Farm Management Deposit (FMD) Application Form

Transcription

1 Farm Management Deposit (FMD) Application Form INSTRUCTIONS FOR COMPLETING THE FARM MANAGEMENT DEPOSIT APPLICATION FORM Please read and complete sections A, B, D, E, F, H and I in BLOCK LETTERS using black ink. If you make a mistake, please cross it out and initial any change. Please read sections C, G and J as these sections contain important information that you need to understand. If you have any questions on completing this form please phone our Customer Service Centre on during normal business hours or service@ruralbankone.com.au If you are a new customer to Rural Bank ONE or Rural Bank you need to complete the Identity Verification Form which can be found on page 5-6. Additional Identity Verification Forms can be downloaded from Please read the Rural Bank ONE Farm Management Deposit (FMD) Terms and Conditions, Rural Bank ONE Accessing Your Account Terms and Conditions and Rural Bank ONE Schedule of Fees and Charges (Terms) available at and consider whether the product is appropriate for you before making any decision in relation to it. If you are applying for a fixed rate FMD, please ensure that you complete the Rural Bank ONE Fixed Rate Farm Management Consent Form. A DETAILS ACCOUNT LABEL (the name you would like to give to this account e.g Crop Production) B ACCOUNT OWNER DETAILS RURAL BANK CUSTOMER NUMBER (if existing customer) POSTAL ADDRESS (if different from residential address) TITLE GIVEN NAME(S) SURNAME STATE POSTCODE OTHER KNOWN NAME (if any) OF BIRTH PREFERRED CONTACT WILL BE HOME PHONE NUMBER WORK PHONE NUMBER RESIDENTIAL ADDRESS (PO Box not acceptable) MOBILE PHONE NUMBER OCCUPATION ADDRESS STATE POSTCODE COUNTRY OF RESIDENCE (if not Australia) DESCRIPTION OF MAJOR COMMODITIES PRODUCED IN THE YEAR OF DEPOSIT Page 1 of 10

2 C IMPORTANT INFORMATION ABOUT FMD ACCOUNTS Authorised deposit-taking institution The FMD provider issuing the application form is an authorised deposittaking institution for the purposes of the Banking Act Purpose of FMD scheme The FMD scheme is designed to allow individuals carrying on a primary production business in Australia (primary producers) with a taxable nonprimary production income, to shift before-tax income from years when they need it least to years when it is most needed. The scheme helps those individuals to manage their exposure to adverse economic events and seasonal fluctuations. Eligibility criteria apply to individuals carrying on a primary production business in Australia under the scheme. Tax consequences of FMDs The scheme allows individuals carrying on a primary production business in Australia to deduct the amount of any FMD they own from their assessable income for the income year in which the deposit is made. However, the amount of the deductions cannot exceed the owner s taxable primary production income for the income year. Under the Pay As You Go system, owners may reduce their instalment income for an instalment period by the amount of FMDs made during that period. The reduction is limited to the amount that the owners can reasonably expect to deduct for the deposit for the income year in which the deposit is made. However, the instalment income for the period cannot be reduced below nil. When a FMD is repaid to an owner in an instalment period, the instalment income of the period will include the amount of the repayment. But the owner s instalment income will only include so much of the repayment as will be included in the owner s assessable income for the income year in which the repayment is made. If neither the owner s tax file number nor Australian Business Number has been quoted to the FMD provider that holds the deposit, the amount repaid will also be subject to withholding tax at the rate equal to the sum of the top marginal tax rate and the Medicare Levy. Important requirements for FMDs Some of the requirements for FMDs are summarised below. There are also other requirements set out in the Income Tax Assessment Act A breach of some of the requirements will result in the deposit not being treated as a FM D, and the tax benefits will be lost. The owner must be an individual who is carrying on a primary production business in Australia when the deposit is made. The deposit must be made by only one individual and on behalf of only one individual. Rights of the depositor are not, and must not be, transferable to another entity. The deposit must not be used as security for any amount owed to the FMD provider or any other entity by the depositor or any other entity. The deposit must not be used, as a mortgage