JBWere Client Identification Form · JBWere collects and holds your personal information for the purposes of providing you with products and services, and in circumstances where the

Issued by: JBWere Limited (JBWere)

ABN 68 137 978 360, AFSL 341162

JBWere Client Identification Form15 May 2017

jbwere.com

2 Client identification form

Important notice about privacy

JBWere collects and holds your personal information for the purposes of providing you with products and services, and in circumstances where the collection of that information is required by law. If you do not provide your personal information, we may not be able to provide you with products or services.

JBWere is part of the National Australia Bank Limited group of companies (NAB Group), and we may disclose your personal information to others both within and outside the NAB Group.

Further details about how your personal information is collected, used, disclosed and handled is set out in our full Privacy Notification and Privacy Policy, which include information on how you may access or correct your personal information, the countries to which your personal information may be sent, and how you may make a complaint about a privacy issue.

You should read our Privacy Policy and full Privacy Notification, which are available at www.jbwere.com.

You can also request a copy from the Privacy Officer, JBWere Limited, Level 16, 101 Collins Street, Melbourne, Vic 3000.

© 2016 JBWere Limited

Client identification form 3

How to complete the client identification form

We require the information requested in this form to comply with legal and regulatory requirements to confirm the identity of clients before providing financial services to them.

Under relevant laws, we may be required to ask you for additional identity verification documents and/or information about you or a related party.

If you require any assistance completing this form, please contact your JBWere Advisor or JBWere Investor Services on 1800 812 267. If you are a New Zealand investor please call 0800 555 555.

Instructions for completing this form• Please print using a black or blue pen.

• If an item is not applicable, please leave the boxes unmarked.

• If you make an error, please initial the change. Please do not use correction fluid.

• To help us process this form promptly, please use the checklist in section 12, to ensure you have provided all information and additional documents required.

In addition to the information and documents requested in this form, we may require further information and documents from you.

Investor identification documentsIn addition to completing this Client Identification Form, you will also need to provide us with current certified copies of certain identification documents (as outlined in Sections A, B and C).

How is a document certified?A document can be certified by one of the persons listed below inspecting the original document and then signing, and writing on the copy ‘I certify this document of [XX] pages to be a true copy of the original as sighted by me’.

The certifier must indicate in which capacity the document is certified.

The certifier must print their name, registration number (where applicable), and date of certification.

Who can certify a document?

A document can be certified by any of the people identified below1:

• a chiropractor;

• a dentist;

• a medical practitioner;

• a nurse;

• an optometrist;

• a pharmacist;

• a physiotherapist;

• a psychologist;

• a veterinary surgeon;

• 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);

• a judge of a court;

• a magistrate;

• a chief executive officer of a Commonwealth court;

• a registrar or deputy registrar of a court;

• a Justice of the Peace;

• a notary public (for the purposes of the Statutory Declaration Regulations 1993);

• a police officer;

• an agent of the Australian Postal Corporation who is in charge of supplying postal services to the public;

• a permanent employee of the Australian Postal Corporation with two or more years of continuous service who is employed in an office supplying postal services to the public;

• an Australian Consular Officer or an Australian Diplomatic Officer (within the meaning of the Consular Fees Act 1955);

• a foreign public notary whose appointment is lawful and their status as a notary public can be verified;

• a finance company officer with two or more continuous years of service with one or more financial institutions (for the purposes of the Statutory Declarations Regulations 1993);

• a member of the Institute of Chartered Accountants in Australia, CPA Australia or the National Institute of Accountants; or

• any other person who, under a law in force in a State or Territory, is currently licensed or registered to practise in an occupation listed in Part 1 of Schedule 2 of the Statutory Declaration Regulations 1993 or a person outlined in Part 2 of Schedule 2 of the Statutory Declaration Regulations 1993.

1 Please note that if documents are being certified outside of Australia, only a subset of these people will be permitted. Please contact us for further details.


What parts of this form do I need to complete and what identification documents do I need to provide?This depends on the type of account you want to open. If you want to open:

An account in the name of an individual or individuals (including in their capacity as a sole trader)

Refer to Section A for information required

An account in the name of an individual or individuals (including in their capacity as a trustee) Refer to Section B for information required

An account in the name of an entity that is not individual (such as an account for a company, corporate trustee, partnership, incorporated association, unincorporated association, registered co-operative or government body)

Refer to Section C for information required

Section A – Accounts in the name of individuals

Information we need from youWe need:

• information about yourself; and

• if you are a sole trader, information about your business name and place of business. A sole trader is a single person operating a business under their own name, for example, James Smith Electrics, or with a registered business name, such as ‘Bright Spark Electrics’.

