Fillable Collection and Verification of Know Your Customer Information (Commonwealth Bank of Australia)

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Collection and Verification of Know Your Customer Information (Commonwealth Bank of Australia)

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  • 208 other fields

Country of origin: AUSTRALIA
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Commonwealth Bank of Australia
ABN 48 123 123 124
Australian credit licence 234945
Sole Trader
A Sole Trader is one individual (natural person) trading in their own name or a registered business name.
Joint Traders
A Joint Traders business structure is where two or more individuals (natural person) are trading under their own names.
Note: For Sole Traders and Joint Traders, please complete Section C in addition to Sections A,B,D & E.
Section A: Personal details
The information against the checkbox
indicates field must be verified against
an acceptable identification document
or data source.
Individual 1
Verified
Verified*
Complete all fields
Title
Mr Mrs Ms Miss Other
Surname Given name(s)
Other names known by (if any)
Date of birth Gender
Male Female
Full residential address (PO Box not acceptable)
State Postcode Country
Daytime phone
Evening phone
Fax number
Mobile number
Email
Occupation Income range
Employment category
Employed Public Servant Employed Public Authority Employed All Other
Employer or Self-Employed Not Employed Non-Resident Customer
Employment frequency
Full Time Part Time Temporary Contract Seasonal Commission
Employment start date
*Verify either the Date of Birth
or the Address
Bank Use Only
Collection and Verification of Know Your Customer
Information for Individual Customers and Sole Traders/
Joint Traders
Do you have an existing Commonwealth Bank account? (Tick (✔) the box that is applicable)
No
Yes Please provide account number
• Please provide all countries where you are a resident for tax purposes; and
Tax Identification Number (TIN) for each country of tax residency; or
• Select one of the below reasons;
a. My country of tax residency does not issue TINs
b. I have not been issued with a TIN by my country of tax residency
c. My country of tax residency does not require disclosure of a TIN (use this if providing
Australia)
d. TIN information will be provided later (If this reason is selected, account operations might
be impacted until TIN is provided)
Tax Residency Information (mandatory)
005-449 201120 Page 1 of 6
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(+ )
(+ )
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Section A: Personal details (continued) Bank Use Only
Individual 2
Verified
Verified*
Complete all fields
Title
Mr Mrs Ms Miss Other
Surname Given name(s)
Other names known by (if any)
Date of birth Gender
Male Female
Full residential address (PO Box not acceptable)
State Postcode Country
Daytime phone Evening phone Fax number Mobile number
Email
Occupation Income range
Employment category
Employed Public Servant Employed Public Authority Employed All Other
Employer or Self-Employed Not Employed Non-Resident Customer
Employment frequency
Full Time Part Time Temporary Contract Seasonal Commission
Employment start date
*Verify either the Date of Birth
or the Address
Country(ies) of Tax Residency
Please list country(ies) of tax
residency.
Tax Identification Number (TIN) or Reason for no TIN
Please provide a TIN for each country of tax residency or select
one of the reasons for no TIN (Refer to options a, b, c, d above)
Do you have an existing Commonwealth Bank account? (Tick (✔) the box that is applicable)
No
Yes Please provide account number
• Please provide all countries where you are a resident for tax purposes; and
Tax Identification Number (TIN) for each country of tax residency; or
• Select one of the below reasons;
a. My country of tax residency does not issue TINs
b. I have not been issued with a TIN by my country of tax residency
c. My country of tax residency does not require disclosure of a TIN (use this if providing Australia)
d. TIN information will be provided later (If this reason is selected, account operations might be
impacted until TIN is provided)
Note: If you are a resident or citizen of the US, it is mandatory to include US as a country of
taxresidency
Tax Residency Information (mandatory)
Note: If you are a resident or citizen of the US, it is mandatory to include US as a country of
taxresidency
(Tick (✔) the box that is applicable)
Australia Only
Australia and/or Other Countries Please complete below
Tax Residency Information (mandatory) continued
005-449 201120 Page 2 of 6
DD/MM/YYYY
(+ )
(+ )
( )
DD/MM/YYYY
The information against the checkbox
indicates field must be verified against
an acceptable identification document
or data source.
Verified
Verified
Do you have an existing Commonwealth Bank account? (Tick (✔) the box that is applicable)
No
Yes Please provide account number
Complete this section when another individual controls either Individual 1 or Individual 2
(for example a parent/guardian of a customer that is a minor or a person appointed under
an enduring power of attorney/guardian for an incapacitated individual).
Section B - Beneficial Owners Bank Use Only
Section A: Personal details (continued) Bank Use Only
Country(ies) of Tax Residency
Please list country(ies) of tax
residency.
Tax Identification Number (TIN) or Reason for no TIN
Please provide a TIN for each country of tax residency or select
one of the reasons for no TIN (Refer to options a, b, c, d above)
(Tick (✔) the box that is applicable)
Australia Only
Australia and/or Other Countries Please complete below
Tax Residency Information (mandatory) continued
Verified
Verified*
Title
Mr Mrs Ms Miss Other
Surname Given name(s)
Other names known by (if any)
Date of birth Gender
Male Female
Full residential address (PO Box not acceptable)
State Postcode Country
Daytime phone
Evening phone
Fax number
Mobile number
Email
Occupation Income range
Employment category
Employed Public Servant Employed Public Authority Employed All Other
Employer or Self-Employed Not Employed Non-Resident Customer
Employment frequency
Full Time Part Time Temporary Contract Seasonal Commission
Employment start date
*Verify either the Date of Birth
or the Address
Section C: Sole Traders/Joint Traders
Section 1
Complete all fields per organisation type
Full Business name (if any) – Sole Trader
Full name of the individual sole trader
ABN (if any)
Bank Use Only
005-449 201120 Page 3 of 6
DD/MM/YYYY
(+ )
(+ )
( )
DD/MM/YYYY
Section C: Sole Traders/Joint Traders (continued)
Section 3
Is the organisation Not For Profit? (Tick (✔) the box that is applicable)
No Yes Please provide industry/sector