offset account or otherwise, to reduce the depositor s liability to pay interest on other debts to the FMD provider. Interest or other earnings on the deposit must not be invested as a FMD with the FMD provider without having first been paid to the depositor. If the depositor requests in writing, the FMD provider must electronically transfer the deposit, or part of the deposit, to another FMD provider that agrees to accept it as a FMD. The FMD provider must not deduct any fees from the principal of a FMD. However, it may charge fees on the deposit. Repayment of FMDs The tax benefits are not retained for deposit amounts repaid within the first 12 months after the deposit was made, unless the repayment is made: (a) because the owner: (i) dies; or (ii) becomes bankrupt; or (iii) ceases to carry on a primary production business in Australia and does not start carrying on such a business again within 120 days; or (iv) has requested the deposit, or part of the deposit, to be transferred to another FMD provider; or (b) because the circumstances specified in regulation 7 of the Income Tax (Farm Management Deposits) Regulations 1998, relating to repayment in the event of a natural disaster, exist. The amount of any repayment of the deposit must be at least $1,000, except where the entire amount of the deposit is repaid. Additional FMD information The minimum deposit is $1,000 (variable) or $5,000 (fixed) and the maximum deposit is $400,000, An individual can own more than one FMD, and can own FMDs with different FMD providers, but the sum of the balances all the FMDs of the owner must not be more than $400,000. The amount of any repayment of the deposit must be at least $1,000, except where the entire amount of the deposit is repaid. The taxable non-primary production income for the year of income must not exceed $100,000. D TRANSFERRING A FMD FROM ANOTHER FINANCIAL INSTITUTION Do you hold a FMD with another FMD provider? Yes* No *You can own more than one FMD, and can own FMDs with different FMD providers, but the sum of all balances of all your FMDs must not be more than $400,000. If yes, and you wish to transfer all, or part of, that FMD to your new Rural Bank ONE FMD please complete the FMD Account Transfer Form attached on page 10 and forward a copy to the FMD provider you are transferring funds from. No monies can be accepted into a Rural Bank ONE FMD until funds from the other FMD provider are electronically received by us. NAME OF FMD PROVIDER OF ORIGINAL DEPOSIT E TAX FILE NUMBERS (TFN) AND ACCOUNT PASSWORDS FOR YOUR CONFIDENTIALITY, THIS SECTION WILL BE DESTROYED AFTER ACCOUNT OPENING. You are not required by law to provide your TFN. However, if you do not provide your TFN or exemption reason, or if you are not an Australian resident, we are obliged to deduct tax at the highest marginal tax rate, plus Medicare Levy. Please nominate an account password for security and identification purposes. The password can be letters and/or numbers with a maximum of 14 characters. TFN/ TFN EXEMPTION REASON PASSWORD Page 2 of 10

3 F PRODUCT DETAILS Please select the product(s) you require, and any associated product features. VARIABLE RATE 3 MONTH FIXED RATE OR 6 MONTH FIXED RATE 12 MONTH FIXED RATE OR 24 MONTH FIXED RATE I want to make a deposit of: The minimum deposit amount is: $ $ $ $1,000 $5,000 $5,000 The maximum deposit amount is 1 : $400,000 $400,000 $400,000 Opening deposit method: Transfer from existing FMD at another financial institution (please complete and return the attached Farm Management Deposit (FMD) Account Transfer Form) Online Banking transfer Transfer from existing FMD at another financial institution (please complete and return the attached Farm Management Deposit (FMD) Account Transfer Form) Online Banking transfer Direct Debit (please complete and return the attached Direct Debit Request Form) Transfer from existing FMD at another financial institution (please complete and return the attached Farm Management Deposit (FMD) Account Transfer Form) Online Banking transfer Direct Debit (please complete and return the attached Direct Debit Request Form) Fixed Rate FMD consent (not applicable) By ticking this box I acknowledge that I have read and completed the Rural Bank ONE Fixed Rate Farm Management Deposit Consent Form By ticking this box I acknowledge that I have read and completed the Rural Bank ONE Fixed Rate Farm Management Deposit Consent Form I want interest to be paid: Interest is paid on 1 July. Interest can only be paid at maturity. Monthly Quarterly Annually Please complete the interest payment instructions: Note: