s business or workplace address
State Postcode
Form continues on next page
Section 1 – Customer Details
Full name (including any middle names) Other name(s) known by (if any) Date of birth
Title
Mr Mrs Miss Ms Other
Occupation
Residential address (PO Box is not acceptable)
State Postcode Country (if not Australia)
Section 2 – Are you a resident of Australia
If No,
What is the purpose of operating an account with the Commonwealth Bank of Australia?
NoYes
CID/File reference number
Employment type Employers name
Start Date
003-210 040520 (CBA1382)
Page 1 of 3
DD/MM/YYYY
DD/MM/YYYY
DD/MM/YYYY
Who is a prescribed person?
For persons based in Australia:
1. 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: Architect; Chiropractor; Dentist; Financial adviser of
financial planner; Legal practitioner; Medical practitioner; Midwife;
Nurse; Occupational therapist; Optometrist; Patent attorney;
Pharmacist; Physiotherapist; Psychologist; Trademarks attorney;
Veterinary surgeon
2. 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);
3. An officer with, or authorised representative of, a holder of an
Australian financial services licence (AFSL), having 2 or more
years of continuous service with one or more licensees;
4. An officer with, or a credit representative of, a holder of an
Australian credit licence (ACL), having 2 or more years of
continuous service with one or more licensees;
5. Agent of the Australian Postal Corporation who is in charge of an
office supplying postal services to the public;
6. Australian Public Service employee engaged on an ongoing basis
with 2 or more years of continuous service who is otherwise not
specified in this section;
7. Bailiff;
8. Bank officer with 2 or more continuous years of service;
9. Building society officer with 2 or more years of continuous service;
10. Chief Executive Officer of a Commonwealth Court;
11. Clerk of a Court;
12. Commissioner for Affidavits;
13. Commissioner for Declarations;
14. Credit union officer with 2 or more years of continuous service;
15. Employee of a Commonwealth Authority engaged on a
permanent basis with 2 or more years of continuous service who
is otherwise not specified in this section;
16. Employee of the Australian Trade and Investments Commission
who is:
a. in a country or place outside Australia; and
b. authorised under paragraph 3(d) of the Consular Fees Act
1955; and
c. exercising his or her function in that place
Section 6 – Prescribed person’s categories (occupation or other persons)
To comply with identification standards you can choose to provide documents described and listed under Option A OR Option B.
Documents must be current/not expired unless specified otherwise.
If your identification documents are not in English then a translation of each document is required. All translations must be
completed by a translator who is accredited by the National Accreditation Authority for Translators and Interpreters Ltd (NAATI) or
an equivalent.
Option A: 1 x Primary Photographic Identification (is sufficient ID by itself)
• Australian Passport (which has not been expired for 2 years or more)
• Australian or New Zealand drivers licence
• Proof of Age card - Australian State or Territory
• NSW Birth Card or NSW / WA Photo Card
• International Passport/ Travel Document/ National Identity card
*
• Australian Government issued Firearms licence (all States)
Option B: Choose from 2 x Primary non photographic ID or 1 x Primary non photographic ID and 1 x Secondary ID
• Australian drivers licence (without photo)
• Australian or foreign birth certificate or extract
• Australian or foreign citizenship certificate
• Centrelink pension or healthcare card OR
Secondary Identification
• A notice from the Commonwealth / State or Territory issued to the person and containing their name and residential address, and
records the provision of financial benefits to that person (issued within the proceeding 12 months)
• Australian Tax Office (ATO) notice containing name and residential address (issued within the proceeding 12 months)
• A utilities notice from a local government body (e.g. council rates bill) or utility (e.g. gas, electricity or water bill) provider showing name
and residential address, and records provision of services to that person (issued within the preceding 3 months)
• Overseas drivers licence
• Commonwealth / State or Territory security guard / crowd safety officer identity card
* issued by a foreign government, the United Nations (UN) or an agency of the UN
Section 5 – Acceptable identification standard (personal customer)
Section 4 – Authenticate Prescribed Person (Bank use only)
I confirm the Prescribed Person has been authenticated via the following:
Listed Prescribed Person Authenticating stamp/seal Business Letterhead confirming authority
Bank Officer name Staff number
Bank Officer signature
✗
Date
Form continues on next page
Page 2 of 3
003-210 040520 (CBA1382)
DD/MM/YYYY
Section 6 – Prescribed person’s categories (occupation or other persons) (continued)
For persons based overseas:
Only person(s) in a foreign country who is authorised by law in that jurisdiction to administer oaths or affirmations or to authenticate
documents, are authorised to certify a document as a true copy of an original identification document for customers located outside
Australia.
