Fillable Customer Identication Form. (Australian National University)

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Customer Identication Form. (Australian National University)

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© 2020 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBCCID001_0220 Page 1 of 10
Customer Identification Form.
Personal customers and sole traders.
Privacy Statement.
The Bank is collecting your personal information to satisfy its identification requirements under the Anti-Money
Laundering & Counter-Terrorism Financing Act 2006 and Anti-Money Laundering & Counter-Terrorism Financing Act
Rules. We collect personal information from you to process your application, provide you with your product or service,
and manage your product or service. We may also use your information to comply with legislative or regulatory
requirements in any jurisdiction, prevent fraud, crime or other activity that may cause harm in relation to our products or
services and help us run our business. We may also use your information to tell you about products or services we think
may interest you. If you do not provide all the information we request, we may need to reject your application or we may
no longer be able to provide a product or service to you.
If you are a proposed guarantor, we collect your personal information in order to assess you as a guarantor, take a
guarantee from you and administer that guarantee. If you do not provide all the information we request, we may be
unable to accept you as a guarantor.
We may disclose your personal information to other members of the Westpac Group, anyone we engage to do
something on our behalf, rewards program administrators and other organisations that assist us with our business.
We may disclose your personal information to an entity which is located outside Australia. Details of the countries where
the overseas recipients are likely to be located are in our privacy policy.
As a provider of financial services, we have obligations to disclose some personal information to government agencies
and regulators in Australia, and in some cases oshore. We are not able to ensure that foreign government agencies
or regulators will comply with Australian privacy laws, although they may have their own privacy laws. By using our
products or services, you consent to these disclosures.
We are required or authorised to collect personal information from you by certain laws. Details of these laws are in our
privacy policy. Our privacy policy is available at westpac.com.au or by calling 132 032. It covers:
• how you can access the personal information we hold about you and ask for it to be corrected;
• how you may complain about a breach of the Australian Privacy Principles or a registered privacy code and how we
will deal with your complaint;
• how we collect, hold, use and disclose your personal information in more detail.
We will update our privacy policy from time to time.
Guide to completing this form.
Complete one form for each individual. Complete all applicable sections of this form in BLOCK LETTERS.
RESET
Customer Indentification Form.
© 2020 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBCCID001 0220 Page 2 of 10
Personal details.
Title Given Names* Surname*
Other names known by (if any) Date of birth* Gender
/ /
 Male   Female
Full residential address* (PO Box not acceptable)
Country Home phone
(   )
Work phone Mobile number
(   )
Fax number Occupation*
(   )
Employment Type (e.g. Full-Time)* Email
Relationship Manager details Marital status
Purpose of business relationship: This refers to your reasons for engaging with us to obtain products and services.
Customers may have multiple reasons for dealing with us. Please indicate all of these reasons below.
 Transactional  Short Term Borrowing  Protection  Financial Markets
 Savings  Long Term Borrowing  Wealth  Correspondent Banking
 Additional information (please specify)
Source of funds: This refers to the origin of the funds that are the subject of the business relationship between you and
us. Please note that many customers have multiple sources of funds. Please indicate all sources of funds below.
 Salary/Wages  Investment income/earnings  Compensation payment  Inheritance
 Commission  Rental income  Government benefits  Gift/Donation
 Bonus  Superannuation/Pension  Sale of assets  Windfall
 Business income/earnings  Loan  Liquidation of assets  Tax refund
 Business profits  Insurance payment  Redundancy
 Additional sources (please specify)
Customer Indentification Form.
© 2020 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBCCID001 0220 Page 3 of 10
Source of wealth: This refers to the origin of your total net assets/total net worth. Please note that many customers will
have multiple sources of wealth. Please indicate all sources of wealth below.
 Employment income/earnings  Superannuation/Pension  Liquidation of assets
 Redundancy  Insurance payment  Inheritance
 Business income/earnings  Compensation payment  Gift/Donation
 Business profits  Government benefits  Windfall
 Investment income/earnings  Owns real estate/property  None
 Rental income  Sale of assets
 Additional sources (please specify)
Complete this section if customer is a Sole Trader.
Full Business Name/Trading Name (if any)  Tick if N/A*
ABN (if any)
 Tick if N/A* Industry Code*
Industry Description*
Full address of principal place of business* (PO Box not acceptable) (if any)
 Tick if N/A*
 Tick if address is same as above
Country
* Compulsory fields
Foreign Tax Residency Information.
