A sample Disclosure Certificate is set out below



4457700-45085Westpac Banking Corporation ABN 33 007 457 141AFSL and Australian credit licence 23371400Westpac Banking Corporation ABN 33 007 457 141AFSL and Australian credit licence 233714Customer Information Certificate – Foreign Company NOT registered in AustraliaDefinition: A foreign company NOT registered in Australia by the Australian Securities and Investment Commission (ASIC) which can be either:1.A foreign public company – a company incorporated outside of Australia entitled to raise funds by offering securities in itself to the public; or2.A foreign proprietary company – a company incorporated outside of Australia which is a private/proprietary or other type of company in accordance with the requirements of the jurisdiction in which it is incorporated.Please note that this certificate may have been pre-populated with information that the Bank has previously collected from the customer. In completing this form you are responsible for completing any blank sections, checking the accuracy of any pre-populated section, informing us if any of the information is not correct and supplying the correct information in substitution.Bank useonly (initials)1Is the company registered in Australia with ASIC? FORMCHECKBOX Yes Complete the Customer Information Certificate for a Foreign Company Registered in Australia FORMCHECKBOX No Go to 2 FORMTEXT ?????2Full name of company FORMTEXT ????? FORMTEXT ????? Does the company have a business/trading name, other than the company name, under which it carries on its business? FORMCHECKBOX Yes (insert business/trading name) FORMTEXT ????? FORMCHECKBOX No FORMTEXT ?????4Does the company have an Australian Business Number (ABN)? FORMCHECKBOX Yes (insert ABN) FORMTEXT ????? FORMCHECKBOX No FORMTEXT ?????5Is the company a tax resident of any country outside of Australia? FORMCHECKBOX Yes FORMCHECKBOX No Go to 7 FORMTEXT ?????6Country(ies) outside of Australia in which the company is a resident for tax purposes and country’s associated Tax Identification Number (TIN)**A TIN is an identifying number or equivalent used for tax purposes. If a ‘TIN’ is not available, please specify the reason against the appropriate country.Note: If the company has more than 3 countries in which it is a tax resident, please provide the details on a separate paper.Country of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authorityCountry of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authorityCountry of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authority FORMTEXT ?????7Country of company’s formation/ incorporation/ registration FORMTEXT ????? FORMTEXT ?????8Date of formation/incorporation/registration FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ???? FORMTEXT ?????9Company’s principal place of business address in country of formation/incorporation/ registration (not a PO box) FORMTEXT ????? FORMTEXT ?????10Company’s registered address in country of formation/ incorporation/registration (not a PO box) FORMTEXT ????? FORMCHECKBOX Same as company’s principal place of business address above FORMTEXT ?????11Is the company registered outside of Australia by a government body responsible for the incorporation/ registration of companies, e.g. company registry office? FORMCHECKBOX Yes Go to 12 FORMCHECKBOX No Contact your bank representative for further guidance FORMTEXT ?????12Name of the government body responsible for the incorporation/registration of the company, e.g. company registry office Note: This is the body responsible for incorporating/ registering your company NOT the body responsible for regulating/overseeing the industry/business of your company. FORMTEXT ????? FORMTEXT ?????13Company registration number issued by the government body, e.g. company registry office FORMTEXT ????? FORMTEXT ?????14Company type as registered with the government body, e.g. company registry office (select appropriate box) FORMCHECKBOX Public Go to 15 FORMCHECKBOX Private/proprietary Go to 18 FORMCHECKBOX Other, specify below Go to 18 FORMTEXT ????? FORMTEXT ?????15Is the company listed on a foreign stock exchange? FORMCHECKBOX Yes Go to 16 FORMCHECKBOX No Go to 19 FORMTEXT ?????16Country or jurisdiction of the foreign stock exchange FORMTEXT ????? FORMTEXT ?????17Name of the foreign stock exchangeInsert stock exchange name FORMTEXT ????? Go to 23Note: subject to due diligence, the Bank may ask for additional information on the company’s beneficial owners. FORMTEXT ?????18Full name (all given names including middle name(s) and family name) of each Director Note: An initial, nickname, alias, shortened name or part of a name is NOT acceptable. FORMTEXT ????? FORMTEXT ?????19Beneficial Owner – OwnerDoes the company have any INDIVIDUALS (NATURAL PERSONS), who ultimately own directly or indirectly, through one or more shareholdings, 25 per cent or more of the issued capital of the company? Note: This includes INDIVIDUALS (NATURAL PERSONS) who are owners of an underlying company and who ultimately own 25 per cent or more of the issued capital of the company listed above at 2. FORMCHECKBOX Yes Go to 22 FORMCHECKBOX No Go to 20 FORMTEXT ?????20Beneficial Owner – ControllerDoes the company have any INDIVIDUALS (NATURAL PERSONS), who ultimately control, through a capacity to make financial and operating decisions on behalf of the company? FORMCHECKBOX Yes Go to 22 FORMCHECKBOX No Go to 21 FORMTEXT ?????21Beneficial Owner – OtherThe company must have at least one ultimate beneficial owner. If you have answered “No” to Q19 and Q20 above, provide the details of any INDIVIDUALS (NATURAL PERSONS), who have 25% or more voting rights (including a power of veto) or hold the position of senior managing official (or equivalent), e.g. CEO? Go to 22 FORMTEXT ?????22Provide