Interest cannot be paid into an FMD account. NAME OF FINANCIAL INSTITUTION BRANCH NAME OF FINANCIAL INSTITUTION BRANCH NAME OF FINANCIAL INSTITUTION BRANCH REFERENCE (if any) REFERENCE (if any) REFERENCE (if any) Please indicate the reason for choosing Rural Bank ONE for your FMD: Account consolidation Customer service Interest rates Product features Marketing/campaigns Other 1 The cumulative balance of FMDs cannot exceed $400,000. FINANCIAL CLAIMS SCHEME DISCLOSURE STATEMENT Deposits with Rural Bank are covered by the Financial Claims Scheme. The account holder may be entitled to payment under the Financial Claims Scheme. Payments under the Scheme are subject to a limit for each depositer. Information about the Financial Claims Scheme can be obtained from the APRA website at and the APRA hotline on Page 3 of 10

4 G PRIVACY DISCLOSURE 1. Collection of your personal information We, Rural Bank, collect your personal information to assess your application, to provide you with the product or service that you have requested and to assess any future applications for products or services you may make to us or our related entities. Collection of some of this information is required by the Anti-Money Laundering and Counter- Terrorism Financing Act Sometimes we collect or confirm your personal information from a third party such as a credit reporting body. If you provide incomplete or incorrect information we may be unable to provide you with the product or service you are applying for. 2. Collection of personal information about third parties We may need to collect personal information about a third party from you as part of this application. If we do this, you agree you will advise that person that we have collected their personal information, and that in most cases they can access and seek correction of the information we hold about them. 3. Use and disclosure of your personal information We may use your personal information to perform our business functions (for example internal audit, operational risk, product development and planning). We may also use your personal information to confirm your details (for example contacting your employer to confirm your employment and income details). We treat your personal information as confidential and only disclose it to others where necessary. For example, we usually disclose your information to organisations to whom we outsource functions such as mailing and printing houses, IT providers, our agents and specialist advisers such as accountants and solicitors. Other disclosures usually include joint account holders, account operators and account applicants, insurers, intermediaries and government authorities. Your information may also be disclosed to our related entities, sales agents and service providers we engage to carry out function on our behalf where (in each case) its confidentiality is maintained at all times. 4. Disclosure of personal information to overseas organisations Some of the organisations we disclose your personal information to may be located overseas. Where an organisation is located overseas we will either take reasonable steps to ensure that it complies with Australian privacy laws or we will seek your consent to the disclosure. 5. Access to and correction of your personal information In most cases you can gain access to and seek correction of your personal information. Should you wish to do so, or if you have any queries about your information, please call our Customer Service Centre on Direct marketing We may use your personal information to inform you about financial products and services that are related to those you have with us or other products and services we think you may be interested in. These may be products and services provided by us, our related entities or other entities we are associated with. If you do not wish to receive any marketing material from us you can mark the box in the opt out provision appearing at the end of this form or contact our Customer Service Centre on Privacy Policy You should also read our Privacy Policy.Our Privacy Policy is an important document containing information about: a. how you can access and seek correction of your personal information held by us; b. how you can complain about a breach of the privacy laws by us and how we will deal with your complaint; c. if we disclose personal information to overseas entities, and where practicable, which countries those recipients are located in. Our Privacy Policy is available on our website or by telephoning H FOREIGN ACCOUNTS TAX COMPLIANCE ACT (FATCA) Is the applicant a Citizen or Resident of the US for Tax purposes? Yes No I DECLARATION AND EXECUTION If you are a new customer, you must complete the Identity Verification section which follows. By signing below, I acknowledge and confirm that; 1. I confirm that I have read and agree to the Privacy Disclosure in this application. 