National Waterexchange Customer Registration Form - How to complete
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1 National Waterexchange Customer Registration Form - How to complete This Customer Registration Form needs to be completed in full and returned as per the contact details at the bottom of this page in order to register to trade water products on The National Waterexchange. Important Before you sign this document please ensure that you have read the Brokerage Agreement (between National Waterexchange Pty Ltd, you, as the Customer whose details appear in this Customer Registration Form and the broker whose details appear in this Customer Registration Form), National Waterexchange Trading Rules, National Waterexchange Privacy Policy and the Direct Debit/Credit Request Service Agreement all of which have been provided to you by your broker and can be found on our website (or by contacting your broker). Addresses We have included a space for you to complete your address on the application form. Please note we are also required to collect your residential address or registered business address. If your mailing address is care of a third party such as your broker, please be aware that all correspondence will be sent to this address. Who should sign? The customer in whose name the water products are held should sign. Joint applicants will be deemed to be joint tenants. If you are signing under Power of Attorney, please provide Individual identification with an attached original certified copy of the power of attorney(s) and specimen signature(s) if not displayed in the document. Brokers If a broker s details are provided, we will supply them with information about your account unless you instruct us not to do so. Client Identification and Supporting Documents If your application form is incomplete and does not fulfil our requirements, the processing of your application may not proceed until it has been completed in full. ALL Individuals must supply an Identification Document showing your full name, and either current residential address or date of birth. A completed Individual Account Identification Form must be included in this registration pack and returned to National Waterexchange or a recognised Waterexchange registered broker. ALL Individuals You must provide ONE primary photographic identification document from the list to the right. If you do not have a primary photographic identification document that shows your current residential address or date of birth you must provide ONE EACH of a Primary Non-Photographic identification document and Secondary Identification document. Primary Photographic Identification Documents: Australian driver licence (current) Australian Passport (not expired more than 2 years) International Passport (current) Proof of Age Card Primary Non-Photographic Identification Documents: Birth Certificate Citizenship Certificate Centerlink Pension Card (current) Secondary Identification Documents: Utility Bill or Council Rates Notice (less than 3 months old) Taxation Notice or Centerlink Statement (less than 3 months old) You must also provide a recent water account statement from the Regulating Water Authority eg. GMW, StateWater. Completing this form When you complete this form, please: use a black pen write in BLOCK LETTERS answer all sections ensure you have attached your Water account statement and Identification Document mail your application form and supporting documents documents to your registered broker or : National Waterexchange Pty Ltd PO Box 1168 Echuca VIC 3564 Individual Pack Brokers: Forward this and following pages to National Waterexchange.Page 1 of 5
2 Customer Registration Form By completing this form, you are entering into the Brokerage Agreement between National Waterexchange Pty Ltd ACN (National Waterexchange), the Customer whose details appear in the Customer Registration Form and the Broker whose details appear in the Customer Registration Form. National Waterexchange operates National Waterexchange and the Broker wishes to provide brokerage services to Customers in relation to the trading of Water Products. National Waterexchange has agreed that the Broker can provide such brokerage services and that the Customer may use the Service in accordance with the terms of the Brokerage Agreement. Customer details (Name on Water licence) Primary contact name: address: Telephone: Area code: Number: Mobile: Fax: Area code: Number: Postal address: Water Licence number: Water licence zone: Water account statement: Water account statement attached Water account statement attached I/we have additional Water Licences and have provided the details on a separate page attached Registered National Waterexchange Broker name: Acknowledgments by Customer (Please cross out whichever is not applicable) We/I acknowledge that we/i have read the Brokerage Agreement between National Waterexchange Pty Ltd, me, as the Customer and the broker whose details appear in this Customer Registration Form (and the Terms and Conditions referred to in the Brokerage Agreement and the Rules referred to in National Waterexchange Trading Rules) and agree to be bound by the terms and conditions as set out in the Brokerage Agreement and National Waterexchange Trading Rules. We/I agree that by signing this Customer Registration Form, we/i authorise National Waterexchange to sign any documentation that is required by a Regulating Water Authority (as defined in the Brokerage Agreement) to transfer any water rights traded by us/me or on my behalf on National Waterexchange and to contact any such Regulating Water Authority to liaise with it in relation to the transfer of any such water rights. We/I further authorise any such Regulating Water Authority to provide information to National Waterexchange in relation to such transfers. *Please note ALL water licence holders to sign below. Name of Customer 1: Name of Witness: Individual Pack Brokers: Forward this and following pages to National Waterexchange.Page 2 of 5
3 Acknowledgements by Broker Broker details: (Please cross out whichever is not applicable) We/I acknowledge that we/i have read the Brokerage Agreement between National Waterexchange Pty Ltd ACN (National Waterexchange), the Customer whose details appear in the Customer registration Form/identification number appears above and me (and the Terms and Conditions referred to in the Brokerage Agreement and the Rules referred to in National Waterexchange Trading Rules) and agree to be bound by the terms and conditions as set out in the Brokerage Agreement and National Waterexchange Trading Rules. Broker: Witness Executed by in accordance with section 127 of the Corporations Act 2001 (Cth): Or if a company Signature of director Signature of company secretary/director Full name of director Full name of company secretary/director Individual Pack Brokers: Forward this and following pages to National Waterexchange.Page 3 of 5
4 Direct debit and direct credit authorisation By completing this form, you authorise National Waterexchange Pty Ltd ACN (National Waterexchange) to debit/credit your nominated bank account for payments due in connection with the trading of water products on National Waterexchange. Direct Debit and Credit Authority I/We understand and acknowledge that in providing the direct debit and credit instructions to Waterexchange that: I/we authorise and request National Waterexchange Pty Ltd ACN (National Waterexchange), until further notice in writing, to debit and/or credit my/our account with any amounts which I/we may owe, or may be entitled to receive from, National Waterexchange in connection with the trading of water products on National Waterexchange I/we understand that this direct debit request is made in favour of National Waterexchange; and I/we understand and acknowledge that I/we have read and understood the terms and conditions of the Direct Debit/Credit Request Service Agreement that can be found on Please complete your bank account details below. Direct Debit Account details: Name of bank or financial institution: BSB: Account number: Direct Credit Account details: Same as Direct Debit Account Name of bank or financial institution: BSB: Account number: Authorised Bank Account holder 1: Authorised Bank Account Holder 2 Individual Pack Brokers: Forward this and following pages to National Waterexchange.Page 4 of 5
5 Individual Account Identification Form National Waterexchange requires each individual listed on a Water licence to provide identification documentation, please complete the below for verification purposes. Please complete section 1 and 1.1 below and return to a registered National Waterexchange broker for verification. If the Applicant is a Trust, you will also need to sight an original and provide an extract of the trust deed. ALL personal identification documents received and sighted by broker are not required to be forwarded to National Waterexchange and must be destroyed following the completion of this form. 1. Each individual must provide Waterexchange with the following information: First name/s: Last name: ID sighted or copy received eg (Drivers Licence No. and expiry date): Residential Address (PO Box is not acceptable) Street number and name: Suburb/Town: State: Postcode: Country: * For Joint Applicant accounts please fill in a separate form 1.1 Individual s Signature (client as named above) Individual s name: Individual s signature: 2. Client Identification Confirmation I the broker confirm I have sighted the original or a copy of the clients Identification documentation and verify the above is true and correct. (see page 1 of this application for acceptable documents) 2.1 Agents Signature (broker) Broker name: Agent's signature: Agents Agent'sname: name: D a te : Individual Pack Brokers: Forward this and following pages to National Waterexchange.Page 5 of 5
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