Complete the following sections of this form

Section 1

Section 2

Section 3

Section 4

Section 5

Section 6

Section 7

Section 8

Section 9

Section 10

Section 11

Section 12

Type of Investor

a b c d e f a b c d e a b c d e a b c d a b c d e f a b

Individual

Individual – Sole Trader

Key: required if applicable

Documents we need from you2

You will need to provide current certified copies that satisfy one of the identification combinations below (a minimum of 100 points):

Identification combinations Pictorial reference

2 x Primary photographic documents +1 x Primary photographic document AND 1 x Primary non-photographic document +1 x Primary photographic document AND 1 x Secondary document +1 x Primary non-photographic document AND 1 x Secondary document +

2 Please note that if a name change has occurred after these documents were issued you will need to provide a current certified copy of your name change documents.


Primary photographic documents

Valid documents description Notes Points value for each document

Driver’s licence Government issued licence. Must have photo. Licence cannot be expired. Licence must show current residential address and date of birth.

70Passport Must have photo. Australian passports may be expired within the preceding two years but not cancelled. Other passports must be current.

Identity card/permit other – Australian Government issue

Document cannot be expired

Primary non-photographic documents


Birth certificate/extractDocument must be current and valid.

70Citizenship certificate

Pension card/Health Care Card/Senior’s Health Card/Other equivalent card

Document must be current and valid and issued by an Australian Government Agency.

Secondary documents


Australian Taxation Office – notice Less than 12 months old from date of issue. Must contain individual’s name and residential address and records a tax debt payable to or by the individual

30

Commonwealth, State or Territory notice For example Centrelink Benefit notice. Must be less than 12 months old from date of issue. Contain individual’s name and residential address

Licence – other (international/foreign) Document cannot be expired

Licence – paper – Australian Government issue

Document cannot be expired

Medicare card Document cannot be expired

Rates notice Issued by a local government, must be under three months old from date of issue and contain the individual’s name and residential address

Utility bill Must record the provision of services to the individual. Must be less than three months old from date of issue and contain the individual’s name and residential address


Section B – Accounts in the name of individuals in the capacity as trustee


• information about yourself; and

• information about the trust, its beneficial owners and beneficiaries.

Complete the following sections of this form:

Section 1

Section 2

Section 3

Section 4

Section 5

Section 6

Section 7

Section 8

Section 9

Section 10

Section 11

Section 12

Type of investor

a b c d e f a b c d e a b c d e a b c d a b c d e f a b

Individual – in the capacity as trustee of an unregulated trust

•

Individual – in the capacity as trustee of a regulated trust

•

Key: required • if applicable


You will need to provide current certified copies of these documents.

Type of investor Description Australian Investor – identification documents

Non-Australian Investor – identification documents

Individual – in the capacity as trustee of an unregulated trust

A trust is a legal structure through which property or income is held in accordance with the Trust Deed or pursuant to a statute for a particular purpose or purposes, or for the benefit of other people or classes of people who may or may not include the trustee.

This investor type can include:

• Family – Discretionary Trust

• Family – Unit Trust

• Testamentary Trust

• Deceased Estate

• Informal Trusts

• Nominee/Custody arrangements

• Charitable Trust

• Trust for person under the age of 18.

• Identification documents as required for individual (refer to page 4 of this document), in respect of each trustee named on the account; and

• certified copy of the Trust Deed or applicable document; or

• a certified extract or extracts from the Trust Deed or applicable document that identifies the name of the trust, the name(s) of the trustee(s), the name of the settlor and the identity of the beneficiaries; or

• if the informal trust is for a person under the age of 18 – a certified copy of that person’s birth certificate or passport.

• Identification documents as required for individual (refer to page 4 of this document), in respect of each trustee named on the account; and

• certified copy of the Trust Deed or equivalent document; or

• a certified extract or extracts from the Trust Deed or equivalent document that identifies the name of the trust, the name(s) of the trustee(s), the place of establishment of the trust and the identity of the beneficiaries; or

• if the informal trust is for a person under the age of 18 – a certified copy of that person’s birth certificate or passport.

Individual – in the capacity as trustee of a regulated trust


• ASIC Registered Managed Investment Scheme

• Trusts that are subject to Commonwealth Statutory regulatory oversight, for example, SMSF

• Government Superannuation Funds established by legislation.

• Unregistered Managed Investment Scheme

• Certified copy of Trust Deed; or

• a certified extract from the Trust Deed or equivalent document that identifies the name of the trust and the name(s) of the trustee(s).

Not applicable



Section C – Accounts in other names (companies, corporate trustees, incorporated associations, unincorporated associations, partnerships, registered co-operatives, government bodies)


• information about the investing entity;

• information about the people who own or operate the investing entity, for example, directors, shareholders, beneficial owners, partners, other key office holders; and

• if the investing entity is a trustee of a trust, information about the trust and its beneficiaries.