2. I acknowledge reading and understanding the important information about FMD accounts as set out in section C. 3. I acknowledge receiving the Financial Services Guide and agree to be bound by the Rural Bank ONE FMD Terms and Conditions. 4. I declare that the information provided in this application is true and complete and that Rural Bank will use it to determine whether or not to open an account. If you wish to opt out from receiving marketing material from Rural Bank please tick this box 5. I acknowledge that only instructions received from the Authorised Signatories via secure detailed in this application apply. Warning: It is an offence under Part 12 of the Anti-Money Laundering and Counter-Terrorism Act 2006 to provide false or misleading information, provide a false or misleading document or forge a document for use in an applicant identification procedure. FULL NAME J NEXT STEPS 1. Make sure you have completed all sections of the application form. 2. If you are a new customer to Rural Bank ONE or Rural Bank: a) complete the attached Identity Verification Form; b) attach the certified ID documents. 3. For Fixed Rate FMDs, please read and complete the attached Rural Bank ONE Fixed Rate Farm Management Deposit Consent Form. 4. If you are transferring this FMD from another financial institution please complete the attached Farm Management Deposit (FMD) Account Transfer Form. 5. If you are making an opening deposit by cheque, please attach your cheque made payable to the account holder or to Rural Bank Ltd to this application. 6. If you are making an opening deposit by direct debit, please complete and return the attached Direct Debit Request Form. 7. Post your documents (no postage stamp required within Australia) to: Rural Bank ONE Farm Management Deposit Account Applications Rural Bank Limited Reply Paid Rundle Mall SA 5000 If you have any questions please contact Rural Bank on or send us an at service@ruralbankone.com.au What happens next? Our staff will check we have all the required documentation from you and activate your account. We will you once the account is opened or if we require any further information. If you are opening your account via direct debit please make sure you have sufficient funds in this account to cover your opening deposit. Thank you for your application. We look forward to receiving your details and opening your Rural Bank ONE Account. F152_ Page 4 of 10

5 Identity Verification Form Please complete sections B, C, D, E and F in BLOCK LETTERS using black ink. Please note that all fields in each section are mandatory unless specified otherwise. You must attach certified copies of the documents used to verify your identity. A certified copy means a document that has been certified as a true copy of an original document by an Acceptable Referee, as listed in section B. To produce a certified copy, you should make a photocopy of the original document and take the original and the copy to the Acceptable Referee. If you have any questions on completing this form, please phone our Customer Service Centre on during normal business hours or service@ruralbankone.com.au A VERIFYING YOUR IDENTITY You must present the originals or certified copies of either: One document from Category 1 AND one document from Category 2 or 3 or 4; or One document from Category 2 AND one document from Category 3. Where the name on the document differs from the name used by the person in relation to the account further documentation will be requested. If you are not able to present the documents listed below, the Identity Verification Special Provisions Form may be used. CATEGORY 1 CATEGORY 2 An Australian Driver s Licence or Learner s Permit (current) A Proof of Age or Photo Card (current and government issued) An Australian Passport (current or expired within the last 2 years) A Foreign Passport (current and with a certified English translation) An Australian Birth Certificate or Birth Extract An Australian Citizenship Certificate CATEGORY 3 CATEGORY 4 A Utility Bill or Council Rates Notice (less than 3 months old) A Taxation Notice or Centrelink Statement (less than 12 months old) A Medicare card (current) A Pension card (current) A Health Care card issued by Centrelink (current) B CATEGORIES OF ACCEPTABLE REFEREES To be completed by the Acceptable Referee please tick the appropriate box. 