Fillable Declaration of Cryptocurrency Assets (Australian National University)

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Declaration of Cryptocurrency Assets (Australian National University)

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The Declaration of Cryptocurrency Assets (Australian National University) form is 1 page long and contains:

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  • 11 other fields

Country of origin: AUSTRALIA
File type: PDF

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Audit - Declaration of Bitcoin and Crypto Assets Page 1 of 1
Copyright © SuperEasy Pty Ltd ABN 48 092 141 083
Declaration of Cryptocurrency Assets
Fund Name:
ABN:
Financial Year:
I/We confirm that the Fund has the Bitcoin Crypto Currency type of assets as detailed below:
I/We confirm that:
(1) The Bitcoin Investment, whilst registered in the name/s of TRUSTEE/S NAMES, is held by the individual/s
in my/our capacity as trustee/s of the SMSF Name
(2) I/We confirm we have no personal or beneficial interest in the bitcoin/ crypto-currency investment
(3) I/We confirm the Bitcoin/ Crypto-Currency investment is maintained in a separate hardware wallet and
maintained at an adequately secured environment; and
(4) I/We have considered the need for insurance coverage of these items (where available).
I/We confirm that The Bitcoin / Crypto-Currency Investment is maintained at the following premises:
Company Name:
Address:
Phone Number:
I/We, declare that the above is confirmation of these conditions to meet compliance with the SIS Act and SIS
Regulations.
Trustee/Director 1 Signature
Name
Trustee/Director 2 Signature
Name
Trustee/Director 3 Signature
Name
Trustee/Director 4 Signature
Name
Signed and Dated:_________________________
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Declaration of Cryptocurrency Assets (Australian National University)

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Completed 26 January 2021

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