Complete the following sections of this form:

Section 1

Section 2

Section 3

Section 4

Section 5

Section 6

Section 7

Section 8

Section 9

Section 10

Section 11

Section 12

Type of Investor

a b c d e f a b c d e a b c d e a b c d a b c d e f g a b

Public Listed company# •

Private or Public Unlisted^ Company

• • •

Company – in the capacity as trustee of an unregulated trust

• • • • • •

Company – in the capacity as trustee of a regulated trust (includes SMSFs)

• • • • • •

Incorporated Association • •

Unincorporated Association • • •

Registered Co‑Operative

Government Body • •

Partnership • •

Key: required • if applicable

#must be listed on an Approved Exchange; includes Majority Owned Subsidiary of an Australian Public Listed company, Regulated company

^ includes public companies listed on a non‑approved exchange.

egprxw

Sticky Note

Marked set by egprxw

egprxw

Sticky Note


egprxw

Sticky Note




You will need to give us current certified copies of these documents:



Public Listed Company# This investor type can include:

• Public companies listed on an Australian securities exchange or approved exchange

• Majority‑owned subsidiaries of Australian public listed companies

• Regulated companies

Not applicable Not applicable

Private or Public Unlisted^ Company

• This investor type can include:

• Proprietary or private companies

• Public companies listed in a non‑approved exchange

• Companies limited by guarantee, for example, some charities.

• Identification documents as required for individual (refer to page 4 of this document) in respect of each Beneficial Owner named on the account.

• Identification documents as required for individual (refer to page 4 of this document) in respect of each Beneficial Owner named on the account; and

• Foreign registration body database extract showing company’s full name, identification number, registered office, company type, name of directors and (if a proprietary company) name of shareholders of company.

Private or Public Unlisted^ Company – in the capacity as trustee of an unregulated trust

A trust is a legal structure through which property or income is held in accordance with the Trust Deed or pursuant to a statute, or other trust arrangement for a particular purpose or purposes, or for the benefit of other people who may or may not include the trustee.


• Family‑ Discretionary Trust

• Family‑ Unit Trust

• Testamentary Trust

• Deceased Estate

• Informal Trusts

• Nominee/Custody arrangements

• Charitable Trust

• Trust for person under the age of 18.

• Identification documents as required for individual (refer to page 4 of this document) in respect of each Beneficial Owner of the company; and

• Certified copy of the Trust Deed or equivalent document; or

• a certified extract or extracts from the Trust Deed or equivalent document that identifies the name of the trust, the name(s) of the trustee(s), the name of the settlor, the place of establishment of the trust and the identity of the beneficiaries; or

• if the informal trust is for a person under the age of 18‑ a certified copy of that person’s birth certificate or passport.


• Foreign registration body database extract showing company’s full name, identification number, registered office, company type, name of directors and (if a proprietary company) name of shareholders of company; and

• Certified copy of the Trust Deed or equivalent document; or

• a certified extract or extracts from the Trust Deed or equivalent document that identifies the name of the trust, the name(s) of the trustee(s), the place of establishment of the trust and the identity of the beneficiaries; or

• if the informal trust is for a person under the age of 18‑ a certified copy of that person’s birth certificate or passport.


# must be listed on an Approved Exchange; includes Majority Owned Subsidiary of an Australian Public Listed company, Regulated company.





Private or Public Unlisted^ Company – in the capacity as trustee of a regulated trust (includes SMSFs)


• ASIC Registered Managed Investment Scheme

• Unregistered Managed Investment Scheme

• Trusts that are subject to Commonwealth Statutory regulatory oversight, for example, SMSF, Government Superannuation Funds established by legislation.


• Certified copy of the Trust Deed; or

• a certified extract from the Trust Deed or equivalent document that identifies the name of trust and the name(s) of the trustee(s)

Not applicable

Incorporated Association Incorporated associations are associations registered under State or Territory based incorporated associations statutes.


• Minutes of the meeting of the association at which office bearers are appointed or Constitution or Rules of Association; and

• certified copy of certificate of incorporation.



• certified copy of certificate of incorporation.

Unincorporated Association Unincorporated associations are associations of persons who are not registered under an incorporated associations statute and thus do not have legal capacity to enter into agreements.

The member(s) of the association seeking to open the account will be deemed to be the legal owner of the account.



• Identification documents as required for individual (refer to page 4), in respect of one of the members of the association seeking to open the account.



• Identification documents as required for individual (refer to page 4), in respect of one of the members of the association seeking to open the account.