Is the organisation operating as a charity? (Tick (✔) the box that is applicable)
No Yes If Yes, please complete the following question:
What is the objective/purpose of the charity? (e.g. vocational training for disabled,
persons, assistance for tsunami victims, building fund for a particular school or
institution etc.)
Bank Use Only
Registered address (PO Box is not accepted)
State Postcode Country
Industry information
Section 2
Partnership name (Joint Traders only)
ABN (if any)
Full name of individual 1
Full name of individual 2
Registered address (PO Box is not accepted)
State Postcode Country
Industry information
Primary Business Activity
Is the organisation’s primary business activity investing?
Tick (✔) ‘Yes’ if the organisation’s earns more than 50% of its total income from investment
activities (e.g. rent, interest or dividends) or more than 50% of the assets produce or are held for
producing investment income.
No Yes
• Please provide the country(ies) where the organisation is resident for tax purposes (the
organisation must be a tax resident of at least one country);and Tax Identification Number (TIN)
of the organisation for each country of tax residency; or
• Select one of the below reasons;
a. The organisation’s country of tax residency does not issue TINs
b. The organisation has not been issued with a TIN by its country of tax residency
c. The organisation’s country of tax residency does not require disclosure of a TIN (use this if
providing Australia)
d. TIN information will be provided later (If this reason is selected, account operations might be
impacted until TIN is provided)
Tick the box that is applicable (✔)
NOTE: For Joint Traders please enter all countries of tax residence and TIN or Reason for no TIN
per whatever has been captured for each Individual e.g. Individual A has advised Australia only
as has Individual B therefore the Countries of tax residency are Australia only for the Joint Trader
Australia Only
Australia and/or Other Countries Please complete the below
Tax Residency Information (mandatory)
Country(ies) of Tax Residency
Please list country(ies) of tax
residency.
Tax Identification Number (TIN) or Reason for no TIN
Please provide a TIN for each country of tax residency or select
one of the reasons for no TIN (Refer to options a, b, c, d above)
005-449 201120
Page 4 of 6
Section E: Declaration
Customer Declaration
I understand and acknowledge that the law requires applicants to provide true and correct information and state all the names
by which they are commonly known. I also understand that the law prohibits the use of false names, as well as the giving, use or
production of false or misleading information or documents in connections with the provision of financial services and the making,
possession or use of a false document in connection with an identification procedure.
I have obtained the consent of any individual(s) whose personal information is provided in this application. I confirm that I have
authority to act on the person’s behalf and my authority to act on behalf of the person has not been revoked, forfeited, or varied
by Court Order or any other means. They have authorised the collection, use or exchange of their information in accordance with
our Privacy Policy. They have also consented to their ID being verified with the document issuer or record holder via a third party
provider to confirm their identity.
I confirm I have made them aware that this information and information relating to the account may be provided to the
tax authorities.
I declare that the details as shown on this form are complete and correct and that I will advise the Commonwealth Bank of
Australia if these details change.
I consent to the Bank verifying the identification information with the document issuer or record holder via a third party provider.
I understand that this consent will be valid for a period of 12 business days, or otherwise for the duration of time needed to
complete the identity verification.
✗
Signature
Date
Applicant 1
Applicant 2
✗
Signature
Date
Additional Information (if applicable)
Section D: Privacy
The Commonwealth Bank of Australia (the Bank) is collecting your personal information to identify you in accordance with the
Anti-Money Laundering and Counter-Terrorism Financing Act 2006.
To identify you, the Bank, and its service providers, will collect and verify details from your identification documents with the
Australian Government’s Document Verification Service to assess whether they match information held by the issuers or official
record holders of those documents.
For more information about how the Bank handles personal information, including how you can access, or seek correction of,
your information or contact us with any feedback, please see the Bank’s Privacy Policy available on www.commbank.com.au.
005-449 201120 Page 5 of 6
DD/MM/YYYY
DD/MM/YYYY
Bank Use Only: Verification
Identification details (eg. passport, driver’s licence) must be completed in all cases where customer identification is obtained.
Applicant 1
Existing account number or Customer ID
Document type Document number Name on document Place of issue Issue date Expiry date
Verification has been performed for the customer:
Full name, and Date of birth, or Residential address
Applicant 2
Existing account number or Customer ID
Document type Document number Name on document Place of issue Issue date Expiry date
Verification has been performed for the customer:
Full name, and Date of birth, or Residential address
Bank Use Only: Discrepancy
Please complete this section if any discrepancy has been identified in KYC information and the way in which it has been
resolved.
In the instance where changes or additions were made by me on this form, all such information was collected by me directly
from the customer and all the changes or additions to this form have been initialled by me
Completed by:
Bank Staff or Broker
I confirm that the information checked in the verification documents correctly reflects the information supplied by the customer
and matches the information in this completed form.
Bank Staff/Broker Bank Staff/Broker number
✗
Signature
Bank Staff/Operations Support
I confirm that the information checked in the verification documents as set out above correctly reflects the information
supplied by the customer in the form.
Support/Operations Staff number
✗
Signature Date
005-449 201120 Page 6 of 6
DD/MM/YYYY
MM/YYYY
DD/MM/YYYY
MM/YYYY
DD/MM/YYYY
MM/YYYY
DD/MM/YYYY
MM/YYYY
DD/MM/YYYY
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Collection and Verification of Know Your Customer Information (Commonwealth Bank of Australia)

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Completed 8 February 2021

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