Section 1

Your personal details

We need to verify your identity as required by AUSTRAC regulations.

Full legal name *

Date of birth *

Residential address *

Postal address

Leave blank if same as residential address

Occupation *

Employer / business name

Country of tax residence *

Tax File Number (TFN)

Providing your TFN is voluntary

Email address *

Phone number *

Identity documents provided

Company details

Details of the company to be formed or for which services are being engaged.

Proposed or existing company name *

ACN

ABN

Registered office address *

Principal place of business

Nature of business activities *

Expected annual turnover

Primary country of operations

Directors

Full name

Date of birth

Address

Shareholders

Full name

Ownership %

Address

Section 3

Trust details

Complete this section if a trust is involved. If no trust applies, click Next to continue.

Trust name

Trust type

Trustee name(s)

Appointor name(s)

Settlor name

Beneficiaries

Purpose of the trust

Section 4

Beneficial owners

A beneficial owner is any person who owns 25% or more of the entity, controls it, or exercises effective influence over its decisions.

All beneficial owners must be listed, even if they are not directors or shareholders.

Full name

Date of birth

Ownership %

Declaration

By proceeding, you certify that the beneficial ownership information provided above is true and complete.

I confirm all beneficial owners have been disclosed

Section 5

Source of funds & wealth

We are required to understand where the funds used in this structure originate.

Purpose of the entity

Source of initial capital

Estimated initial investment / capital amount

Source of wealth explanation *

Section 6

Politically exposed persons & sanctions

These declarations are required by law. Most clients will answer No to both questions.

Politically exposed person (PEP) check

Are you, any director, shareholder, trustee, or beneficial owner a current or former senior government official, their immediate family member, or a close associate?

No — none of the above apply Yes — details below

PEP details (if yes)

Sanctions & high-risk jurisdictions

Do any parties reside in, transact with, or have connections to sanctioned jurisdictions or countries on Australia's high-risk list?

No Yes — details below

Sanctions details (if yes)

Section 7

Transaction activity

These questions help us complete our risk assessment as required by AUSTRAC.

Expected transaction activity *

Section 8

Declaration & acknowledgement

Please read and confirm the following before submitting.

By submitting this form, you acknowledge that:

All identification information provided is true, accurate, and complete.
Services may be delayed or declined pending successful identity verification.
We are required by law to report suspicious matters to AUSTRAC where applicable.
We may conduct ongoing customer due diligence throughout the engagement.
You must notify us within 30 days of any change to ownership, directors, trustees, beneficial owners, address, or business activities.
All information must be kept current for the duration of the engagement.

I confirm that all information provided in this form is true and correct I have read and understood the AML/CTF compliance notice above I authorise the collection, use, and storage of this information for AML/CTF compliance purposes

Full name (as signatory) *

Date *

Documents to be provided

Please confirm which documents you will provide to our office (originals or certified copies):

Photo ID (driver licence or passport) Address verification (utility bill or bank statement — within 3 months) ASIC company extract (if existing company) Company constitution (if existing company) Trust deed (if applicable) Share register (if applicable)

Please tick all three declaration boxes before submitting.

New client information form

Your personal details

Company details

Trust details

Beneficial owners

Source of funds & wealth

Politically exposed persons & sanctions

Transaction activity

Declaration & acknowledgement

Thank you — form submitted

Id Verification