Registered Co-Operative A registered co‑operative is an autonomous association of persons united voluntarily to meet their common economic, social and cultural needs and aspirations through a jointly‑owned and democratically‑controlled enterprise registered under a registry system maintained by a State or Territory.

This investor type can include an agricultural business such as a dairy co‑operative.


• Current certified copy of the Certificate of Registration; or

• Minutes of meeting where a Senior Managing Official has signed off on; or

• Any register maintained by the co‑operative, which contains the details of the beneficial owners or senior managing official.


• Current certified copy of the Certificate of Registration; or

• Minutes of meeting where a Senior Managing Official has signed off on; or

• Any register maintained by the co‑operative, which contains the details of the beneficial owners or senior managing official.





Government Body A government body is a legal entity whose ownership is held by a government.


• universities

• local councils

• public utilities

Not applicable • Identification documents as required for individual (refer to page 4 of this document) in respect of each Beneficial Owner named on the account; and

• Current certified copy of enacting instrument or legistlation.

Partnership This investor type relates to partnerships created pursuant to a partnership agreement. It does not include joint investors.


• Current certified copy of the partnership agreement or minutes of the partnership meeting at which office bearers are appointed; and

• Identification documents as required for individual (refer to page 4), in respect of one partner named on the account.


• Current certified copy of the partnership agreement or minutes of the partnership meeting at which office bearers are appointed; and

• Identification documents as required for individual (refer to page 4), in respect of one partner named on the account.


1. Name of investing entity

Examples of entity names and account description:

Type of Investor 1 (a) Entity name 1 (b) Account description

Individual and Joint Peter Alfred Brown & Sue Ellen Brown

Individual (in the capacity as trustee of a trust or superannuation fund)

Sue Brown Sue Brown Family Trust or Brown SMSF

Company P Brown Pty Ltd

Company (in the capacity as trustee of a trust or superannuation fund)

P Brown Pty Ltd Brown Super Fund

Deceased estate Josie Brown Estate of Peter Brown

Partnership Peter Alfred Brown & Sue Ellen Brown Brown Partnership

Incorporated association Metro Soccer Club Inc

Unincorporated association Peter Alfred Brown & Sue Ellen Brown Downtown Social Club

Registered co-operative Maple Street Co-operative

Government body Downtown Council

(a) Entity name

(b) Account description

2. Contact detailsPlease provide details of the person we should contact with any queries about this form.

Name

Telephone

( )

Email

Client identification form


3. Investing entity source of fundsPlease identify the major source of funds for investment, by selecting one or more of the following which are applicable to the entity named in section 1.

Employment

Please indicate the nature of employment

Investments

Please indicate the type of investments, for example, superannuation, real estate, financial, etc.

Business activity

Please indicate the nature of business

Please indicate the industry

Inheritance/Gift

Please indicate the name of deceased/donor

Legal settlement

Please specify type of legal settlement

Other

Please specify


4. Details of individualsNotes for completion of this section – if you require space for additional individuals, please attach a separate page providing this information:

Company / Corporate trustee Each director must provide their details5

Incorporated Association, Unincorporated Association or Registered Co-operative

Each of the chairperson, secretary, treasurer and public officer (or equivalents) must provide their details

Unincorporated Association In addition to the above, one member must provide their details

Trustee Each Individual (trustee) must provide their details where the investing entity has more than one Individual (trustee)

Partnership If a regulated partnership, one partner must provide their details. If an unregulated partnership, each partner must provide their details.

1st IndividualCapacity

Individual (personal) Individual (trustee) Director Sole director and sole secretary

Chairperson / Secretary / Treasurer Partner Member Other (please specify)

Title

Mr Mrs Miss Ms Other

First name(s)

Surname

Residential address

Suburb State Postcode Country

Occupation (Individual (personal), sole trader investors only)

Business name (sole trader only)

Date of birth (DD/MM/YYYY) ABN (sole trader only)

5 This is not required for public listed companies


2nd IndividualCapacity

Individual (personal) Individual (trustee) Director


Title


First name(s)

Surname

Residential address





3rd IndividualCapacity



Title


First name(s)

Surname

Residential address






4th IndividualCapacity



Title


First name(s)

Surname

Residential address






5th IndividualCapacity



Title


First name(s)

Surname

Residential address





5. Company/Corporate Trustee

Notes for completion of this section – This section must be completed for the company or each corporate trustee. If you require space for additional corporate trustees, please attach a separate page providing all the below information.

(a) Company/Corporate Trustee Details

Please refer to investor description on page 8‑10.