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); An agent of the Australian Postal Corporation who is in charge of an office supplying postal services to the public; A permanent employee of the Australian Postal Corporation with 2 or more years of continuous service who is employed in an office supplying postal services to the public; A police officer; An Australian consular officer or an Australian diplomatic officer (within the meaning of the Consular Fees Act 1955); An officer with 2 or more continuous years of service with one or more financial institutions (for the purposes of the Statutory Declaration Regulations 1993); A finance company officer with 2 or more continuous years of service with one or more finance companies (for the purposes of the Statutory Declaration Regulations 1993); An officer with, or authorised representative of, a holder of an Australian financial services licence, having 2 or more continuous years of service with one or more licensees; or A member of the Institute of Chartered Accountants in Australia, CPA Australia or the Institute of Public Accountants with 2 or more years of continuous membership. C TITLE APPLICANT DETAILS GIVEN NAME(S) RESIDENTIAL ADDRESS (PO Box not acceptable) SURNAME OTHER KNOWN NAME (if any) CONTACT NUMBER OF BIRTH STATE COUNTRY OF RESIDENCE (if not Australia) POSTCODE Page 5 of 10

6 D DETAILS OF DOCUMENTS PROVIDED TO VERIFY YOUR IDENTITY Please ensure that certified copies of these documents are attached. DOCUMENT 1 DOCUMENT 2 TYPE OF DOCUMENT TYPE OF DOCUMENT DOCUMENT NUMBER DOCUMENT NUMBER PLACE OF ISSUE PLACE OF ISSUE OF ISSUE EXPIRY OF ISSUE EXPIRY E APPLICANT DECLARATION You must sign below in the presence of the Acceptable Referee. Warning: It is an offence under Part 12 of the Anti-Money Laundering and Counter-Terrorism Act 2006 to provide false or misleading information, provide a false or misleading document or forge a document for use in an applicant identification procedure. I acknowledge that the information on this form is true and complete. FULL NAME F ACCEPTABLE REFEREE DETAILS To be completed by the Acceptable Referee. TITLE GIVEN NAME(S) SURNAME EMPLOYER DETAILS NAME OF ORGANISATION ADDRESS OF ORGANISATION CONTACT NUMBER PROFESSIONAL MEMBERSHIP NUMBER (if any) STATE POSTCODE 1. I have selected my certifier type in section B; 2. I have checked that sections C and D are complete; 3. I have certified the documents listed in section D, that verifies the Applicant s name, date of birth and residential address, as a true copy of the original by signing and dating each page; and 4. I have witnessed the Applicant s signature in section E. I understand that Rural Bank may contact me regarding this identity verification. F150_ Page 6 of 10

7 Direct Debit Request RURAL BANK ONE FIXED FARM MANAGEMENT DEPOSIT (FIXED FMD) Request and authority to debit the account named below to pay: Rural Bank ONE Fixed Farm Management Deposit (Fixed FMD) If you wish to open your Rural Bank ONE Fixed FMD by direct debit, please complete this form and post it with your account opening application. A DIRECT DEBIT REQUEST I/we and of request and authorise Rural Bank Limited (User ID ) to arrange for any amount Rural Bank Limited may debit or charge me/us to be debited through the Bulk Electronic Clearing System from an account held at the financial institution identified below subject to the terms and conditions of the Direct Debit Request Service Agreement (and any further instructions provided below). B PAYMENT DETAILS PAYMENT AMOUNT PAYMENT AMOUNT $ AMOUNT IN WORDS ACCOUNT DETAILS BANK NAME BRANCH NARRATION (if required) Note: Please check with your financial institution to ensure the account nominated facilitates direct debiting. PAYMENT INSTRUCTIONS PAYMENT (dd/mm/yy) ACCOUNT TO BE CREDITED C PROTECTING YOUR PRIVACY We, Rural Bank Limited, collect your personal information to provide you with the direct debit services you have requested. To do that, we may need to disclose your personal information to electronic network administrators, other financial institutions and to an entity or person you have requested us to pay on your behalf. Some of these entities may be located overseas. If any of that information is not provided, we may not be able to provide you with those direct debit services. You should also read our privacy policy which contains information about how you can gain access to and seek correction of your personal information, and how you can complain about a breach of the privacy laws by us and how we will deal with a complaint. Our privacy policy is available at Page 7 of 10