Are you a tax resident of any other country outside of Australia?*    Yes   No
If yes, please indicate the country(ies) in which you are a resident for tax purposes and each country’s associated Tax
Identification Number (TIN).
If a ‘TIN’ is not available, please specify one of the following reasons against the appropriate country:
Reason 1: Foreign TIN not issued by this country
Reason 2: Individual is under age (applies to individuals only)
Reason 3: Foreign TIN pending issue by the country’s tax authority
Country of Tax Residency
Tax Identification Number (TIN)* or
TIN not applicable reason (see reasons above)
Foreign TIN:
OR
 Reason 1    Reason 2     Reason 3
Foreign TIN:
OR
 Reason 1    Reason 2     Reason 3
* A Foreign TIN is an identifying number or equivalent issued by the country of tax residency that is used for tax purposes.
NOTE: If you have more than 2 countries in which you are a tax resident, please photocopy this section to provide more details.
* Compulsory fields
Customer Indentification Form.
© 2020 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBCCID001 0220 Page 4 of 10
Verification Procedure.
Verify the individual’s full name and date of birth.
Where certified copies of verification documents are provided they must be accompanied by a completed
CertifiedCopy Certificate Form.
Information must be verified from:
• ONE Primary Photographic document from Table A or if unable to;
• ONE Primary Non Photographic document from Table B and one Secondary document from Table C.
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.
Note: If any document is written in a language other than English, it must be accompanied by an English translation prepared by an
accreditatedtranslator.
TABLE A – Primary Photographic identification documents.
(When a photo ID is presented ensure the likeness of the photo matches the customer and the signature, if any, matches)
Tick ✓ Select at least ONE option from this section
  Australian driver licence/learner’s permit^
  Foreign driver licence/permit
  Australian passport (can either be current or expired within the last 2 years but must not be cancelled,
defaced or mutilated)
  Foreign passport issued by a foreign government, the United Nations or an agency of the United Nations (must
not be cancelled, defaced or mutilated) which contains either a signature OR a unique identifier of the person^^
  Foreign travel document issued by a foreign government, the United Nations or an agency of the United Nations
which contains either a signature OR a unique identifier of the person
 Australian proof of age card issued by a State or Territory^^^
  National identity card issued by a foreign government, the United Nations or an agency of the United Nations
which contains either a signature OR a unique identifier of the person
^ Includes a digital driver licence/learner’s permit that the Westpac Group must view directly through the issuing Government website/app.
^^ A unique identifier of the person is a biometric marker of that person, for example a fingerprint.
^^^ Includes a digital proof of age card that the Westpac Group must view directly through the issuing Government website/app.
TABLE B – Primary non-photographic identification documents.
Tick ✓ Select at least ONE option from this section
  Australian birth certificate (or extract) issued by a State or Territory
  Foreign birth certificate issued by a foreign government, the United Nations or an agency of the United Nations
  Australian citizenship certificate
  Citizenship certificate issued by a foreign government
 Centrelink pension card (Australian)
 Centrelink health card (Australian)
Customer Indentification Form.
© 2020 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBCCID001 0220 Page 5 of 10
TABLE C – Secondary identification documents.
(When a photo ID is presented ensure the likeness of the photo matches the customer and the signature, if any, matches)
Tick ✓ Select at least ONE option from this section
  A notice issued by the Commonwealth or a State/Territory within the last 12 months that includes the individual’s
name and residential address and records the provision of financial benefits (e.g. Centrelink notice)
  A notice issued by the Australian Taxation Oce (ATO) within the last 12 months that includes the individual’s
name and residential address and records a debt payable by or to the individual (e.g. tax assessment)
  Utilities notice issued by a local government or utilities provider within the last 3 months and includes the
customer’s name and residential address and records the provision of a service to that address or name
  If the individual is under the age of 18 years, notice issued by the principal of a school within the last 3 months,
that includes the name of the individual, residential address and period of school attendance
  Foreign driver licence which does not contain a photograph
  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) which
contains a photograph and signature
  A current card issued under a Commonwealth, State, or Territory law for the purpose of identification, for a
government service, or as a licence
Exception Categories – acceptable identification documents.
Only ONE of the options from this section is required.