Name in full

ACN

ABN

Registered office



Principal place of business/administration in Australia (if different from above – not a PO box)


Nature of business/industry

Type of company:

Foreign (proceed to 5(b))

Domestic

Public (company whose name does not include the word Pty or proprietary) (proceed to 5(c))

Proprietary (company whose name ends with Proprietary Ltd or Pty Ltd; also known as private companies) (proceed to 5(d))

(b) Foreign Company Details (for entities formed outside Australia only)

Country of formation, incorporation or registration ARBN if registered in Australia

If registered with ASIC, please provide principal place of business in Australia or local agent name and address

If not registered with ASIC, please provide the principal place of business of the company in its country of formation or incorporation (not a PO box)

Date of registration (DD/MM/YYYY)

Registered office in country of formation

If registered overseas:

Name of relevant foreign registration body

Registration identification number

Type of company

Public (company whose name does not include the word ‘Pty’ or ‘proprietary’) (proceed to 5(c))

Proprietary (company whose name ends with ‘Proprietary Ltd’ or ‘Pty Ltd’; also known as private companies) (proceed to 5(d))


(c) Listing and Regulatory Details (select all that apply)

Public Listed company (companies that are listed on an Approved Exchange^)

Name of market/exchange

Country

Majority Owned Subsidiary of an Australian Public Listed company

(companies that are majority owned by an Australian company that is listed on an Australian financial market such as the ASX)

Australian listed company name

Name of market/exchange

Regulated company (subject to the supervision of a Commonwealth, State or Territory statutory regulator beyond that provided

by ASIC as a company registration body. Examples include Australian Financial Services Licensees (AFSL);

Australian Credit Licensees (ACL); or Registrable Superannuation Entity (RSE) Licensees).

Regulator name

Licence details (e.g. AFSL, ACL, RSE)

If your entity type is one of those listed in section 5(c) and you have completed the required fields, this section is complete. Please proceed to section 11.

(d) Beneficial Ownership

Are there any individuals who ultimately own or control (directly or indirectly) through one or more shareholdings 25% or more of the issued capital of the company?

Yes proceed to 5(e) No proceed to 5(f)

(e) Shareholder Beneficial Owners

Provide the names of the individuals who ultimately own or control (directly or indirectly) through one or more shareholdings 25% or more of the issued capital of the company. If you require space for additional individuals, please attach a separate page providing this information.

Section 10 must also be completed for each individual named below.

Full given name(s) Surname

^Please contact us for further details


(f) Other Beneficial Owners

If there are no individuals who meet the requirements in section 5(e) above, please complete this section.Provide the names of the individuals who hold the position of senior managing officials (or equivalent) e.g. Managing Director or Directors.Section 10 must also be completed for each individual named below.

Full given name(s) Surname Role (for example Chairman, President etc)

6. Incorporated Association/Unincorporated Association

Please refer to investor description on page 8‑10.

(a) Incorporated Association/Unincorporated Association Details

Type of entity

Incorporated Association Unincorporated Association

Name in full

Registration Number (Incorporated Association only)

State/Territory registered

Registered office


Principal place of business/administration in Australia (if different from above – not a PO box)



(b) Beneficial Ownership

Are there any members entitled to 25% or more of the voting rights in the association (directly or indirectly), including a power of veto?

Yes (proceed to 6(c))

No Unincorporated Association (proceed to 6 (d); Incorporated Association (proceed to 6(e))


(c) Beneficial Owners

Provide the names of the members who are entitled to 25% or more of the voting rights in the association (directly or indirectly), including a power of veto. If you require space for additional members, please attach a separate page providing this information.Section 10 must also be completed for each member named below.


(d) Other Beneficial Owners (Unincorporated Association only)

If there are no members who meet the requirements in section 6(c) above, please complete this section. Provide the names of all those members with an interest of 25% or more in the assets of the Unincorporated Association upon the dissolution of the association.Section 10 must also be completed for each individual named below.


(e) Other Beneficial Owners (Incorporated and Unincorporated Associations)

If there are no members who meet the requirements in section 6 (c) or 6 (d) above (as relevant) please complete this section.

Provide the names of the individuals who hold the position of senior managing official(s) of the association (e.g. Chairman, Secretary or Treasurer or public officer who is authorised to sign on the association’s behalf).


Full given name(s) Surname Role (for example Chairman, Secretary etc)

7. Registered Co-Operative/Government Body

Please refer to investor type description on page 8‑10.

(a) Type of Entity

Registered Co-Operative (proceed to 7(b))

Government Body (proceed to 7(c))


(b) Registered Co-Operative

Name in full

Registration Number State/Territory Registered

Registered Office/Principal Place of Operations



Please proceed to section 7 (d).