8 D CUSTOMER AUTHORITY By signing this Direct Debit Request you acknowledge you have read and understood the terms and conditions governing the debit arrangements between you and Rural Bank Limited as set out in this request and in the Direct Debit Request Service Agreement below. 1 2 NAME NAME F DIRECT DEBIT REQUEST - SERVICE AGREEMENT Definition of Terms account means the account held at your financial institution from which we are authorised to arrange for funds to be debited; agreement means this Direct Debit Request Service Agreement between you and us; business day means a day other than a Saturday or a Sunday or a public holiday listed throughout Australia; debit day means the day that payment by you to us is due; debit payment means a particular transaction where a debit is made; direct debit request means the Direct Debit Request between you and us; us or we means Rural Bank Limited; you means the customer who signed the Direct Debit Request; and your financial institution means the financial institution where you hold the account that you have authorised us to debit. 1. Debiting your account 1.1. By signing a direct debit request, you have authorised us to arrange for funds to be debited from your account. You should refer to the direct debit request and this agreement for the terms of the arrangement between us and you We will only arrange for funds to be debited from your account as authorised in the direct debit request If the debit day falls on a day that is not a business day, we may direct your financial institution to debit your account on the following business day. 2. Changes by us 2.1. We may vary any details of this agreement or a direct debit request at any time by giving you at least fourteen (14) days written notice. 3. Changes by you 3.1. Subject to 3.2 and 3.3, you may change the arrangements under a direct debit request by contacting us via secure If you wish to stop or defer a debit payment you must notify us via secure at least seven (7) days before the debit day. This notice should be given to us in the first instance. You may also stop or defer a direct debit payment by contacting your financial institution You can cancel your authority for us to debit your account at any time by giving us seven (7) days notice in writing via secure before the debit day. This notice should be given to us in the first instance. You may also cancel your direct debit payment by contacting your financial institution. 4. Your obligations 4.1. It is your responsibility to ensure there are sufficient clear funds available in your account to allow a debit payment to be made in accordance with the direct debit request If there are insufficient funds in your account to meet a debit payment: i) you may be charged a fee and/or interest by your financial institution; ii) you may also incur fees or charges imposed or incurred by us. Please refer to the Rural Bank ONE Schedule of Fees and Charges for more information; and iii) you must arrange for the debit payment to be made by another method or arrange for sufficient clear funds to be in your account by an agreed time so that we can process the debit payment You should check your account statement to verify that the amounts debited from your account are correct If Rural Bank Limited (the Bank ) is liable to pay goods and services tax ( GST ) on a supply made by the Bank in connection with this agreement, then you agree to pay the Bank on demand an amount equal to the consideration payable for the supply multiplied by the prevailing GST rate. 5. Dispute 5.1. If you believe there has been an error in debiting your account, you should notify us directly on and confirm that notice in writing via secure with us as soon as possible so that we can resolve your query more quickly If we conclude as a result of our investigations that your account has been incorrectly debited we will respond to your query by arranging for your financial institution to adjust your account (including interest and charges) accordingly. We will also notify you in writing of the amount by which your account has been adjusted If we conclude as a result of our investigations that your account has not been incorrectly debited we will respond to your query by providing you with reasons and any evidence for this finding Any queries you may have about an error made in debiting your account should be directed to us in the first instance so we can attempt to resolve the matter between us and you. If we cannot resolve the matter you can still refer to your financial institution, which will obtain details from you about the disputed transaction and may lodge a claim on your behalf. 