the details of each INDIVIDUAL (NATURAL PERSON) who is a beneficial ownerNote: the identity of all beneficial owners must be verified. This can be completed through the provision of certified copies of identification documents or via electronic verification. Electronic verification is only available to individuals with an Australian residential address and an Australian mobile number. Foreign Tax Residency Information:A Tax Identification Number (TIN) is an identifying number or equivalent used for tax purposes. If a ‘TIN’ is not available, please specify the reason against the appropriate country.Note: If the beneficial owner has more than 3 countries in which they are a tax resident, please provide the details on a separate paper.Beneficial Owner 1All given names: FORMTEXT ?????Family name: FORMTEXT ?????Other name(s) known by (if any): FORMTEXT ?????Date of birth: FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????Permanent residential address, including country (not a PO Box): FORMTEXT ????? FORMTEXT ?????Email address for electronic verification purposes: FORMTEXT ?????Foreign Tax Residency Information:Is beneficial owner 1 a tax resident of any country outside of Australia? FORMCHECKBOX Yes FORMCHECKBOX No If yes, please indicate the country(ies) in which beneficial owner 1 is a resident for tax purposes and each country’s associated TIN.Country of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authorityCountry of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authorityCountry of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authorityBeneficial Owner 2All given names: FORMTEXT ?????Family name: FORMTEXT ?????Other name(s) known by (if any): FORMTEXT ?????Date of birth: FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ???? Permanent residential address, including country (not a PO Box): FORMTEXT ????? FORMTEXT ?????Email address for electronic verification purposes: FORMTEXT ?????Foreign Tax Residency Information:Is beneficial owner 2 a tax resident of any country outside of Australia? FORMCHECKBOX Yes FORMCHECKBOX No If yes, please indicate the country(ies) in which beneficial owner 2 is a resident for tax purposes and each country’s associated TIN.Country of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authorityCountry of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authorityCountry of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authorityBeneficial Owner 3All given names: FORMTEXT ?????Family name: FORMTEXT ?????Other name(s) known by (if any): FORMTEXT ?????Date of birth: FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????Permanent residential address, including country (not a PO Box): FORMTEXT ????? FORMTEXT ?????Email address for electronic verification purposes: FORMTEXT ?????Foreign Tax Residency Information:Is beneficial owner 3 a tax resident of any country outside of Australia? FORMCHECKBOX Yes FORMCHECKBOX No If yes, please indicate the country(ies) in which beneficial owner 3 is a resident for tax purposes and each country’s associated TIN.Country of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authorityCountry of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authorityCountry of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authorityBeneficial Owner 4All given names: FORMTEXT ?????Family name: FORMTEXT ?????Other name(s) known by (if any): FORMTEXT ?????Date of birth: FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????Permanent residential address, including country (not a PO Box): FORMTEXT ????? FORMTEXT ?????Email address for electronic verification purposes: FORMTEXT ?????Foreign Tax Residency Information:Is beneficial owner 4 a tax resident of any country outside of Australia? FORMCHECKBOX Yes FORMCHECKBOX No If yes, please indicate the country(ies) in which beneficial owner 4 is a resident for tax purposes and each country’s associated TIN.Country of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authorityCountry of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authorityCountry of tax residence: FORMTEXT ?????TIN: FORMTEXT ?????OR FORMCHECKBOX TIN not issued by this country FORMCHECKBOX TIN pending issue by country's tax authority FORMTEXT ?????23Full name of person providing this certificate FORMTEXT ?????24Capacity of person providing this certificate (select appropriate box) FORMCHECKBOX Director FORMCHECKBOX Secretary FORMCHECKBOX Financial Controller FORMCHECKBOX Authorised Representative (e.g. solicitor, accountant)25CertificationI hereby certify that:1.I am authorised to complete this certificate on behalf of the Customer;2.The details included in this certificate are true and correct as at the date of this certificate;3.All documents in the possession or control of the Customer that verify the information in this certificate have been supplied to the Bank and all documents so supplied are true and correct as at the date of this certificate; and4.I acknowledge that the Bank will rely on this certificate to determine whether to provide services to the Customer in compliance with the law. 26Signature of person providing this certificate27Date FORMTEXT ?? / FORMTEXT ?? / FORMTEXT ????Privacy Statement: The personal information Westpac is collecting from you on this form will be used to satisfy our identification requirements under the Anti-Money Laundering & Counter-Terrorism Financing Act and Rules. If you do not provide all the information requested, we may not be able to provide any product or service to the Customer. Note: It is an offence 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. Penalty: Imprisonment for 10 years.Our processing of your personal data (which includes collection, use, sharing, storage and other activities involving personal data) is regulated by certain laws. Details of