(c) Government Body Details

Name in full

Principal Place of Operations



Commonwealth of Australia Government Body (proceed to section 11)

Australian State or Territory Government Body – please specify State or Territory (proceed to section 11)

Foreign (Non Australian) Government Body – please specify Foreign Country (proceed to section 7(e))


(d) Beneficial Owners (Registered Co-Operative only)

Provide the names of the individuals who control the business affairs of the co‑operative (e.g. Chairman, Secretary, Treasurer or Public Officer). If these roles do not exist, please provide the names of the individuals who hold the position of senior managing official(s) (e.g. who make(s) decisions affecting a substantial part of the business or who can significantly affect the financial standing of the Registered co‑operative).


Full given name(s) Surname Role (for example Chairman, Secretary etc

Please proceed to section 10.

(e) Beneficial Owners (Foreign Government Body Only)

Provide the names of the individuals who directly or indirectly control the Government Body or who hold the position of senior managing official(s) of the Government Body (e.g. CEO, CFO, COO or equivalent).


Full given name(s) Surname Role (for example Chairman, Secretary etc)

Please proceed to section 10.

8. PartnershipPlease refer to investor type description on page 8‑10.

(a) Partnership Details

Partnership name

Business name in full (if any)

Is this partnership regulated by a professional body?

No Yes, please specify


Country in which established

(b) Beneficial Ownership

Are there any individuals who ultimately own 25% or more of the shares, or who are entitled to (either directly or indirectly) exercise 25% or more of the voting rights of the partnership, including a power of veto?

Yes proceed to 8(c) No proceed to 8(d)


(c) Beneficial Owners

Provide the names of the individuals who ultimately own 25% or more of the shares, or who are entitled to (either directly or indirectly) exercise 25% or more of the voting rights of the partnership, including a power of veto.



(d) Other Beneficial Owners

If there are no individuals who meet the requirements in section 8(c) above, please complete this section.

Provide the names of individuals who hold the position of senior managing official(s) of the partnership (such as the managing partner or the senior managing official).


Full given name(s) Surname Role (for example Senior Managing Partner)

9. Trusts (including superannuation funds)

(a) Trust details

Trust name in full

Country in which established

(b) Business name of the trustee

Please specify full business name of the trustee in respect of the trust, if any


(c) Type of trust:

Australian Regulated Trust (proceed to 9(d))

Unregulated Australian Trust or Foreign Trust (proceed to 9(e))


(d) Type of Australian regulated trust

Self-Managed Superannuation Fund

ABN

Registered Managed Investment Scheme

Australian Registered Scheme Number (ARSN)

Unregistered Managed Investment Scheme (A managed investment scheme that is not registered by ASIC, that only has wholesale clients and does not make small scale offerings to which section 1012E of the Corporations Act 2001 applies)

ABN

Government Superannuation fund

Name of the legislation establishing the fund

Other regulated Trust (A trust that is subject to the regulatory oversight of a Commonwealth, State or Territory statutory regulator such as an approval deposit fund, a pooled superannuation trust or an APRA-regulated superannuation fund)

Provide name of the regulator (e.g. ASIC, APRA, ATO)

Provide the Trust’s ABN or registration/licensing details

Please proceed to section 11

(e) Type of unregulated trust

Please select which type of trust

Unit/Discretionary trust e.g. family Informal trust e.g. for minor Testamentary

Charitable Custody/Nominee arrangement Other – specify

Please provide the full name of Settlor(s)#

# The person(s) who settles the initial sum to create the trust.

(f) Beneficiary

Do the terms of the trust identify the beneficiaries by reference to membership of a class?

Yes Please provide details of the membership class(es) e.g. unit holders, family members of named person, charitable purpose

No How many beneficiaries are there? Provide full names of each beneficiary below


Beneficiary Details

Notes for completion of this section – if you require space for additional beneficiaries, please attach a separate page providing their individual name or company name.

Individual or company name

(g) Beneficial Ownership

Any individual trustees listed in section 4 and/or the beneficial owners of any corporate trustees listed in section 5 will be considered the beneficial owners of the trust.

10. Details of Beneficial OwnersPlease provide the details of the Beneficial Owners or senior managing officials in the section below (if you require space for additional Beneficial Owners, please attach a separate page providing this information).

For each Beneficial Owner identified below, please note that current certified copies of identification documents, which meet the identification requirements of an individual investor must be provided.

1st Beneficial Owner

Title


First name(s)

Surname

Residential address


Date of birth (DD/MM/YYYY)


2nd Beneficial Owner

Title


First name(s)

Surname

Residential address



3rd Beneficial Owner

Title


First name(s)

Surname

Residential address




4th Beneficial Owner

Title


First name(s)

Surname

Residential address



11. Foreign Account Tax Compliance Act (FATCA) / Common Reporting Standard (CRS)This section 11 must be completed for all individual, company, partnership, trust, association and registered co-operative accounts.

