Fillable Wbc Notification Of Death Funds Distribution Indemnity Form (Australian National University)

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Wbc Notification Of Death Funds Distribution Indemnity Form (Australian National University)

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© 2018 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. DEC001 0918 Page 1 of 5
Notification of Death, Funds Distribution & Indemnity Form.
We’re sorry for your loss. When you are experiencing grief, dealing with practical matters can seem overwhelming.
Please know that we’re happy to give you any help, support or guidance – just drop into a branch or call us any time.
This Form
• Is required to be completed if the deceased’s combined Account Balances are greater than $15,000.
If the combined Account Balances are less than $15,000 please visit any Westpac Branch to finalise the Estate.
• Authorises the Bank to finalise the Estate (close their accounts and distribute funds, as provided in Section3).
• Must be signed by the executors, administrators or next of kin (as detailed in Section 4).
• Must be submitted with the required supporting documentation (as detailed in Section 4).
Remember all copies ofdocuments must be certified.
If you need any help completing this form or for any other matters relating to Estate Management please call us on
1300130240 (Mon-Fri 9am-5pm AEST).
1. Details of the Deceased.
First Name Surname
Date of Death Customer Number or Date of Birth
  /  /
2. Your Details (Correspondence Details).
Relationship to the Deceased:
 Executor/Administrator   Next of Kin   Solicitor    Other
Name:
Title First Name Surname
Mailing Address
Suburb State Postcode
Email Address
Phone Mobile
© 2018 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. DEC001 0918 Page 2 of 5
Notification of Death, Funds Distribution & Indemnity Form.
3. Distribution of Funds (Disbursal Instructions).
Payment Instructions:
  Transfer to Domestic Account/s
Account Name BSB Account Number Value
$
Account Name BSB Account Number Value
$
Account Name BSB Account Number Value
$
Account Name BSB Account Number Value
$
  Transfer to an International Account
Account Name Bank Name
SWIFT Code IBAN Sort Code Required Currency
  Convert to Estate of the Late Account
Account will be converted into an Estate of the Late account with the Executors/Administrators listed as signatories
Operating rule for the account 
  One to sign    All to sign
(i) This option is only available to Executors/Administrators with Probate or Letters of Administration and may
only be applied to one (1) valid account.
(ii) All Executors/Administrators must be Westpac customers and ‘identified’ for the conversion to take place.
(iii) Please note that withholding tax could be charged if a valid TFN is not applied to the account(s). This can
becompleted at any Westpac Branch.
Note: Term Deposits and Credit Cards are unable to be converted into the Estate of the Late. If “Yes” has been
selected above any Term Deposits will be left until maturity at which point additional instructions will need
tobe provided.
  Other/Special Instructions
© 2018 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. DEC001 0918 Page 3 of 5
Notification of Death, Funds Distribution & Indemnity Form.
4. Authority to Release Funds & Indemnity Checklist
(i) Did the deceased leave a Will?   Yes   No
If Yes, please provide a certified copy of the Will.
(ii)
Is a Grant of Probate/Letter of Administration being sought on the Estate?   Yes   No
If Yes, please provide a certified copy of the Grant of Probate/Letter of Administration.
Please note all Estates with a combined account balance of greater than $100,000 will require either a Grant of Probate/
Letter of Administration.
Estate Situation Documents Required
Combined Account Balances greater than $100,000
AND/OR
Property held in the deceased’s name only
 
Death Certificate
 
Grant of Probate/Letter of Administration
 
Will (If you answered Yes to (i) above)
 
This form signed by all
Executors/Administrators named in the
Grant of Probate/Letter of Administration
Combined Account Balances greater than $15,000
butless than $100,000
AND
Deceased left a Will
(If you answered Ye s to (i) above)
 
Death Certificate
 
Will
 
This form signed by all Executors named in the Will
Combined Account Balances greater than $15,000
butless than $100,000
AND
Deceased did not leave a Will
(If you answered No to (i) above)
 
Death Certificate
 
Statutory Declaration signed by all Next of Kin(s)
listed on the Death Certificate
 
This form signed by all Next of Kin(s) listed on the
DeathCertificate
© 2018 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. DEC001 0918 Page 4 of 5
Notification of Death, Funds Distribution & Indemnity Form.
4. Authority to Release Funds & Indemnity Checklist (continued).
As per the table above please complete the following section:
Full Name
Date of Birth
   /   /
Address:
Suburb
State Postcode
I am:
  An existing Westpac customer
Customer Number:
OR
 