Refugee/Humanitarian category. (must include Visa subclass no. ranging from 200 – 217)
Tick ✓
  Certificate of identity (issued by the Australian government)
  Convention travel document (titre de voyage) (issued by the Australian government)
  Passport – Foreign (refer to Table A for rules)
Remote Indigenous Communities.
Tick ✓
  Indigenous Community ID Card from a list of Group AML approved cards available on the Group AML intranet
  Remote Indigenous Communities Verification form (P/C 2055) (this form must be signed by one referee and
one witness. Areferee is a leader or elder of the community to which the customer belongs, who is listed on the
Westpac Register of Community Representatives)
Data to be verified.
Refugees
Full name
Date of birth
/ /
Remote
Indigenous
Communities
Full name
Date of birth
/ /
Customer Indentification Form.
© 2020 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBCCID001 0220 Page 6 of 10
Record of Verification Procedure.
ID Document Details. Document 1 – from Table A or B. Document 2 – from Table C.
Verified from
  Original   Certified Copy   Original   Certified Copy
Document issuer
Document Type
Place issued
Issue date
/ / / /
Expiry date
/ / / /
Document number
For newly arrived customers < 6 weeks
Date of arrival is compulsory
For Refugee/Humanitarian category
Visa sub-class no. is compulsory
Accreditated English translation   N/A   Sighted   N/A   Sighted
Signature of Individual to be identified.
Individual (name in full)
Individual’s Signature Date
✗
/ /
Customer Indentification Form.
© 2020 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBCCID001 0220 Page 7 of 10
Certifier’s Details and Declaration.
Note to Certifier: Please ensure copies are legible and record the following on each copy of the identification provided:
“This is a true copy of an original or certified copy document provided”; then print and sign your name, date and
Qualification No. (ifapplicable) and also provide your details below so that we may contact you if necessary to confirm
this information.
Certifier’s Declaration.
I certify that:
1. The person named above signed this form in my presence.
2. I sighted originals of the documents noted on reverse of form.
3. I am satisfied that the documents produced were genuine and that to the best of my knowledge they confirm the
name, address and/or date of birth of the person named above.
Category no. of acceptable certifier
(see list below) Qualification no. (if applicable)
Full Name of Certifier.
Title First Name Family Name
Residential address – PO Box not allowed
Daytime Contact Number
Country
Code Area Code Number
Signature Date
✗
/ /
Customer Indentification Form.
© 2020 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBCCID001 0220 Page 8 of 10
Our reporting obligations.
We are required to identify tax residents of a country(ies) other than Australia in order to meet account information
reporting requirements under local and international laws.
If at any time after account opening, information in our possession suggests that you, the entity and/or any individual
who holds ownership and/or control in the entity of 25% or more (controlling person/beneficial owner) may be a tax
resident of a country(ies) other than Australia, you may be contacted to provide further information on your foreign tax
status and/or the foreign tax status of the entity and/or any controlling person/beneficial owner. Failure to respond may
lead to certain reporting requirements applying to the account.
By completing this application you certify that if at any time there is a change to the foreign tax status details for you,
the entity and/or any controlling person/beneficial owner, you will inform the bank. You will also certify that at any time
there is a change of a controlling person/s/beneficial owner/s in your entity you will inform the bank.
A controlling person/beneficial owner refers to the individuals(s) that directly or indirectly owns a legal interest in the
entity of 25% or more and/or exercises actual eective control over the entity, whether from an economic or other
perspective such as through voting rights. In addition, in the case of a trust, a controlling person/beneficial owner
includes the settlor(s), trustee(s), appointer(s), protector(s), beneficiary(ies), or classes of beneficiaries and in the case
of an entity other than a trust, the term includes person in equivalent or similar positions.
Categories of acceptable certifiers.