Notes for completion of this section – If you require space for additional individuals/entities, please attach a separate page providing the below information. Individuals go to section (a) and Entities go to section (b).

(a) INDIVIDUAL

1st Individual

Is the individual a tax resident of a country other than Australia Yes No

If yes, please provide their tax identification number or equivalent (TIN) below. If they are a tax resident of more than one other country, please list all relevant countries below. If no, please proceed to the next individual or section.

If a TIN is not provided, please list one of the three reasons specified (A, B or C) for not providing a TIN.

Country TIN If no TIN, list reason A, B or C

1.

2.

3.

If there are more countries, provide details on a separate sheet and tick this box.

Reason A The country of tax residency does not issue TINs to tax residents

Reason B The individual has not been issued with a TIN

Reason C The country of tax residency does not require the TIN to be disclosed

See page 33 for FATCA and CRS definitions and descriptions.


2nd Individual





1.

2.

3.





3rd Individual





1.

2.

3.







b) ENTITY ACCOUNT (COMPANY, PARTNERSHIP, TRUST, ASSOCIATION AND REGISTERED CO-OPERATIVE)

1. Tax Status

Select ONE of the Tax Status boxes below (if the entity is a Financial Institution, please provide all the requested information below)

Regulated super funds (Self‑Managed Superannuation Funds, APRA regulated super funds, government super funds or pooled superannuation trusts)

If the entity is a Regulated super fund, please proceed to section 12 to complete the form.

A Financial Institution (A custodial or depository institution, an investment entity or a specified insurance company for FATCA / CRS purposes)

Provide the entity’s Global Intermediary Identification Number (GIIN), if applicable

If the entity is a Financial Institution but does not have a GIIN, provide the entity’s FATCA (select ONE of the following statuses)

Deemed Compliant Financial Institution

Excepted Financial Institution

Exempt Beneficial Owner

Non Reporting IGA Financial Institution

(If the Entity is a Trustee-Documented Trust, provide the Trustee’s GIIN)

Non Participating Financial Institution

US Financial Institution

Other (describe the FATCA status in the box provided)

Please answer the question below for all financial institutions

Is the Financial Institution an Investment Entity located in a Non-Participating CRS Jurisdiction and managed by another Financial Institution?

Yes No

If Yes, proceed to section 2 (Foreign Controlling Persons). If No, Please go to section 12 to complete the form.

A Public Listed Company, an Australian Registered Charity, Deceased Estate, Majority Owned Subsidiary of a Public Listed Company, Governmental Entity, International Organisation or Central Bank.

If you have ticked this option, please proceed to section 12 to complete the form.

A Foreign Charity or an Active Non-Financial Entity (NFE)

If the entity is a Foreign Charity or an Active NFE, please proceed to section 3 (Country of Tax Residency).

Other (Entities that are not previously listed – Passive Non-Financial Entities)

Please proceed to section 2 (Foreign Controlling Persons).



2. Foreign Controlling Persons

Does the entity have any Controlling Persons who are tax residents of countries other than Australia? Yes No

If Yes, please provide the details of these individuals below and then proceed to section 3.

If No, please proceed to section 3.

1st Individual

First name(s)

Surname

Residential Address (If already provided, state ‘as above’)


Date of birth (DD/MM/YYYY) (If already provided, state ‘as above’)

Please list all foreign (non-Australian) tax residencies below.



1.

2.

3.







2nd Individual

First name(s)

Surname







1.

2.

3.





3rd Individual

First name(s)

Surname









1.

2.

3.





3. Country of Tax Residency (Entity)

Is the entity a tax resident of a country other than Australia? Yes No

If Yes, please provide the entities’ country of tax residence and tax identification number or equivalent (TIN) below. If the entity is a tax resident of more than one other country, please list all relevant countries below.

If No, please proceed to the next section to complete the form.



1.

2.

3.







12. Checklist

Please return this Client Identification Form with any additional documents to JBWere.

All relevant sections have been completed (refer to page 4,6 or 7 for instructions).

Current certified copies of all identification documentation have been provided (refer to pages 3 to 10 for details).

Current certified copy of Power of Attorney has been provided (if applicable).

Please note: if you have appointed another person to operate your account with JBWere (for example under Power of Attorney), we may require additional information about that person before we can act on their instructions.

Foreign Account Tax Compliance Act (FATCA)/ Common Reporting Standard (CRS)

The Foreign Account Tax Compliance Act (FATCA) is a United States (US) regulatory requirement that aims to deter tax evasion by US tax residents. FATCA has been in place since July 1, 2014.

The Organisation for Economic Cooperation and Development (OECD) developed the Common Reporting Standard (CRS) for the collection, reporting and exchange of financial account information among participating countries. The CRS is a global standard for the collection and exchange of account information and applies in Australia from July 1, 2017.