Below are examples of offshore certifiers by jurisdiction:
China
Notarial Office
Hong Kong
Appointed insurance agent
Auditor
Authorised broker
Authorised financial institution
Authorised insurer
Certified public accountant
Charted secretary
Estate agent
Justice of the Peace
Lawyer
Licensed corporation
Member of the Judiciary
Notary public
Officer of an Embassy, Consulate or High Commission of the
country of issue of documentary verification of identity
Tax advisor
Trust or company service provider licensee
Indonesia
Notary
New Zealand
Chartered Accountant
Commonwealth representative
New Zealand (cont...)
Honorary Consul at a New Zealand Consular Office
Justice of Peace
Kaumātua
Lawyer
Member of Parliament
Member of the police who holds the office of constable
Minister of religion
Notary public
Registered medical doctor
Registered teacher
Singapore
CPA
Lawyer
Notary public
United Kingdom
Bank official
Building society official
Chartered Accountant
Councillor
Dentist
Minister of religion
Notary
United States of America
Notary
If you reside in a country outside of the above list please contact your local CBA Branch to confirm a suitable certifier.
17. Employee of the Commonwealth who is:
a. in a country or place outside Australia; and
b. authorised under paragraph 3(c) of the Consular Fees Act
1955; and
c. exercising his or her function in that place
18. Engineer who is:
a. a Registered Professional Engineer of Professionals
Australia; or
b. registered as an engineer under a law of the Commonwealth,
a State or Territory; or
c. registered on the National Engineering Register by Engineers
Australia
19. Fellow of the National Tax Accountants’ Association;
20. Finance company officer with 2 or more years of continuous
service;
21. Holder of a statutory office not specified in another item on this list;
22. Judge of a Court;
23. Justice of the Peace;
24. Magistrate;
25. Marriage celebrant registered under Subdivision C of Division 1
of Part IV of the Marriage Act 1961;
26. Master of a Court;
27. Member of Engineers Australia, other than at the grade of student;
28. Member of the Association of Taxation and Management
Accountants;
29. Member of the Australian Defence Force who is:
a. an officer;
b. a non-commissioned officer within the meaning of the
Defence Force Discipline Act 1982 with 2 or more years of
continuous service; or
c. a warrant officer within the meaning of the Defence Force
Discipline Act 1982
30. Member of the Governance Institute of Australia Ltd;
31. Member of the Institute of Chartered Accountants in Australia
and New Zealand, the Australian Society of Certified Practising
Accountants or the Institute of Public Accountants;
32. Member of: the Parliament of the Commonwealth; the Parliament
of a State; a Territory legislature; or a local government authority
of a State or Territory.
33. Minister of religion registered under Subdivision A of Division 1 of
Part IV of the Marriage Act 1961
34. Notary public, including a notary public (however described)
exercising functions at a place outside the Commonwealth and
the external Territories of the Commonwealth;
35. Permanent employee of the Australian Postal Corporation with 2
or more years of continuous service who is employed in an office
supplying postal services to the public;
36. Permanent employee of:
a. the Commonwealth or a Commonwealth authority;
b. a State or Territory or a State or Territory authority; or
c. a local government authority, with 2 or more years of
continuous service and the person is not already specified in
another item on this list
37. Person before whom a statutory declaration may be made under
the law of the State or Territory in which the declaration is made;
38. Police officer;
39. Registrar, or Deputy Registrar, of a Court;
40. Senior Executive Service employee of:
a. the Commonwealth or a Commonwealth authority; or
b. a State or Territory or a State or Territory authority
41. Sheriff;
42. Sheriff’s officer;
43. Teacher employed on a full-time basis at a school or tertiary
education institution;
44. Member of the Australasian Institute of Mining and Metallurgy;
45. For customers located outside Australia, a person in a foreign
country who is authorised by law in that jurisdiction to administer
oaths or affirmations or to authenticate documents.
003-210 040520 (CBA1382)
Page 3 of 3
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Certified Copies Identification Form (Commonwealth Bank of Australia)

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Completed 8 February 2021

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