these laws are on our Privacy page, the link to which is contained in the Further Information paragraph below.This Privacy Statement describes how we process your personal data and your key rights under applicable privacy laws.Personal data means any information relating to you where you are either identified or identifiable.Where you provide personal data about other individuals, you must tell those individuals that you have supplied their information to us and make them aware of the contents of this Privacy Statement.Who are we?When we say “Westpac”, “we”, “our”, “us”, we mean Westpac Banking Corporation (incorporated in Australia) ABN 33 007 457 141 who acts as the data controller for the personal data we process about you, unless stated otherwise. References to the “Westpac Group” in this Privacy Statement are a reference to Westpac Banking Corporation and its related companies. How do we collect your personal data?We collect your personal data from you as the representative or signatory of your organisation, but in certain circumstances we may collect personal data about you from third parties (e.g. other Westpac Group companies or publicly available sources).Where you apply for credit products or services, we may collect personal data about you from third parties, such as other financial institutions, for verification purposes. We may collect personal data from you in writing (e.g. letters and application forms) or electronically (e.g. emails, through cookies when you use online banking or mobile applications). 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 will keep your personal data for as long as you are a customer of the Westpac Group. We also generally retain your personal data for at least seven years after you stop being a customer to comply with our legal obligations and so that we can respond to any questions or complaints regarding our interactions with you.Why do we collect your personal data?We collect your personal data to:review your suitability for our products and services; manage the delivery of products and services to you; manage our relationship with you;confirm your identity;comply with legislative or regulatory requirements in the jurisdictions in which we operate;comply with requests from regulatory bodies, government agencies and law enforcement bodies;assist you with product information that you have requested; make automated decisions in order to detect, prevent and report on financial crime;make credit approval decisions involving a combination of automated and non-automated decisions; communicate with you in relation to products and services we offer (including through third parties);communicate with you on behalf of our partners and third parties; andshare information with companies within the Westpac Group.Who do we share your personal data with?We may share your personal data with third parties (some of which are located outside of Australia or the European Economic Area) including:our contracted services providers who help us with various aspects of the management and administration of our business activities relating to the product(s) or service(s) you applied for (e.g. transaction processing providers, mailing houses, technology service providers and cloud storage providers); affiliates or companies within the Westpac Group; other organisations, who jointly with us, provide products or services to you, or with whom we partner to provide products and services to you;fraud bureaus or other organisations to identify, investigate or prevent fraud or other misconduct; regulatory bodies, government agencies and law enforcement bodies in any jurisdiction subject always to a legitimate and lawful basis for sharing or disclosing your personal data;credit reporting bodies and other credit providers; andyour representatives including your legal adviser, mortgage broker, financial adviser, executor, administrator, guardian, trustee, or attorney.Please refer to the Further information section to find a link to our Privacy Policies which disclose the locations of our third parties.What are your rights?Our Privacy Policy and EU Data Protection Policy cover:how you can request access to or correct your personal data; andhow you can make a complaint where you have concerns about our handling of your personal data (including where you believe there has been a breach of the Australian Privacy Principles or a registered privacy code). If you are not satisfied with how we are processing your personal data, or you would like to make a complaint, you can contact:in Australia, our Privacy Officer by, calling 1300 130 467, using the Feedback Form or writing to us at Reply Paid 5265, Sydney NSW 2001. in the United Kingdom, our Data Protection Officer by, calling + 44 (0) 20 7621 7000, or writing to us at Westpac Banking Corporation, Camomile Court, 23 Camomile Street, London EC3A 7LL.You can also visit any of our branches or instores in Australia or our London branch.Further informationFor more details on how we collect, hold, use and disclose your personal data, please see our Privacy Policy and EU Data Protection Policy.You can view or download a copy of these policies by visiting .au/privacy/privacy-policy or .au/privacy/eu-data-protection-policy or request a printed copy in a Westpac branch or through your Relationship Manager or by contacting us using the Contact details above.We will update our Privacy Policies from time to time.Westpac’s 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 persons/beneficial owner, you will inform the bank. You also certify that if 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 individual(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 persons in equivalent or similar positions. ................
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