Collection and Verification of Know Your Customer Information for Government BodiesBPB KYC Form

Guide to completing this form

This form applies to Government Bodies.

It does not apply to Trusts, Individual Customers, Sole Traders / Joint Traders, Companies, Partnerships, Incorporated Associations, Unincorporated Associations, Body Corporate, Incorporated Limited Partnerships or Registered Co-Operatives

Section 1 – General Organisation Information

Section 2 – Government Bodies

Section 3 – Privacy

Section 4 – Declaration

Guide to completing this formThis form can be completed by either a Customer, Bank Staff or Broker to collect and verify the Know Your Customer (KYC) information requirements.

Completed By: Customer Bank staff Broker • Bank Staff and Broker to complete the Bank Use Only section by adding a tick into the Verified boxes below on the right

hand side regardless of completion method during the process of collecting the KYC information from the customer and where required, verifying it against identification document(s) or via electronic search.

• Where the method of completion has been marked as Bank Staff, the Bank Staff Declaration in Section 4 must be completed by Bank Staff only

• Where the method of completion has been marked as either Customer or Broker, the Customer Declaration in Section 4 must be completed by the customer.

• Bank Staff to image the supporting documentation to CommSee in all circumstances• Bank Staff and Broker to complete the Bank Use Only: Verifications section in all circumstancess• Bank Staff to complete the Bank Use Only: Reasonableness section

Section 1 – General organisation information

Full name of organisation#

Full business name* (if any)

Verified#

The information against the checkbox indicates field must be verified against an acceptable identification documentation or data source.

Bank Use Only

Industry

Registered office address (PO Box is not acceptable)

State Postcode Country

#Verify Full Name of organisation

Complete all fields per organisation type

Principal place of business/administration/operations address (PO Box is not acceptable) Same as registered office address

State Postcode Country

# Government Bodies only Verified#

Postal address Same as registered office address Same as principal place of business/administration address

State Postcode Country

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Section 1 – General organisation information (continued) Bank Use Only

Is the organisation Not For Profit? (Tick (✔) the box that is applicable)

No Yes Please provide industry/sector

Is the organisation operating as a charity? (Tick (✔) the box that is applicable)

No Yes If Yes, please complete the following question: What is the objective/purpose of the charity? (e.g. vocational training for disabled, persons, assistance for tsunami victims, building fund for a particular school or institution etc.)

Complete all fields per organisation type

Section 2 – Government Body Bank Use Only

Verifiedis established under legislation of the:

Commonwealth of Australia Government

Australian State or Territory Government Please provide state or territory

Local Government Please provide state or territory

Please provide Local Government Area

Foreign Country Government Please provide country

Nature of government activity

Verified

Please tick one of the following:The government body is an:

Entity OR Emanation OR

Verified

Please provide additional information below for the Head of Foreign Country Government

If the Head of Foreign Country Government intends to be a signatory, a separate KYC Form for Individuals will be required to be completed.

Title Full given name(s) Surname

Other names known by (if any) Date of birth Gender

Male FemaleResidential address (PO Box is not acceptable)

State Postcode Country

Do you have an existing Commonwealth Bank account? (Tick (✔) the box that is applicable)

No

Yes Please provide account number

Verified**Verify either the Date of Birth or the Address

Section 3 – Privacy

Commonwealth Bank of Australia is collecting your personal information to identify you in accordance with the Anti-Money Laundering and Counter-Terrorism Financing Act 2006. For more information about how we collect and handle personal information, including how you can access, or seek correction of, your information or contact us with any feedback, please see our Privacy available on www.commbank.com.au.

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Section 4 – Declaration

Customer Declaration (Complete if “Completed By: Customer or Broker” has been selected)

This declaration is to be signed by a nominated representative (e.g. director, secretary or authorised officer of the company, partner for a partnership, office holder for an association/co-operative or delegate holding appropriate delegation on behalf of the government) of the entity.

I understand and acknowledge that the law requires applicants to provide true and correct information and state all the names by which they are commonly known. I also understand that the law prohibits the use of false names, as well as the giving, use or production of false or misleading information or documents in connection with the provision of financial services and making, possession or use of a false document in connection with an identification procedure.

I have obtained consent of any individual(s) whose personal information is provided in the application. They have authorised the collection, use or exchange of their information in accordance with Group Privacy Policy.

I certify that I am authorised by, and have the consent of the organisation and all beneficial owners to provide this information on their behalf and they have confirmed to me that the information provided about them is true and correct. I confirm I have made them aware that this information and information relating to the account may be provided to the tax authorities.

I declare that the details as shown on this form are complete and correct and that I will advise the bank if these details change.

✗

Signature Date

Name Position

Bank Staff Declaration (Complete if “Completed By: Bank Staff” has been selected)

Note: Brokers cannot complete this section

I confirm the information collected in this form has been supplied by the customer.

The customer has confirmed that:

The information is true and correct and they will promptly advise the Bank if any of their information changes.

They are authorised by, and have the consent of the organisation and all beneficial owners to provide this information on their behalf and the beneficial owners have confirmed that the information provided about them is true and correct.

They have made them aware that this information and information relating to the account may be provided to the tax authorities.

A. Name of the person who completed this checklist:

Name Date

B. How was the customer information collected i.e. meeting/phone/email

C. Date of the meeting/phone call/email

D. Customer/s Authorised representative who provided the Customer information

Full given name(s) Surname

Position (if applicable)

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Bank Use Only: Verifications

Completed by:Bank Staff or Broker

I confirm that the information checked in the verification documents correctly reflects the information supplied by the customer and matches the information in this completed form.

Bank Staff/Broker Bank Staff/Broker number

✗

Signature

Bank Staff/Operations Support

I confirm that the information checked in the verification documents as set out above correctly reflects the information supplied by the customer in the form.

Support/Operations Staff number

✗

Signature Date

Bank Use Only: Reasonableness

Completed by:Bank Staff

I confirm that the declaration of country/ies of tax residence is reasonable given the information known about the customer, including the information collected for AML/KYC purposes.

Bank Staff Staff number

✗

Signature Date

Comment

Bank Use Only: Discrepancy

Please complete this section if any discrepancy has been identified in KYC information and the way in which it has been resolved.

In the instance where changes or additions were made by me on this form, all such information was collected by me directly from the customer and all the changes or additions to this form have been initialled by me

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