1/200 Victoria Parade National Australia Bank Limited. BSB 081-CFI East Melbourne Vic 3002

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1 Help Sheet for efraud Statutory Declaration/ Authorisation for Police Investigation Have customer complete Statutory Declaration for either one or two declarants and Authorisation for Police Investigation. These forms must be witnessed before an appropriate person (refer to List people who may witness a Statutory Declaration ). Return original Statutory Declaration and Authorisation for Police Investigation to Cheque and Electronic Fraud Investigation Team by either internal mail or customer may post directly. Internal mail address Postal address Cheque and Electronic Fraud Investigation Team Cheque and Electronic Fraud Investigation Team 1/200 Victoria Parade National Australia Bank Limited East Melbourne 1/200 Victoria Parade BSB 081-CFI East Melbourne Vic 3002 Determine which Statutory Declaration to use Any one (1) to sign Any two (2) to sign One means operating this account is: (Customer to tick applicable method) Internet Banking Phone Banking The payment type used for these paymennt/s is: (Customer to tick applicable method) Funds transfer BPAY National Identification Number and Password (Customer to confirm) Where password held? Who has access? For multiple transactions Complete list transactions on a separate sheet/s Title the separate sheet/s Annexure A, B, C etc. to Statutory Declaration How to provide an annexure: On original Statutory Declaration, write Refer to Annexure Each Annexure is to be signed by declarant in the presence authorised witness and witnessed as in accordance with the original Statutory Declaration Attach Annexure/s to Statutory Declaration Details circustances (Customer to provide as much information as possible) Any suspicious circumstances surrounding this incident? National Australia Bank Limited ABN EF00471 (1/06)

2 List people who may witness a Statutory Declaration Alderman or Councillor a Municipal or Shire Council Australian Consular Officer Australian Diplomatic Officer within the meaning the Consular Fees Act 1985 Australian Postal Corporation Officer with five (5) years service Bailiff Bank Manager Bank Officer with five years service Barrister Building Society Officer with five (5) years service Chief Executive Officer a Federal Court Civil Marriage Celebrant Clerk a Court Clerk Petty Sessions Commissioner for Affidavits Commissioner for Declarations Credit Union Officer with five (5) years service Dentist Full-time Teacher at a school or tertiary education institution with five (5) years service Holder a Statutory Office Judge Justice the Peace Magistrate Master a Court Member a State Parliament Member the Commonwealth Parliament Member the Legislative Assembly Norfolk Island Member the Legislative Assembly the Australian Capital Territory Member the Legislative Assembly the Northern Territory Minister Religion designated as an authorised marriage celebrant Non-Commissioned Officer within the meaning the Defence Force Discipline Act 1982 with five (5) years service Notary Public Officer the Australian Navy or the Australian Air Force within the meaning the Defence Force Discipline Act 1982 Permanent Employee a Local Government with five (5) years service Permanent Employee a State Government with five (5) years service Permanent Employee a Territory Government with five (5) years service Permanent Employee the Commonwealth Government with five (5) years service Person before whom a statutory declaration may be made under the law the State or Territory in which the declaration is made Pharmacist Police Officer Postal Manager Registered Medical Practitioner Registered Member the Institute Chartered Accountants in Australia, the Australian Society Certified Practising Accountants or the National Institute Accountants Registered Nurse or Enrolled Nurse with five (5) years service Registered Patent Attorney within the meaning the Patents Act 1990 Registrar or Deputy Registrar a Court Senior Executive Service Officer a State Public Service Senior Executive Service Officer a Territory Public Service Senior Executive Service Officer the Commonwealth Public Service Sheriff Sheriff s Officer Solicitor Veterinary Surgeon Warrant Officer within the meaning the Defence Force Discipline Act 1982 with five (5) years service

3 I Commonwealth Australia Statutory Declaration (One declarant to sign) (Full name) (Address) make the following declaration under the Statutury Declarations Act 1959: I conduct an account styled BSB number Account number with the National Australia Bank Limited; and am one the authorising signatories this account/the authorising signatory this account. I am the which (Position) (Nature business) (Business) One means operating under this account is Internet Banking/ Phone Banking. The payments type used for these payment/s is Funds transfer/ BPAY. My National Identification Number and password to Internet Banking/ Phone Banking is held at and is accessible to (Location) On / / 20, from information provided by transaction/s from account number/s, I became aware the following unauthorised Funds Transfer From account To account Date Amount BSB number Account number BSB number Account number Financial Institution name BPAY Date Amount Biller name Biller CRN Having made appropriate enquiries, I can state that neither I nor any person authorised to operate on this/these account/s conducted these transactions nor was any other person authorised to conduct these transactions. (Details circumstances or suspicions surrounding this incident) I understand that a person who intentionally makes a false statement in a statutory declaration is guilty an fence under section 11 the Statutory Declarations Act 1959, and I believe that the statements in this declaration are true in every particular. Declared at On the day 20 Before me Name witness Title person (Signature witness) Note 1 A person who intentionally makes a false statement in a statutory declaration is guilty an fence, the punishment for which is imprisonment for a term 4 years - see section 11 the Statutory Declarations Act Note 2 Chapter 2 the Criminal Code applies to all fences against the Statutory Declrations Act see section 5A the Statutory Declarations Act 1959.

4 We Commonwealth Australia Statutory Declaration (Two declarant to sign) (Full name) (Address) make the following declaration under the Statutury Declarations Act 1959: We conduct an account styled BSB number Account number with the National Australia Bank Limited; and are the authorising signatories this account. We are the which (Position) (Business) (Nature business) One means operating under this account is Internet Banking/ Phone Banking. The payments type used for these payment/s is Funds transfer/ BPAY. My National Identification Number and password to Internet Banking/ Phone Banking is held at and is accessible to (Location) On / / 20, from information provided by transaction/s from account number/s, we became aware the following unauthorised Funds Transfer From account To account Date Amount BSB number Account number BSB number Account number Financial Institution name BPAY Date Amount Biller name Biller CRN Having made appropriate enquiries, we can state that neither we nor any person authorised to operate on this/these account/s conducted these transactions nor was any other person authorised to conduct these transactions. (Details circumstances or suspicions surrounding this incident) We understand that a person who intentionally makes a false statement in a statutory declaration is guilty an fence under section 11 the Statutory Declarations Act 1959, and we believe that the statements in this declaration are true in every particular. Name Declared at On the day 20 Name Before me Name witness Title person (Signature witness) Note 1 A person who intentionally makes a false statement in a statutory declaration is guilty an fence, the punishment for which is imprisonment for a term 4 years - see section 11 the Statutory Declarations Act Note 2 Chapter 2 the Criminal Code applies to all fences against the Statutory Declrations Act see section 5A the Statutory Declarations Act 1959.

5 Authority to Disclose Information to Police I/We being the signatory/ies to the following account/s. Description account/s affected by e-fraud Account holder name/s BSB number Account number maintained with the National Australia Bank Limited ABN ( the National ) hereby authorise the National to provide information including without limitation document and statements (whether original or copied), relating to the following Internet/Telephone Banking transactions on such account/s: Description transactions Account/s Date Amount to any Australian police force, or policing body or capability, for purposes investigation, research, analysis or statistical information gathering. Signed by signatory Name Title Date / / Signed by signatory Name Title Date / / for and on behalf : Company/Business name National Australia Bank Limited ABN EF00471 (1/06)

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