Fillable Customer Identification Form (CIF) (Australian National University)

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Customer Identification Form (CIF) (Australian National University)

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Page 1 of 6 STG2122 SGB CIF 1119
SECTION 
Details of Individual to be identified (Individual Customers and Sole Traders)
CIS no. (if known) Account number (if known) Account name
Individual (name in full)
Date of birth Gender Are you known by any other names?
/ /
 Male   Female  Yes   No
If yes, please specify all names (use a separate sheet if required)
Residential address (PO Box not allowed)
Employment type: Please select the employment type that reflects your current situation best.
 Casual  Independent Contractor  Retired  Student
 Dependant Contractor  Other  Self Employed  Temporary
 Full Time  Part Time  Social Security Recipient  Unemployed
Occupation
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)
St.George Bank – A Division of Westpac Banking Corporation
ABN 33 007 457 141 AFSL and Australian credit licence 233714.
St.George Motor Finance Limited – ABN 53 007 656 555 Australian
credit licence 387946.
St.George Finance Limited – ABN 99 001 094 471 Australian
credit licence 387944.
Customer Identification Form (CIF)
Information Required
Individual Customers must complete section 1, 3 and 4
Sole Traders must complete sections 1, 2, 3 and 4.
PRINT
CLEAR FORM
Page 2 of 6 STG2122 SGB CIF 1119
SECTION  continued
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)
SECTION 
Details to be completed by Sole Traders only
Full Business/Trading Name ABN (if any)
Full address of the principal place of business (PO Box not allowed) (if any)
Business Classification (ANZSIC)
SECTION 
Foreign Tax Residency Information
Are you a tax resident for 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 select one of the reasons against the appropriate country:
* A foreign TIN is an identifying number or equivalent issued by the individual country of tax residency that is used for tax purposes. NOTE: If you have
more than 3 countries in which you are a tax resident, please photocopy this section to provide more details.
Country Tax Identification Number (TIN) Reason (if a TIN not available)
 Foreign TIN not issued by this country
 Individual is underage (applies to individuals only)
 Foreign TIN pending issue by the countries tax authority
 Foreign TIN not issued by this country
 Individual is underage (applies to individuals only)
 Foreign TIN pending issue by the countries tax authority
 Foreign TIN not issued by this country
 Individual is underage (applies to individuals only)
 Foreign TIN pending issue by the countries tax authority
Page 3 of 6 STG2122 SGB CIF 1119
SECTION 
Details Certified for an Individual (Individual Customers and Sole Traders)
Information Required: Certifiers must complete the Certifier’s details & declaration section on the following page and certify
legible copies of either:
One document from Group 1
Or
One document from Group 2 and one other document from Group 3.
Group 1 – Primary Photographic Identification Documents.
 Australian Passport (current or expired by less than 2 years).
  Foreign passport issued by a foreign government, the United Nations or an agency of the United Nations.
  Foreign Travel document issued by a foreign government, the United Nations or an agency of the UnitedNations.
 Australian licence/permit.
 Foreign driver’s licence which contains a photograph.
 Proof of age card issued by State or Territory.
 National Identity card issued by a foreign government, the United Nations or an agency of the United Nations.
Group 2 – Primary Non-Photographic Identification Documents.
 Australian Birth Certificate or extract.
 Foreign Birth Certificate.
 Citizenship Certificate – Australian.
 Citizenship Certificate – Foreign.
 Centrelink Pension Card.
Group 3 – Secondary Identification Documents.
 Notice of Financial Benefits issued by a Commonwealth or State/Territory Department (less than 12 months old).
 Notice issued by the Australian Taxation Office (issued in the last 12 months).
 Notice issued by a Local Government Body or Utilities Provider (less than 3 months old).
 Foreign driver’s licence which does not contain a photograph.
 Department of Veteran’s Affairs pension card.
 Tenancy/lease agreement (must be current).
 Medicare Card.
 Australian Marriage Certificate.
 Student ID card issued by an Australian tertiary institution (TAFE or University).
  Notice issued by the principal of a school (less than 3 months old, must include the name of the customer, residential
address, period of school attendance & be issued on a school letterhead).
  A current card issued under Commonwealth, State or Territory law for the purpose of identification for a government
serviceor as a licence.
Special Provisions – for Refugees only, either of the following documents.
 Certificate of Identity issued by the Australian Government.
 Convention Travel Document (Titre de Voyage or equivalent) issued by the Australian Government.
Page 4 of 6 STG2122 SGB CIF 1119
SECTION  continued
Signature of Individual to be identified
Individual (name in full)
Individual’s Signature Date
✗
/ /
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
Signature Date
✗
/ /
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 effective 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.
Page 5 of 6 STG2122 SGB CIF 1119
SECTION  continued
Privacy Statement
Our privacy policy is available at stgeorge.com.au or by calling 13 33 30, and covers how we handle your personal information.
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 office supplying postal services to the public
4. Australian Consular Officer or Australian Diplomatic Officer
(within the meaning of the Consular Fees Act 1955)
5. Bailiff
6. Bank officer with 2 or more continuous years of service
7. Building society officer with 2 or more years of
continuousservice
8. Chief executive officer of a Commonwealth court
9. Clerk of a court
10. Commissioner for Affidavits
11. Commissioner for Declarations
12. Credit union officer 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 officer with 2 or more years of
continuous service
17. Holder of a statutory office 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 officer; or
ν a non-commissioned officer within the meaning of the
Defence Force Discipline Act 1982 with 2 or more
years of continuous service; or
ν a warrant officer 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
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 office 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
Page 6 of 6 STG2122 SGB CIF 1119
34. Police officer
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. Sheriff
38. Sheriff’s officer
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 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
42. 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.
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 officer of an Australian bank, building society or
finance company branch or office located in a foreign
jurisdiction with 2 or more years of continuous service
3. Australian Consular Officer or Australian Diplomatic Officer
(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 affirmations or to
authenticate documents.
SECTION  continued
Branch/Office Use Only
Employee name Employee number
Branch name Branch no.
Signature Date
✗
/ /
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Customer Identification Form (CIF) (Australian National University)

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Completed 20 July 2021

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