Fillable Customer Identification Form Authorised Referee (Australian National University)

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Customer Identification Form Authorised Referee (Australian National University)

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Customer Identification Form – Authorised Referee
HBAA302CUA 06/20
Page 1 of 2
Issued by HSBC Bank Australia Limited ABN 48 006 434 162 AFSL 232595
Complete the form using blue or black pen and print in clear CAPITAL LETTERS
Continued over page
PART A – INDIVIDUAL TO COMPLETE
Applicant’s signature
Application reference number
(if applicable)
YOUR SIGNATURE MUST BE WITNESSED BY THE AUTHORISED REFEREE
Declaration
I declare that the information contained above is true and correct and has been completed by me and not any other person.
Date
DD MM YY
Current residential address
(cannot be a PO Box)
CountryPostcodeSuburb StateCity
Nationality
(if not Australian, nationality must be verified via a foreign passport or foreign national identity card †)
DD MM YY
Date of birth
First nameTitle Last nameMiddle name
PART B – AUTHORISED REFEREE TO COMPLETE
Work phone number
( )
Employer’s name
Identity documents sighted
Write name + identification number (if any) + date/place/office of issue
1.
2.
First nameTitle Last name
Work address
Postcode
This form will be used to verify your identity only where an individual cannot attend an HSBC branch. You must verify your identity
using Primary and if necessary Secondary documents overleaf. The total document(s) must show:
(1) FULL NAME
(2) DATE OF BIRTH
(3) YOUR RESIDENTIAL ADDRESS and
Only an Authorised Referee (listed overleaf) may certify your identity documents.
Verified copy of documents must be signed and dated by Authorised Referee.
Where a Primary document contains all items and matches the applicant details in Part A (e.g. Australian drivers licence), no other
document is required. If the document cannot verify all items, then a Secondary document must be used to verify the missing item.
Mail the completed form to: GPO Box 5302, SYDNEY NSW 2001
Note: Make sure that you include the certified copies of your identity documents with this form.
Account numberBSB
Instructions
Print
Clear
On completion of this form,
please print and sign by hand
Page 2 of 2
PART B – AUTHORISED REFEREE TO COMPLETE
continued
AUTHORISED REFEREES
Authorised Referee’s signature
THE AUTHORISED REFEREE MUST SIGN, DATE AND WRITE
'I have sighted the original of this document'
ON EACH COPY OF THE IDENTITY DOCUMENTS.
Declaration
I declare that:
(i) I have sighted the abovementioned Individual’s original identity documents as listed in the section “Identity documents
sighted” and can confirm that the full name, residential address and date of birth match the details provided above by the
Applicant;
(ii) I certify that all documents are a true and correct copy of the original presented to me; and
(iii) the Applicant signed this form in my presence.
Date
DD MM YY
ID number
(if applicable)
Authorised referee category
(see below)
PRIMARY IDENTIFICATION DOCUMENTS
You MUST use one of the following to verify your identity:
• Photocard Australian drivers licence issued by an Australian
State or Territory #
• Passport – signature and photo page(s)
• Government issued Proof of Age card
• Foreign National Identity card †
• Foreign drivers licence *
• Birth Certificate ¥
EQUIVALENT JURISDICTIONS
Australia, Austria, Belgium, Canada, China, Denmark, Finland,
France, Germany, Greece, Guernsey, Hong Kong, Iceland,
Ireland, Isle of Man, Italy, Japan, Jersey,Korea (South),
Luxembourg, Mauritius, Netherlands, New Zealand, Norway,
Portugal, Singapore, Spain, Sweden, Switzerland, Dubai
International Financial Centre, United Kingdom, United States
of America.
# Includes renewed, interim, learners, provisional, bus, motor cycle
or truck licence. This does not include a driving licence issued on
paper or a boat licence.
† Must be issued by a foreign government, the United Nations or a
United Nations agency.
* Issued under a law of a foreign country for the purposes of driving
a vehicle (as detailed in the Australian driving licence above). This
does not include a driving licence issued on paper.
¥ For primary or secondary school students aged under 18 only.
^ Must record the individual’s lease of a residential property; be
current; and be issued by a real estate agent or serviced apartment.
~ Where the minimum contract length of 12 months for the provided
service is confirmed and is dated within the last 3 months.
SECONDARY IDENTIFICATION DOCUMENTS
You MUST use one of the following to verify your address
(except if using an Australian drivers licence as outlined overleaf):
• Local Authority or Government Department letter, or
statement dated within the last 12 months, e.g. Australian
Taxation Office (ATO) notice letter
• Bank statements, Australian council rates notice or utility
bills (including e-statements) dated within the last three
months (internet screenshots are not accepted) – must
contain full first and last names
• Residential property lease agreement / Residential Serviced
Apartment lease agreement ^
• Mobile phone bill, home internet bill, pay TV bill or utility
welcome letter ~
•
A letter issued by an Australian school ¥. The letter must
record the period of time the individual attended the school
and be issued with the preceding 3 months, printed on the
school’s letterhead and be signed by the school principal.
IDENTIFICATION DOCUMENTS
Important notes:
• Expired documents will not be accepted
• Any document not written in English must be accompanied
by an accredited translation or translation from an HSBC
staff member. An accredited translator means a person
currently accredited by the National Accreditation Authority
for Translators and Interpreters Ltd. (NAATI) at the level
of Professional Translator, or above, to translate from a
language other than English into English –
see www.naati.com.au
• Copies of identity documents must be of both sides
(where double-sided) and clear
Authorised Referees must satisfy one of the occupations below
and cannot be an immediate family member.
a) Legal professional who is currently licensed or registered
to practise under a law in force in a State or T
erritory
b) Accountant who is a member of:
1. a fellow of the National Tax Accountants’ Association;
or
2. a member of any of the following:
– Chartered Accountants Australia and New Zealand;
– the Association of Taxation and Management
Accountants;
– CPA Australia;
– the Institute of Public Accountants
c) A current member of The Governance Institute of Australia
d) An officer 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
e) An officer 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
f) Bank officer with 2 or more continuous years of service
g) Australian Consular Officer or Australian Diplomatic Officer
who is appointed by the Commonwealth to hold or act
the role in a country or place outside Australia
h) Justice of the peace
i) An agent of the Australian Postal Corporation who is in
charge of an office supplying postal services to the public
j) Police Officer
k) Commissioner of Oaths/Affidavits of an Australian State
or Territory
l) A member of an Australian Commonwealth, State or
Territory Parliament
m) 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
n) Notary public, including a notary public exercising
functions in an equivalent jurisdiction
o) A Person in an equivalent jurisdiction who is authorised
by law in that jurisdiction to administer oaths or
affirmations or to authenticate documents
On completion of this form,
please print and sign by hand
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Customer Identification Form Authorised Referee (Australian National University)

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Completed 17 April 2021

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