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:
ν Chiropractor
ν Dentist
ν Legal practitioner
ν Medical practitioner
ν Nurse
ν Optometrist
ν Patent attorney
ν Pharmacist
ν Physiotherapist
ν Psychologist
ν Trade marks attorney
ν 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. Agent of the Australian Postal Corporation who is
in charge of an oce supplying postal services to
thepublic
4. Australian Consular Ocer or Australian Diplomatic
Ocer (within the meaning of the Consular Fees
Act1955)
5. Baili
6. Bank ocer with 2 or more continuous years of
service
7. Building society ocer with 2 or more years of
continuous service
8. Chief executive ocer of a Commonwealth court
9. Clerk of a court
10. Commissioner for Adavits
11. Commissioner for Declarations
12. Credit union ocer with 2 or more years of continuous
service
13. Employee of the Australian Trade and Investment
Commission who is:
ν in a country or place outside of Australia; and
ν authorised under paragraph 3(d) of the Consular
Fees Act1955; and
ν exercising his or her function at that place
14. Employee of the Commonwealth who is:
ν in a country or place outside Australia; and
ν authorised under paragraph 3(c) of the Consular
Fees Act1955; and
ν exercising his or her function in that place
15. Fellow of the National Tax Accountants’ Association
16. Finance company ocer with 2 or more years of
continuous service
17. Holder of a statutory oce not specified elsewhere in
thislist
18. Judge of a court
19. Justice of the Peace
20. Magistrate
21. Marriage celebrant registered under Subdivision C of
Division 1 of Part IV of the Marriage Act 1961
22. Master of a court
23. Member of Chartered Secretaries Australia
24. Member of Engineers Australia, other than at the
grade ofstudent
25. Member of the Association of Taxation and
Management Accountants
26. Member of the Australian Defence Force who is:
ν an ocer; or
ν a non-commissioned ocer within the meaning of
the Defence Force Discipline Act 1982 with 2 or more
years of continuous service; or
ν a warrant ocer within the meaning of that Act
27. Member of the Institute of Chartered Accountants in
Australia, the Australian Society of Certified Practising
Accountants or the Institute of Public Accountants
Customer Indentification Form.
© 2020 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBCCID001 0220 Page 9 of 10
28. Member of:
ν the Parliament of the Commonwealth; or
ν the Parliament of a State; or
ν a Territory legislature; or
ν a local government authority of a State or Territory
29. Minister of religion registered under Subdivision A of
Division 1 of Part IV of the Marriage Act 1961
30. Notary public
31. 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
32. Permanent employee of:
ν the Commonwealth or a Commonwealth authority;
or
ν a State or Territory or a State or Territory authority;
or
ν a local government authority
with 2 or more years of continuous service and is a
person not already specified elsewhere in this list
33. Person before whom a statutory declaration may be
made under the law of the State or Territory in which
the declaration is made
34. Police ocer
35. Registrar, or Deputy Registrar, of a court
36. Senior Executive Service employee of:
ν the Commonwealth or a Commonwealth authority;
or
ν a State or Territory or a State or Territory authority
37. Sheri
38. Sheri’s ocer
39. Teacher employed on a full-time basis at a school or
tertiaryeducationinstitution
40. Member of the Australasian Institute of Mining
andMetallurgy
41. 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
42. 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 of Australia.
1. A legal practitioner who holds a current practicing
certificate under a law in force in a State or Territory
inAustralia
2. 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
3. Australian Consular Ocer or Australian Diplomatic
Ocer (within the meaning of the Consular Fees Act
1955)
4. Employee of the Australian Trade and Investment
Commission who is:
ν in a country or place outside of Australia; and
ν authorised under paragraph 3(d) of the Consular
Fees Act1955; and
ν exercising his or her function at that place
5. Employee of the Commonwealth who is:
ν in a country or place outside Australia; and
ν authorised under paragraph 3(c) of the Consular
Fees Act1955; and
ν exercising his or her function in that place
6. Judge of a court
7. Magistrate
8. Registrar, or Deputy Registrar, of a court
9. A person authorised as a notary public in a foreign
jurisdiction
10. Member of the Institute of Chartered Accountants in
Australia, the Australian Society of Certified Practising
Accountants or the Institute of Public Accountants
11. A person who is authorised by law in the relevant
jurisdictiontoadminister oaths or armations or to
authenticate documents.
Customer Indentification Form.
© 2020 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. WBCCID001 0220 Page 10 of 10
Employee details – identification and verification conducted by.
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.
This form and any attached documents are a record of the identification procedure for this customer and the
information obtained in the course of carrying out the procedure.
Employee name
Salary number BSB Phone number
(   )
I have followed the process for identification and verification as required by Westpac’s policy and procedure and
have verified the required information provided by the customer using an approved verification source(s). Where
theverification source has been provided by the customer the document is to the best of my knowledge the original
or certified copy.
Employee signature Date
✗
On completion of this form, please print it out and sign and date by hand.
/ /
Customer number* Customer Type
  Individual     Sole Trader
CIS Key
*Note: Not for use by In-store employees
ID Status
  Individual     Sole Trader
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Completed 1 February 2022

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