Not an existing Westpac customer and have
completed the Certified Copy Certificate and
supplied Certified Copies of Identification.
Full Name
Date of Birth
   /   /
Address:
Suburb
State Postcode
I am:
  An existing Westpac customer
Customer Number:
OR
 
Not an existing Westpac customer and have
completed the Certified Copy Certificate and
supplied Certified Copies of Identification.
I/We acknowledge receipt/or request payment of this money.
I/We indemnify the bank against any actions or claims which may be made by any person for this money.
I/We undertake to reimburse the bank for this money and any other costs if it is subsequently proved that I am not
entitled to it.
I/We have read and agree to the Privacy Statement.
Signature
✗
Date
   /   /
Signature
✗
Date
   /   /
Next Steps:
Email this form with certified copies of all required supporting documentation to Estates Management
(estatesmanagement@westpac.com.au)
OR
Hand into any Westpac Branch with certified copies of all required supporting documentation.
OR
Mail this form with certified copies of all required supporting documentation to Westpac Estates Management
Estates Management IBN 11, GPO Box 3433, Sydney, NSW 2001.
© 2018 Westpac Banking Corporation ABN 33 007 457 141 AFSL and Australian credit licence 233714. DEC001 0918 Page 5 of 5
Notification of Death, Funds Distribution & Indemnity Form.
5. Privacy Statement.
Personal information.
We collect personal information from you to process
your request, provide you with a 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 no longer be able to provide a product or
serviceto you.
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.
Direct marketing.
We will use your personal information to contact you or
send you information about other products and services
oered by the Westpac Group or its preferred suppliers.
Please call us on 132 032 or visit any of our branches if you
do not wish to receive marketing communications from us.
Other acknowledgements and consents.
• Where you have provided information about another
individual, you must make them aware of the fact and
the contents of the Privacy Statement;
Our reporting obligations.
We are required to identify certain US persons in order to
meet account information reporting requirements under
local and international laws.
If you or (where you are applying on behalf of an entity)
the entity and/or any oce bearer* of the entity and/or
any individual who holds an interest in the entity of more
than 25% (a Controlling Person) are a US citizen or US tax
resident, you must telephone 1300 658 194 at the time
of completing this application. When you contact us you
will be asked to provide additional information about your
UStax status and/or the US tax status of the entity and/or
any Controlling Person which will constitute certification
of US tax status for the purposes of this application.
Unless you notify us that you or (where you are applying
on behalf of an entity) the entity and or Controlling
Person are a US citizen or US tax resident as specified
above, by completing this application you certify that you
or (whereyou are applying on behalf of an entity) the
entity and/or any Controlling Person are not a US citizen
or UStax resident.
If at any time after account opening information in our
possession suggests that you, the entity and/or any
Controlling Person may be a US citizen or US tax resident,
you may be contacted to provide further information
on your US tax status and/or the US tax status of the
entity and/or any Controlling Person. Failure to respond
may lead to certain reporting requirements applying to
theaccount.
* Director of a company, partner in a partnership, trustee of a trust,
chairman, secretary or treasurer of an association or co-operative.
Definitions.
“we”, “our”, “us” means Westpac Banking Corporation
ABN 33007 457 141.
“Westpac Group” means Westpac Banking Corporation
and itsrelated bodies corporate.
Acknowledgements.
I agree:
• That documents presented for identification
purposesmay be verified by the Bank with an
appropriate authority;
• If I have opened an e-Saver account and I’m registered
for Online Banking to be notified via my nominated
email address to view electronic statements online.
Iunderstand that I can elect to receive printed
statements instead by signing onto Westpac
OnlineBanking;
• To be bound by the terms and conditions which apply
from time to time to this account opened by me with
theBank;
• The Bank may charge to this or any other account(s)
Imay conduct with the Bank or recover from me
any bank fees, government charges, taxes or duties
imposedon transactions on/or which relate to my
accounts(s); and
• To check my account statements and notify the Bank
ofany errors or unusual transactions within 3 months
ofreceiving each account statement.
I acknowledge that I have received a copy of the relevant
terms and conditions that applies to this account.
I believe the details in this form to be true and correct.
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Wbc Notification Of Death Funds Distribution Indemnity Form (Australian National University)

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Completed 18 July 2020

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