6. Accounts 6.1. You should check: i) with your financial institution whether direct debiting is available from your account as direct debiting is not available on all accounts offered by financial institutions; ii) your account details which you have provided to us are correct by checking them against a recent account statement; and iii) with your financial institution before completing the direct debit request if you have any queries about how to complete the direct debit request. 7. Notice 7.1. If you wish to notify us in writing about anything relating to this agreement, you should write to Rural Bank Limited, PO Box 3660, Rundle Mall SA, We will notify you by sending a notice in the ordinary post to the address you have given us in the direct debit request Any notice will be deemed to have been received two business days after it is posted. F153_ Page 8 of 10

9 Farm Management Deposit (FMD) Account Transfer Form Request to transfer Farm Management Deposit to Rural Bank. This form is to be completed and provided to the other FMD provider when transferring funds from an existing Farm Management Deposit held with another FMD provider to Rural Bank. A TRANSFER FROM (if more than one account, please complete an additional Rural Bank ONE FMD Transfer Form for each account) BANK NAME BRANCH AMOUNT B TRANSFER TO BANK NAME RURAL BANK LIMITED BANK ADDRESS LEVEL 6, 80 GRENFELL STREET ADELAIDE, SA 5000 C TRANSFER CONFIRMATION AND DETAILS (TO BE COMPLETED BY AN AUTHORISED OFFICER OF THE FMD PROVIDER FROM WHICH THE FMD IS BEING TRANSFERRED) ORIGINAL START OF THE FMD BEING TRANSFERRED BANK STAMP TITLE GIVEN NAME(S) SURNAME CONTACT NUMBER Once transfer has been processed, please fax this form to D CUSTOMER DECLARATION I hereby confirm that the sum of all my Farm Management Deposit accounts with Rural Bank and other FMD providers does not exceed $400,000 (including any deposit made when opening this Farm Management Deposit account). I hereby authorise the Farm Management Deposit detailed in the transfer from section above to be transferred to Rural Bank Limited. I hereby authorise (FMD provider from which funds are being transferred) to provide Rural Bank Limited with the initial start date of my Rural Bank Farm Management Deposit. F154_ Page 9 of 10

10 Rural Bank ONE Fixed Rate Farm Management Deposit Consent Form A CUSTOMER DETAILS CUSTOMER NUMBER/LEDGER: : : B Please consider the information below before investing in a Rural Bank ONE Fixed Rate Farm Management Deposit with us: 1. If you require immediate access to your funds in the future, please consider whether or not a Fixed Rate Farm Management Deposit is appropriate for you. We have other farm management deposit products available which may be more suitable. 2. By opening a Rural Bank ONE Fixed Rate Farm Management Deposit, you consent to us automatically renewing your investment on the maturity date. If no instructions are received by us before the maturity date, we will automatically roll your principal into an account with the same investment term (or nearest equivalent term if the previous investment term is no longer available) at the prevailing interest rate for that term. Due to interest rate movements over time, the interest rate applicable to the new FMD may be lower than the rate applied to the previous FMD. 3. Whenever you invest with us you have a 10 calendar day grace period, starting on the day after maturity, to make any changes to your Fixed Rate Farm Management Deposit. For instance, you may want to withdraw funds from your account, increase your investment amount or change the length of your investment term. During the grace period, you can make any such changes to your investment without incurring an interest rate reduction. 4. From 1 January 2015, should you wish to withdraw or transfer your funds after the grace period, your funds will be available 31 days after we receive your request, or at maturity, whichever occurs sooner. This does not apply in cases of proven hardship, as defined by us. Any funds withdrawn after the grace period and prior to maturity will be subject to an interest rate reduction. By ticking this box you acknowledge you have read and consent to the information above C IMPORTANT CUSTOMER INFORMATION CUSTOMER DECLARATION Please note: All parties to the account must acknowledge by also signing below. CUSTOMER 1 NAME D OFFICE USE ONLY STAFF MEMBER STAFF MEMBER NAME/ADM NO. Rural Bank Limited ABN AFSL PO Box 3660, Rundle Mall, SA 5000 Phone: Fax: F267_ Page 10 of 10