Under FATCA / CRS, financial institutions are required to identify clients that hold certain “financial accounts” and are US / foreign tax residents or that are entities with controlling persons that are US / foreign tax residents. Information on accounts and investments held by these clients must then be reported to the US Inland Revenue Service (IRS) / participating countries tax authority via the local tax authority (Australian Taxation Office in Australia). In certain cases, financial institutions are also required under FATCA to withhold and pay to the IRS a percentage of certain categories of US source payments.

FATCA/CRS Definitions

Active Non-Financial Entity (NFE)Active NFEs include entities where, during the previous reporting period, less than 50% of their gross income was passive

income (e.g. dividends, interests and royalties) and less than 50% of assets held produced passive income. For other types of Active NFEs, refer to Section VIII in the Annexure of the OECD ‘Standard for Automatic Exchange of Financial Account Information’ at www.oecd.org.)

Controlling PersonsA Controlling Person is any individual who directly or indirectly exercises control over the entity. For a company, this includes any beneficial owners controlling more than 25% of the shares in the company. For a Trust, this includes Trustees, Settlors or Beneficiaries. For a partnership this includes any partners.

CRS Participating JurisdictionsCRS Participating Jurisdictions are on the OECD website at http://www.oecd.org/tax/automatic‑exchange/crs‑implementation‑and‑assistance/crs‑by‑jurisdiction.

FATCA status Where a financial institution does not have a GIIN they will need to provide their FATCA status. This status can ONLY be one of the following:

• Deemed compliant Financial Institution

• Excepted Financial Institution

• Exempt beneficial owner

• Non reporting IGA Financial Institution

• Non‑participating Financial Institution

• US Financial Institution

• Other e.g. GIIN applied for but not yet issued

Entities that are financial institutions should be aware of their FATCA status and it is not your advisor’s responsibility to determine this. If you are not aware then it may be possible that the entity is not actually a financial institution.

Financial Institution A financial institution is an entity (e.g. company, partnership or trust) that engages in one of the following:

• accepts deposits in the ordinary course of a banking or similar business (depository institution);

• holds a substantial portion of its business (equals or exceeds 20 percent of the entity’s gross income) in financial assets for the account of others (custodial institution);

• is an investment entity including entities that trade in financial assets or that are investing, administering, managing funds, money, or certain financial assets on behalf of other persons;

• is an insurance company that issues or is obligated to make payments with respect to a Cash Value Insurance Contract or an Annuity Contract; or

• is an entity that is a holding company or treasury centre that is a part of a group that includes one of the above.

Global Intermediary Identification Number (GIIN) A Global Intermediary Identification Number (GIIN) is a unique ID number that non‑US financial institutions receive from the IRS when they register as a financial institution for FATCA.


Passive NFEA passive NFE means any NFE that is not an Active NFE.

Tax Residence for IndividualsTax Residency rules differ by country. Whether an individual is tax resident of a particular country is often (but not always) based on the amount of time a person spends in a country, the location of a person’s residence or place of work. For the US, tax residency can be as a result of citizenship or residency.

If you think you may be a foreign tax resident, but are not certain, it is advisable that you seek specialist tax advice. If you identify yourself as a foreign tax resident we will have to report your information to the ATO which, may in turn, report you to the relevant tax authority.

Taxpayer Identification Number (TIN)A TIN is the number assigned by each country for the purposes of administering tax laws. This is the equivalent of a Tax File Number (TFN) in Australia or an Employer Identification Number (EIN) in the US. Some jurisdictions use a functional equivalent, for example, the social security number in the US.

The OECD has published information on the usage and structure of the TINs on their Automatic Exchange Portal.

Client identification form 35 A13

5361

-051

7

Corporate directoryYou can contact JBWere using the details below.

Melbourne Level 16, 101 Collins Street Melbourne Vic 3000

Telephone: +61 3 9906 5000 Fax: 1300 798 149

Sydney Level 42, Governor Phillip Tower 1 Farrer Place Sydney NSW 2000

Telephone: +61 2 9325 2600 Fax: 1300 307 307

Adelaide Level 6, 22 King William Street Adelaide SA 5000

Telephone: +61 8 8407 1111 Fax: +61 8 8407 1112

Brisbane 34th Floor, Riverside Centre 123 Eagle Street Brisbane Qld 4000

Telephone: +61 7 3258 1111 Fax: +61 7 3258 1112

Canberra Level 3, 60 Marcus Clarke Street Canberra ACT 2600

Telephone: +61 2 6218 2000 Fax: +61 2 6218 2001

Perth Level 11, 100 St Georges Terrace Perth WA 6000

Telephone: +61 8 9212 7900 Fax: +61 8 9212 7999